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Iuliana Magdalena Starcea,1,2 Roxana Alexandra Bogos,1 Georgiana Scurtu,1 Mihaela Munteanu,2 Radu Russu,2 Vasile Valeriu Lupu,1 Ancuta Lupu,1 Laura Trandafir,1 Ingrith Crenguta Miron,1 Maria Adriana Mocanu1,2 1Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania; 2Nephrology Division, St. Mary’s Emergency Children Hospital, Iasi, RomaniaCorrespondence: Iuliana Magdalena Starcea, Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University St, Iasi, 700115, Romania, Tel +40726704612, Email magdabirm@yahoo.com; magdalenastarcea@gmail.comBackground: Nephrotic syndrome (NS) is the term used for the association of edema and massive proteinuria. From a therapeutic point of view, it is important to distinguish between primitive and secondary kidney damage. The clinical evolution, prognosis and therapeutic response in the NS in children are directly determined by the anatomopathological aspect. Steroid resistant nephrotic syndrome was diagnosed in patients with idiopathic NS based on lack of complete remission despite treatment with steroids.Purpose: To analyse the anatomopathological aspects of steroid resistant nephrotic syndrome (SRNS) and their correlation with evolution.Materials and Methods: We made a retrospective study with the aim to analyze the anatomo-pathological aspects and their correlations with evolution in 68 cases of steroid resistant nephrotic syndrome (SRNS) hospitalized in the Pediatric Nephrology Department in Iaşi, Romania. We defined SRNS in all cases without response to corticosteroids after the first month of therapy. For all the cases selected, the period of follow-up was the minimal 6 months.Results and Discussions: A 36% case of nephrotic syndrome was corticoresistant, with the mean age at onset of patients with SRNS being 9.18 years, compared to KDIGO studies in which the corticosteroid resistance is 10– 20%. Renal biopsy was performed in 80.88% children with SRNS and was allowed the evaluation of the activity and chronicity index. Total remission was obtained in 44.01% children with SRNS. The correlation of the anatomopathological aspects with the evolution is not statistically significant (p = 0.76), observing different therapeutic responses to all the analyzed histological types.Conclusion: Almost half of NS in children are cortico resistant. Remission was obtained in 44% of cases of SRNS. Predicting the response to long-term treatment in SRNS is difficult using only renal biopsy; it is necessary to introduce genetic molecular analyses to establish a judicious therapeutic attitude.Keywords: nephrotic syndrome, children, steroid resistance, evolution

This study aims to assess a case of severe vesico-ureteral refl ux (VUR) admitted at 6 weeks of age with urinary infection and azotate retention, with antenatal ultrasound suspicion of bilateral hydronephrosis. The authors present diagnosis and therapeutic methods, analyzing the factors for unfavorable outcome, the complications and the problems of long-term follow-up. Antenatal discovery of a bilateral hydronephrosis requires the specifi c investigations since the very fi rst days of life, for an early etiologic diagnosis and initiation of prophylactic measures. [ABSTRACT FROM AUTHOR]

Este prezentat un caz de reflux vezico-ureteral (RVU) sever, internat la vârsta de 6 săptămâni, cu infecţie urinară şi retenţie azotată, având semnalată ecografi c antenatal hidronefroza bilaterală. Autorii prezintă metodele de diagnostic şi tratament, analizează factorii de risc pentru prognostic nefavorabil, complicaţiile şi problemele dispensarizării pe termen lung. Depistarea antenatală a unei hidronefroze bilaterale impune practicarea explorărilor specifi ce încă din maternitate, pentru încadrarea etiologică şi iniţierea măsurilor profilactice. [ABSTRACT FROM AUTHOR]

The management of patients with steroid-resistant nephrotic syndrome is difficult. We report our experience on treatment with Mycophenolate mofetil versus Cyclophosphamide, in a retrospective analysis of 54 cases of idiopathic steroid-resistant nephrotic syndrome with different histological aspects. The complete and sustained remission rate was 50% for Mycophenolate, which confirm the efficacy of treatment, higher than with Cyclophosphamide (39.53%). [ABSTRACT FROM AUTHOR]

Managementul pacienţilor cu sindrom nefrotic corticorezistent (SNCR) este dificil. Vom prezenta experienţa noastra În tratamentul cu Mycofenolat de mofetil versus Ciclofosfamida, Într-o analiza retrospectiva a 54 de cazuri cu sindrom nefrotic corticoresistent idiopatic cu aspecte histologice diferite. Rata remisiunii complete şi susţinute a fost de 50% pentru Mycofenolat, ceea ce confirms eficienţa tratamentului, aceasta rata fiind mai mare decât În tratamentul cu Ciclofosfamida (39,53%). [ABSTRACT FROM AUTHOR]

Infective endocarditis is a rare disease in children. The etiology is mainly bacterial. However, viral infective endocarditis, possibly related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has also been reported. The pathophysiological principle of the connection between the two entities seems to be attributed to the transient immune deficiency of the body during the infection. Additionally, SARS-CoV-2 is reported in the literature as a direct cardiopathic virus. Therefore, the new coronavirus seems to have the ability to affect both the intact cardiac tissue and the previously damaged one both during the acute episode and at a distance from it. Consequently, we propose to review the main pathophysiological aspects of pediatric cardiac damage caused by SARS-CoV-2. The ultimate goal is to deepen existing knowledge, broaden the horizon of understanding and analysis regarding the systemic damage induced by viral infections, and strengthen an information base from which to start a meta-analysis. Next, we performed a non-systematized screening of the specialized literature with reference to cases of endocarditis in the pediatric population, reported in the period 2020-2023. From the total of articles found, we chose to include in the review a number of 6 case reports, including a number of 7 patients (5 children and 2 adolescents). Analysis of reports suggests that SARS-CoV-2 infection could play a role in the development of endocarditis, either directly through active infection or indirectly through a post-infectious immune response. Also, pre-existing conditions and complex medical history predispose to an increased risk of developing a severe, complicated form of endocarditis. Also, the lack of data on the vaccination history and the failure to categorize the infection depending on the type of antibodies (IgM or IgG) in some studies represent a major bias in the reports. The latter make it difficult to evaluate the influence of vaccination and the impact of acute versus chronic infection on the course of cases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Lupu, Nedelcu, Budescu, Jechel, Starcea, Frasinariu, Ioniuc, Badescu, Salaru, Munteanu, Russu, Sascau, Statescu and Lupu.)

The COVID-19 outbreak has placed substantial pressure on the medical systems worldwide. This study aimed to investigate the influence of the prepandemic vs. pandemic period on the activity of the Vascular Surgery Unit of a large emergency hospital in Eastern Europe. We performed a retrospective review of the vascular surgery cases admitted, comparing the statistics from the two time periods. We examined data of a total of 1,693 patients over the two periods. We report a 34.51% decrease in the surgical procedures performed during the pandemic period, with a disproportionate 80.6% decrease in the number of cases admitted with a diagnosis of venous insufficiency diagnosis and an increase of 67.21% in the number of patients admitted with acute arterial ischemia. Furthermore, individuals not classed as emergencies were delayed or denied surgical care. The number of nonurgent procedures conducted by our Vascular Surgery Unit decreased significantly, whereas the number of emergency surgeries increased. COVID-19's effect is projected to have a long-term impact on how surgical treatments are provided in Romania., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Emil-Marian, Reka, Vasile Adrian, Septimiu, Eliza-Mihaela and Eliza.)

Children present many relations between psychic and somatic processes. The most important clinical aspect is the pain that cannot be attributed to any medical condition and occurs in at least one organ. Psychogenic pain is frequent in the pediatric population and its incidence is increasing. The authors present some of the most debated theories on the mechanisms of psychosomatic pain and some types of such pain, underlining the importance of full investigations. The pain is diagnosed as psychogenic after the exclusion of a potentially lethal disease.

Non invasive assessment of large arteries structure and function is a valuable tool for early detection of athero/arteriosclerosis and the cardiovascular risk. The vascular injury is mainly represented by increased arterial stiffness (increased pulse wave velocity--PWV), increased peripheral arteries reflectivity (Aix) and the occurrence of significant atheromatosis (increased clMT). Although well described in adult, there are few data in children regarding the impact of uremia on vascular structure and function. This paper is an overview of the main determinants of arterial compliance in children, focusing on recent data describing the repercussions of hypertension and renal failure in this age group. To date, our group has performed the only case control study in children in order to describe the arterial stiffness, the reflective properties of peripheral arteries as well as the carotid intima-media thickness on 18 children under chronic dialysis treatment (hemodialysis and peritoneal dialysis). Comparing with control cases the dialysed children had a significantly higher PWV and Aix, which reinforce that uremia is associated with arterial stiffness even in children. There were no significant differences on IMT and PWV between hemodialysed and peritoneal dialysed children. In contrast with adult patient data, there was no favourable impact of hemodialysis session over PWv and Aix.

We studied the spontaneous resolution rate in children with primary vesicoureteral reflux (VUR) and the interference of some specific factors. We reviewed the records of 110 children (14 days - 16 years) admitted in the 4th Pediatric Clinic Iaşi with primary VUR, between 1994 - 2003, which had exclusive medical management and minimum one follow-up cystogram. We used Kaplan-Meier curves to analyze the resolution rate of VUR during the follow-up in relation with initial grade, age at diagnosis, gender, recurrent urinary tract infections (UTIs) and the presence of renal scarring. The remission rate for all the cases was 70%, with differences based on the reflux grade: 100% for grade I and 45% for grade IV. The cases diagnosed during infancy recovered faster than those diagnosed after this period. The presence of renal scarring and breakthrough UTIs increased the remission time. In conclusion the majority of patients with VUR resolved during medical management, the remission rate being influenced by the reflux grade, presence of renal scarring and breakthrough UTIs.

In children, the nephrotic syndrome is usually corticoid-responsive; approximately 70% of patients experience relapses, frequently triggered by infections. Our paper presents the results obtained using a 4 month prednisone regimen. This retrospective study included 83 children afflicted with nephrotic syndrome over a 10 year span. We analyzed: age at diagnosis, boys/girls ratio, response to corticoid treatment - after one month of prednisone and at the completion of the treatment course, number of relapses and their frequency, complications of prednisone treatment. The median age at diagnosis was 4.8 years, males predominating M:F = 1.5:1. Complete response after 4 weeks of prednisone therapy was noted in 98.79% of cases. We had 116 episodes of relapses during the first year of follow-up, occurring in 67.4% of children (27.9% were frequent relapsers, 11.62% subsequently became corticoid-dependent). Late relapses, after the first year, occurred in 32.55% of cases. We noted mostly mild adverse effects of the prednisone treatment: occurrence of infections during therapy (16.27%), cushingoid facies (37.2%), hirsutism (4.6%), high blood pressure (4.65%), stretch marks (2.32%). In conclusion, the 4 month prednisone treatment regimen is efficient in inducing and maintaining a remission. The incidence of relapses is 32.55%, comparable to the figure cited in larger studies. Serious adverse effects are significantly lower with this regimen compared to other corticoid treatment schemes. Key wo

The management of primary vesicoureteral reflux (VUR) in child suffered major changes by focusing on the medical treatment in order to prevent the urinary tract infections and the occurrence of postinfectious renal scars. Continuous antibiotic prophylaxis and the follow-up by serial cystography of the spontaneous resolution of the reflux are considered nowadays the best choice in most of the cases. Surgery is recommended only in selected cases. Sub-ureteral injection of bulking agents to correct the reflux holds promise as an alternative to open surgery, but presents the challenge of identifying the ideal bulking agent.

The medical care of children with acute renal failure and the necessity of the substituting the renal functions has dramatically modified over the past 15 years. The study has been conducted retrospectively on 35 children diagnosed with acute renal failure (ARF), for analyzing the etiological spectrum, the evolutionary patterns and the influence factors of the ARF evolution. The following parameters have been taken into consideration: ARF etiology, hTA/HTA, oliguria, level of serum creatinine, the type of treatment (renal substitution by hemodialysis, peritoneal dialysis, or conservative treatment). The ARF etiology is dominated by the sepsis (31.4%) and by the hemolytic and uremic syndrome (17.1%). The treatment applied was conservative in 48.5% of the cases; 51.50% of the patients were in critical state and required extrarenal substitution by hemodialysis--42.8%--and peritoneal dialysis--8.5%. Global mortality is reduced (22.8%), but in the dialysed patients it is of 44.44%. The main death causes were: severe hepatic failure, oncological diseases, severe neurological damage and hemodynamic damages. In conclusion, the ARF prognosis in children is influenced by the comorbidity states. Dialysis has improved the therapeutic results in the currently presented lot, the death causes being extrarenal.

The comparative study of two groups of children suffering from acquired or congenital toxoplasmosis, being in hospital during two different decades (1979-1985--39 children and 1991-1997--117 children) proved: the fact that atypical or subclinical manifestations of the acquired toxoplasmosis (54%) draws our attention to the systematic research of the infection with Toxoplasma gondii, especially at the groups with increased risk now that the frequency of the diseases generating immunodeficiency; the increased frequency of congenital toxoplasmosis (5% in the first group, 8% in the second group) and especially of the invalidating of screening tests to the pregnant women; the therapeutic arsenal limited by the rate price/toxicity/medical resistance, must be individualized for each case, taking into account the increased number of other associated diseases (chronic hepatitis B 7%, TB 17%, HIV infection 5%); Rovamicine treatment at the second group had similar results to those obtained by administrating Pirimetamine--Trimetoprim to the children from the first group.

The relationship between bronchic asthma and tuberculosis has stimulated the greatest interest and most controversy. The present paper refers to 55 cases, i.e. 29 males (52%) and 26 females (48%). Most of the men were over 50 and the women over the age of 40 years. In 50 cases (90%) bronchial asthma developed 6 to 25 years after the tb lesions had become stable. Only 5 cases (10%) presented bronchial asthma with evolutive pulmonary tb. Although tuberculin hyperergy was encountered in 26 cases (47%) in none of the cases could a diagnosis of tuberculin asthma be established. In the group studied, the patients' age, the clinical and evolutive aspect of the bronchial asthma lists in the group of late asthmas. Against the background of the postuberculosis syndrome, the evolution of asthma is as a rule severe. Similarly, asthma accompanied by evolutive pulmonary tb, is in general very severe, hypersecretory and suprainfected with common germs.

In a group of 84 patients with recidivating bronchial infections IgA were evaluated with the aid of radial immunodiffusion according to Mancini. In all the patients IgA were determined from expectoration extractions and in 50 of them serum IgA were also determined. In 38 cases the determinations were simultaneous. Concentration of S IgA was low in most of the cases (65%). These results are probably influenced by the technical difficulties raised by detaching the connections existing between S IgA and mucus fibrils from the bronchial secretion. The results obtained in the dosage of serum IgA are comparable with those mentioned in the current literature. No correlations were possible between S IgA and serum IgA and there proteins can be considered as independent.