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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.

Background/Objectives: Viral gastroenteritis can have a potentially fatal outcome at young ages and the recognition of severe cases could be aided by clinically derived severity scores. Methods: This observational study intended to conduct a comparative assessment of the utility of the Vesikari and modified Vesikari score in the evaluation of viral gastroenteritis severity and for the possible prediction of the dehydration degree. A total number of 113 children diagnosed with gastroenteritis were retrospectively enrolled and divided based on viral etiology into group 1 (34 children with unknown viral etiology), group 2 (60 children with rotavirus) and group 3 (19 children with adenovirus). Results: The highest mean Vesikari and modified Vesikari scores were found in group 2 (p < 0.01; p = 0.01). A significant increase in liver enzymes was also identified in patients infected with rotavirus. The highest mean diarrhea, vomiting duration and body temperature were found in group 3 (p < 0.01; p < 0.01; p = 0.02), as well as the highest mean inflammatory markers, such as C-reactive protein (CRP; p = 0.01) and the erythrocyte sedimentation rate (p < 0.01). Significant linear associations were found between pH, bicarbonate level, base excess and the Vesikari scores, whereas urea, CRP and aspartate aminotransferase levels were associated with both severity scores. ROC curve analysis revealed a significant correlation between the Vesikari scores and dehydration degree (p < 0.01), with numeric cut-off values of 11.5 being proposed for the differentiation between mild and moderate gastroenteritis and 13.5 for the distinction between moderate and severe gastroenteritis. Conclusions: Both severity scores are useful in clinical settings, but more studies enrolling populations with various enteral infections could provide more insight into their etiology-based performance and reflection of paraclinical changes. [ABSTRACT FROM AUTHOR]

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Background and objectives. Type 1 diabetes is a chronic disease, whose incidence is increasing worldwide. Patients with chronic illnesses are more likely to have a deficiency in vitamin D. The aim was to evaluate the impact of vitamin D on biochemical parameters in type 1 diabetes in patients under 18 years of age. Materials and methods. We performed a prospective observational study in 2023, on a sample of 121 type 1 diabetic patients aged between 5 and 18 years, who had previously undergone vitamin D screening before the study's start date. This time was called the initial time (T0). During the consultation, patients who agreed to participate in the study received a voucher for vitamin D screening, referred to as the final time (Tf). The period between T0 and Tf was 3 months. Results. At the initial time, 88 (72.73%) of patients had vitamin D deficiency, while at the final time, 11 (9.09%) had deficiency (p<0.05). Vitamin D levels were 18.69 ± 4.14 ng/mL at T0 compared to 31.28 ± 7.60 ng/mL at Tf (p<0.05). Additionally, at the initial time, 72.73% of patients presented with hypocalcemia, and 66.94% of them with hypophosphatemia, whereas at the final time, hypocalcemia was noticed in 19.01% (p<0.05), and hypophosphatemia in 25.62% (p<0.0001). Correlation between T0 and Tf vitamin D levels shows an r = 0.5764 (p<0.0001, 95% CI = 0.4392 - 0.6873). Conclusions. The study reveals a direct proportional relationship between imbalances in biochemical parameters and vitamin D deficiency, and indicates that vitamin D supplementation significantly contributed to the improvement of biochemical parameters. [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]

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]

Background. Obesity associates multiple complications, as consequence of chronic inflammation and insulin-resistance, changes induced by adipocytes products. Aim. Determination of serum-levels of inflammation adipokines in obese children and assessment of their relationship with anthropometric and biochemical parameters. Methods. prospective study including 110 obese children assessed between 1 October 2010-1 March 2013. We determined the leptin levels, adiponectin, interleukins (IL6-8), looking for their correlations with anthropometric and metabolic parameters. Results. Leptin was 16.79±1.39ng/ml in obese, higher than in control-group (2.78 ± 0.43 ng/ml), while adiponectin was 14871.07 ± 713.17 ng/ml in controls and 9883.49 ± 562.54 ng/ml in obese, with statistically significant differences (p < 0.0001 for both). IL6 and IL8 were also higher in obese group. There were significant correlations between the adipokines and anthropometric indices. Dyslipidemia was found in 20% of obese, 8.18% with increased LDLCholesterol, 26.36% hypertriglyceridemia and 9.09% low HDL-Cholesterol. Conclusions. inflammatory adipokines are elevated in obese children, correlated with dyslipidemia, and adiponectin decreases, suggesting that marked adiposity in children also can play a role in the pathogenesis of complications. [ABSTRACT FROM AUTHOR]

Introducere. Obezitatea prezintă multiple complicaţii, consecinţa inflamaţiei cronice şi insulinorezistenţei, modificări induse de produşii secretaţi de adipocite. Scop. Determinarea nivelurilor serice a adipokinelor inflamatorii la copiii obezi şi evaluarea relaţiei cu indicii antropometrici şi parametrii biochimici. Material şi metodă. Studiu prospectiv incluzând 110 copii obezi, între 1 octombrie 2010-1 martie 2013. S-au determinat leptina, adiponectina, interleukinele (IL6-8), căutând corelaţiile acestora cu parametrii antropometrici şi de metabolism. Rezultate. Leptina a fost 16,79 ±1,39 ng/ml la obezi, mai mare decât la lotul martor (2,78 ± 0,43 ng/ml), iar adiponectina 14871,07 ± 713,17 ng/ml la martor şi 9.883,49 ± 562,54 ng/ml la obezi, cu diferenţe semnificative statistic (p < 0,0001 ambele). IL6 şi IL8 au fost, de asemenea, mai mari la lotul de obezi. Au fost corelaţii semnificative între adipokine şi indicii antropometrici. Dislipidemia s-a semnalat la 20% din obezi, 8,18% cu LDL-colesterol crescut, 26,36% hipertrigliceridemie şi 9,09% HDL-colesterol scăzut. Concluzii. Adipokinele inflamatorii sunt crescute la copiii obezi, corelate cu dislipidemia, iar adiponectina scade, sugerând că adipozitatea marcată poate avea şi la copil rol în patogeneza complicaţiilor. [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]

Elastography is a new imaging method based on ultrasounds, which allows the assessment of the tissues structure in terms of their stiffness, being useful in the exploration of different organs and systems, having more and more clinical applications. The development of the contrast agents of second generation led to the amplification of the ultrasound signals using the microbubbles, which can not cross the vascular wall and are eliminated through exhalation within 15 minutes. Material and methods. We present the results of a prospective study conducted in our Clinic, assessing the performance of the ARFI method ("Acustic Radiation Force Imaging") in the assessment of the liver elasticity in children and we present some pediatric cases in which the ultrasound with contrast has brought real benefits, making it easier to diagnose and facilitate optimal therapeutic decisions. [ABSTRACT FROM AUTHOR]

Elastcgrafia este o nouă metodă imagistică bazată pe ultrasunete, care permite evaluarea structurii ţesuturilor în ceea ce priveşte rigiditatea lor, fiind utilă în explorarea diferitelor organe şi sisteme şi cu tot mai multe aplicaţii clinice. Dezvoltarea substanţelor de contrast de generaţia a doua a dus la amplificarea semnalului ecografic cu ajutorul microbulelor, care nu pot străbate peretele vascular şi care se elimină prin exhalare în 15 minute. Material şi metode. Prezentăm rezultatele unui studiu prospectiv derulat în clinica noastră, evaluând performanţele metodei ARFI (impulsul de difuzie a forţei acustice) în evaluarea elasticităţii ficatului la copii; prezentăm şi câteva cazuri pediatrice în care ecografia cu contrast a adus reale beneficii, uşurând diagnosticul şi facilitând luarea deciziilor terapeutice optime. [ABSTRACT FROM AUTHOR]

Nephrogenic diabetes insipidus (NDI) is characterized by impaired urinary concentrating ability, despite normal or elevated plasma concentrations of the antidiuretic hormone, arginine vasopressin (AVP). NDI can be inherited or acquired. NDI can result from genetic abnormalities, such as mutations in the vasopressin V2 receptor (AVPR2) or the aquaporin-2 (AQP2) water channel, or acquired causes, such as chronic lithium therapy. Congenital NDI is a rare condition. Mutations in AVPR2 are responsible for approximately 90% of patients with congenital NDI, and they have an X-linked pattern of inheritance. In approximately 10% of patients, congenital NDI has an autosomal recessive or dominant pattern of inheritance with mutations in the AQP2 gene. In 2% of cases, the genetic cause is unknown. The main symptoms at presentation include growth retardation, vomiting or feeding concerns, polyuria plus polydipsia, and dehydration. Without treatment, most patients fail to grow normally, and present with associated constipation, urological complication, megacystis, trabeculated bladder, hydroureter, hydronephrosis, and mental retardation. Treatment of NDI consist of sufficient water intake, low-sodium diet, diuretic thiazide, sometimes in combination with a cyclooxygenase (COX) inhibitor (indomethacin) or nonsteroidal anti-inflammatory drugs (NSAIDs), or hydrochlorothiazide in combination with amiloride. Some authors note a generally favorable long-term outcome and an apparent loss of efficacy of medical treatment during school age. [ABSTRACT FROM AUTHOR]

Background: An association of signs and symptoms is a syndrome (all changes that occur together in a disease). Purpose: We present the case of a patient whose clinical and paraclinical findings were suggestive, but the diagnosis was delayed. Material and Methods: The history of a Kawasaki-disease case in an infant. Results: NS(7months), presented in emergency for fever. From the Anamnesis he had been discharged the day before from another Pediatric Service. From History he underwent an episode of symptomatically treated respiratory- tract-infection, and was then vaccinated. The disease started ten days before, with fever, mouth and skin lesions;the general practitioner recommended anti-thermic and antimycotic; anorexia appeared, the patient being hospitalized;hydrocortisone, anti-thermic, electrolyte and eye-drops were administered;dermatological consultation labeled as Hand-foot-and-mouth disease; peeling of the fingers-skin occurred; he was discharged after 7 days. At hospitalization in our clinic: general influenced condition, hyperemic facies, warm skin, desquamation (flaps) of upper and lower limb skin, swollen edema of the hands and feet, red lips, mouth sores, angular cheilitis, sabour tongue, hiperemic pharynx (otherwise negative). Due to anamnestic, clinical and paraclinical data (leukocytosis, positive inflammatory-tests) the case was interpreted as Kawasaki-disease and treatment according to the guide was started. The outcome was favorable without complications or coronary lesions. Conclusions: For a correct diagnosis, the signs and symptoms should be analyzed and synthesized; thus, having a patient, with at least 5 days fever and four elements of: extremity changes, polymorphous exanthem, bilateral conjunctival injection, mouth/lips changes and cervical lymphadenopathy, the diagnosis of Kawasaki disease should be considered. [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]

Background: Acute respiratory failure refers to a condition in which the respiratory system is unable to adequately supply oxygen to the body to effectively remove carbon dioxide, leading to impaired gas exchange and potentially life-threatening complications. This condition can result from various factors such as respiratory infections, lung diseases, neuromuscular disorders, or trauma, and it can present with symptoms such as increased respiratory effort, tachypnea, cyanosis and altered mental status. Objective: The purpose of this study is to assess the correspondence in between the clinical presentations and the paraclinical findings in pediatric patients experiencing acute respiratory failure. Material and methods: For this study, a retrospective study was conducted including 160 patients admitted to Pediatric Clinic I Targu-Mures diagnosed with acute respiratory failure during the period 01.01.2023 to 01.01.2024. The patients were between 28 days and 18 years old. The following data was extracted from each patient's medical record: sex, age, clinical manifestations, laboratory results, diagnosis, and treatment. Results : 70% of the cases presented SpO2 under 92% at admission. The most frequently encountered clinical symptom was dyspnea (39%), followed by coughing (31%) and fever (30%). The most frequent pathological element observed during the physical examination was paleness (56%), followed by tachypnea (53%), intercostal retraction and tachycardia (50%), decreased vesicular murmur (45%), perioral and perinasal cyanosis (42%), suprasternal retraction (37%), crepitant rales (33%) and harsh vesicular murmur (30%). Statistical analysis revealed indicators of correspondence between certain variables, demonstrating a statistically significant correlation in between children with asthma and pericarditis (r=, p<0,001), chest X-ray with diffuse opacities and Acinetobacter etiological agent (r=, p<0,01) as well as VSR etiological agent and sibilant rales (r=, p<0,001). Conclusions: Most pediatric patients with respiratory failure tend to present SpO2 values below 92%. Common clinical symptoms include dyspnea and cough, associated with paleness and tachypnea. The statistical correlations suggest potential relationships between specific etiological agents and clinical manifestations, which can aid in diagnosis and treatment planning. [ABSTRACT FROM AUTHOR]

Introduction: Infant mortality, measuring the deaths of newborns in their first year of life, holds a special position in demographic analysis. Romania is among the EU countries with the highest child mortality rate and the lowest life expectancy at birth, although the infant mortality rate has decreased by 50% in 2009 compared to 2000. The purpose of the paper is to analyze the medical and social factors responsible for child mortality by analyzing epidemiological, demographic, pediatric medical conditions and living conditions. Material and methods: Retrospective study. The study group includes 94 patients, aged 0-18 years, hospitalized and deceased at the Emergency County Hospital Tîrgu-Mureş, between 2013-2017. The followed parameters: age, sex, birthplace, living conditions, family, cause of death, associated diseases. Results: Majority of deaths were of infants under 1 year (55%). Difficulty in access of health services and hospitalization in severe conditions explains the 3-fold increase in deaths among rural patients (73%), plus the fact that only 30% had adequate living conditions. Associated cardiovascular diseases (18% congenital heart diseases), malignancies (10%) and neurological diseases (21%) are risk factors for death. Sepsis (62.2%) and lower respiratory tract infections (77.66% pneumonia) were the main cause of death. Conclusions: Improving access to medical services, living conditions, parents education are factors that can reduce the mortality rate among children. [ABSTRACT FROM AUTHOR]

Introduction: Congenital heart deffects are one of the most common health issuess in pediatrics. Amongst this cathegory falls the persistance of ductus arteriosus, a pathology that is usually solved physiologically in a few days or weeks after birth. Its persistance after this period is solved either by medication or by surgery, as fast as posible for each child. It is uncommon in developed countries to get to teenage period with this problem unsolved. Adolescents with congenital heart defects present unique diagnostic challenges, particularly when complicated by recurrent respiratory infections and social vulnerabilities. Case Report: We present a case of a 14-year-old male with a patent ductus arteriosus (PDA) who experienced bronchopneumonia, febrile syndrome, and glomerulonephritis. Despite multiple hospitalizations, his PDA remained undiagnosed until his recent presentation, fact that has exposed him to some risks. Upon admission, the patient exhibited dramatic abdominal symtomatology, overshadowing the signs of respiratory distress and cardiac affections. Pacient presented reduced bilateral vesicular murmur and basal bilateral crepitant rales on auscultation. Laboratory investigations revealed mild neutrophilia, lymphocytopenia, and elevated inflammatory markers. Radiographic and CT findings were suggestive for pulmonary desease but shown no indication of heart damage. The concerning facts were represented by mild ascites and high blood pressure (147/88mmHg) due to which, after the infirmation of acute surgical abdomen, cardiology consult was requested. Ecocardiography showed the particularity of this case, represented by PDA. Aortic bycuspidy was also present. After further investigations, the high blood pressure was attributed to poststreptococcal glomerulonephritis. The evolution was favorable under antibiotic treatment for bronchopnumonia and diuretics. Discussions : This case underscores the diagnostic challenge of identifying congenital heart defects such as PDA in adolescents even with a sugestive history of recurrent infections, all placed in the social context. Multidisciplinary collaboration and comprehensive care are essential for optimizing outcomes in such cases. Furthermore, the presence of PDA may complicate the management of concurrent respiratory and renal conditions, necessitating a tailored approach to treatment. Conclusions: Despite the complexity of the case and the presence of PDA, the patient's renal function stabilized, with a favorable prognosis for glomerulonephritis. However, surgical correction of the PDA, even tho much needed, was deferred due to the patient's social circumstances. This case highlights the importance of timely diagnosis and management of persistent ductus arteriosus and underscores the need for holistic care in vulnerable populations. [ABSTRACT FROM AUTHOR]

Maple urine syrup disease (MSUD) is part of a heterogenous group of inborn errors of metabolism. The aim of the paper was to present 2 cases of MSUD diagnosed in our clinic, their evolution and response to treatment. Patients and method. The diagnosis was documented by determining serum and urinary aminoacids. Each case was examined and evaluated in dynamics in terms of clinical, laboratory, treatment and evolution. Results. The MSUD onset-age in the first case was in the 5th-6h days and 3rd week for the second case (both were breastfed). The onset of clinical manifestations: lethargy, apathy, adinamy(first case), drowsiness, capping the eyes, hypotonia(second case); capricious appetite/eating disorders in both cases, intercurrent symptoms (cough, rhynorrhea in the second case, probably urosepsis in the first case). Evolution: the first case who had a severe type: associated drowsiness, generalized weakness, sometimes alternating with bouts of tonic contractions/rigidity, tendency to opistotonus, changes in reflexes, trismus, needing mechanical ventilation and ultimately death; the second case (a milder type) had a favorable evolution dependent on hygienic-dietary and drug-treatment. Conclusions Since postnatal infants are apparently clinically healthy, there are no genotype-phenotype correlation, in many countries it has been added in the neonatal screening of metabolic diseases. Early diagnosis, along with specific treatment can prevent complications allowing a normal intellectual development of children with such defects. [ABSTRACT FROM AUTHOR]

Boala urinilor cu miros de sirop de arţar face parte dintr-un grup heterogen de afecţiuni, respectiv erorile înnăscute de metabolism. Scopul lucrării. Ne propunem să prezentăm 2 cazuri diagnosticate în clinica noastră, urmărirea evoluţiei şi a răspunsului la tratament. Material şi metodă. Diagnosticul s-a documentat prin determinarea amino-acizilor serici şi urinari. Fiecare caz a fost analizat, urmărindu-se în dinamică datele anamnestice, examenul clinic, examinări paraclinice şi de laborator, scheme terapeutice, evoluţie. Rezultate. Vârsta la debutul tipic în primul caz, adică în zilele 5-6 de viaţă, şi la 3 săptămâni de viaţă la al doilea caz (deşi în ambele cazuri alimentaţia era naturală). Manifestările clinice la debut. Tabloul neurologic: letargie, apatie, adinamie (primul caz), somnolenţă, plafonarea privirii, hipotonie (cazul 2); apetitcapricios/tulburări de alimentaţie (acumularea AAşi a metaboliţilor acestora), în ambele cazuri; simptomatologia intercurenţei (tuse, rinoree la cazul 2; probabil ITU/ urosepsis în primul caz). Evoluţie. Primul caz, prezentând o formă severă asociază somnolenţă, hipotonie generalizată, uneori alternând cu crize de contractură tonică/rigiditate, trismus, cu necesitatea ventilaţiei mecanice şi în final deces; al doilea caz, cu o formă mai uşoară, a avut evoluţie favorabilă dependentă de tratament igieno- dietetic şi medicamentos. Concluzii. Deoarece postnatal nou-născuţii sunt aparent sănătoşi din punct de vedere clinic, neexistând o corelaţie fenotip-genotip, în multe ţări a fost adăugată în screening-ul neonatal al afecţiunilor metabolice. Diagnosticul precoce, alături de regimul specific, poate preveni complicaţiile, permiţând astfel o dezvoltare intelectuală normală a copiilor purtători ai acestor defecte. [ABSTRACT FROM AUTHOR]

The liver is divided into eight segments, numbered clockwise, I to VIII; the caudate lobe is anatomically distinct from the left and right lobes, with its own vascularization. Elastography, a new imagistic method, gives information on the stiffness of the examined tissue. The aim: assessment of liver structure by real-time elastography, of the differences between segments in normal and pathological situations in children. Material and methods: a prospective study between September 15, 2010-March 15, 2011, including 93 children admitted in Ist Pediatric Clinic of Tg.-Mures, Romania: 43 healthy children and 50 patients with liver damages of various causes. The global and segmental Shear Wave Velocity (SWV) “elasticity” was assesed, establishing correlations between values for caudate-lobe and segment 8 in healthy children versus children with hepatopathies. Results and discussion: the global median SWV in controls was statistically significant lower than the SWV in children with hepatopathies. On assessing separate SWV for each segment, in control group segment 8 SWV was significantly higher than segment 1 SWV (p=0,0216), while in the group of children with liver diseases SWV was not statistically significant different between segments. Considering the SWV values Individually there were no significant differences for the 8th segment between controls and hepatopathies. Such differences were, however, present for the 1st segment (p=0.003). Conclusions. SWV is higher in liver-diseases, particularly for segment 1. In healthy children, SVW was significantly higher for segment 8 versus segment 1, which has not been observed for hepatopathies, probably due to fibrosis and primary damage of the caudate lobe. We emphasize the role of elastography for assessing the degree of liver damages. [ABSTRACT FROM AUTHOR]

We present a 9-year-old boy with epilepsy refractory to previous treatment diagnosed with Stevens Johnson syndrome appeared after the introduction of Lamictal in treatment. The boy had fever, polymorphous exanthema, papulopustular erythematous, bullous generalized vesiculobullous elements and skin denudation, conjunctivitis, mouth lesions. We have interpreted the associated pneumonia as a damage of a lower respiratory tract mucous membranes within Stevens Johnson syndrome. The evolution of the disease was favourable after high doses of Ig IV (intravenous immunoglobulin). In conclusion, even if the Steven Johnson syndrome incidence is low in children, pediatricians should be aware of the possibility of its reggresion (even after antiepileptics - Lamictal), and even if the use of Ig IV is controversial, it leads to healing when is given in high doses. [ABSTRACT FROM AUTHOR]

Prezentăm cazul unui băiat de 9 ani cu epilepsie refractară la tratamentul anterior, diagnosticat cu sindrom Stevens Johnson apărut după introducerea în tratament a Lamictalului. Băiatul a prezentat febră, exantem polimorf maculo-papulo-eritematos, cu elemente veziculo buloase generalizate şi denudare tegumentară, conjunctivită, leziuni bucale. Pneumonia asociata am interpretat-o ca afectare a mucoasei tractului respirator inferior din cadrul sindromului Stevens Johnson. Evoluţia bolii a fost favorabilă după doze mari de imunoglobuline intravenos. În concluzie, deşi incidenţa sindromului Steven Johnson este mică la copil, pediatrii trebuie să fie conştienţi de posibilitatea apariţiei ei (chiar după antiepileptice -- Lamictal), iar utilizarea imunoglobulinelor IV, deşi con troversată, administrată în doze mari pare că duce la vindecarea bolii. [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 diabetic ketoacidosis patient with no history of diabetes can be difficult to diagnose because most children present vague symptoms. Purpose: The study is justified by the increased incidence of ketoacidosis in children with type 1 diabetes and the severity of possible failure without intervention on time. Materials and methods: A retrospective study of pediatric patients, who were admitted to First and Second Pediatrics Clinic of Mures County. The data collected include the demographic data, clinical and biochemical characteristics, different correlations were established. Results: The highest number of cases was observed in 2017. Patients aged 10-15 years (41.7%) and urban area (53%) more frequently experience episodes of ketoacidosis. The causes for the recurrent ketoacidosis episode are the presence of associated pathology (more frequently in the respiratory system), the inadequacy of insulin doses and inappropriate diet. The mean age of those who refuse insulin is 15.5 years ± 1.3DS. Polyuria, polydipsia and fatigability are present at onset in almost all patients. Abdominal pain is important to consider because there is a risk of diagnostic errors (2 cases - 4.1%). Most patients have symptoms between 7-14 days until diagnosis (40.82%). The mean blood glucose for the inaugural episode was 540 mg/dl and the glycosylated hemoglobin was 12.4 ± 2.1% DS. Conclusions: In newly diagnosed patients, DKA may be "inaugural", and in patients with known diabetes, precipitating factors are insulin delivery errors or infectious diseases. [ABSTRACT FROM AUTHOR]

Introduction: neutropenia is defined as a reduction of the absolute number of neutrophils below normal value, being influenced by age, genetic factors and environment. Case presentation: we present the case of a 5.8 year-old female child, whose personal pathological history highlights multiple infectious episodes treated at the territorial level and one admission to the 1st Pediatric Clinic of Targu-Mures, one year ago, for right pleuro-pneumonia, associated with neutropenia, anemia, raising the suspicion of immunodeficiency. In March current year she was being hospitalized in a severe overall condition with marked respiratory functional syndrome, fever, requiring transfer to the Intensive Care Department for ventilator support, being intubated for 10 days, retransferred to our department after 2 weeks, in the meanwhile the infection with AH1N1 Influenza Virus being confirmed. Laboratory findings revealed persistent severe neutropenia (0/mm3), and the marrow count showed very poor granulocytes, mature forms lacking, with reversal of G/E ratio. Granulocyte-colony stimulating factor was initiated, the neutrophil number rising after 6 days, reaching 1040/mm3 after 12 days. In evolution, approximately 1 month after discharge, the patient was admitted to hospital for pneumonia with MSSA Staphylococcus aureus and she was treated with broad-spectrum antibiotics. Severe neutropenia was also seen this time, for which she received granulocyte stimulation factor for 12 days with a variation in the neutrophil count between 160-560/mm3. Particularity of the case is the very high susceptibility to serious infections during prolonged neutropenia. [ABSTRACT FROM AUTHOR]

Elastography is a method which, using ultrasound, obtains images and measurements of tissue elasticity when applying a force on it. As an imaging method it was developed to quantify objectively the pathological changes related to the presence of an abnormal tissue, compared to the surrounding tissues, giving information about the elasticity/stiffness of the examined tissue, the degree of fibrosis, the degree of stiffness compared to tumor free tissue. The tissue analysis can be done through a compression technology "eSie touch elasticity imaging" (with applications for the surface elastography) or ARFI technology--"acoustic radiation force imaging" (the diffusion impulse of the acoustic force). The ARFI method allows valid, accurate and flexible evaluation of liver stiffness and it is correlates with the fibrosis stage. The liver elastosonography, through new technologies available, has reached the level of the fibro-elastoscanner and magnetic resonance imaging. The ultrasound elastography application quickly advances, starting with the researches in this field. At present, it has analised the most various fields of application, from the breast, prostate, thyroid, pancreas imaging to the study of abdominal lymphnodes and peripheral vessels, gastrointestinal stromal tumors, primary and secondary liver tumors, the evaluation of uterine cervix, from cardiology to gastroenterology and urology, both in adults and in pediatrics.