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Celiac disease (CD), also known as gluten-sensitive enteropathy or celiac sprue, is defined as a chronic, multifactorial, immune-mediated condition affecting small intestine in genetically susceptible children and adults. Gluten-sensitive enteropathy is characterized by heterogeneous clinical manifestations of variable severity that can occur at any age. For patients with prompt diagnosis and correct treatment the prognosis is excellent. Therefore, CD needs a quick diagnosis in order to start the treatment. Because of the wide range of signs and symptoms, an accurate differential diagnosis is required.

Background Kawasaki disease (KD) is a systemic vasculitis that occurs predominantly in young children. Diagnosis is based on clinical criteria of KD. Coronary artery lesions are the most important complications of KD. First-line treatment consists of intravenous immunoglobulin (IVIM) administration. There are biological markers that are considered predictors of treatment response and heart complications. Aims highlighting factors that influence treatment response and heart complications in KD. Methods We had to investigate a paediatric patient with persistent fever. A 3 years old boy presented with a history of fever over 10 days, sore throat, and pain and swelling of the knee. The boy diagnosed with acute tonsillitis received intravenous antibiotics treatment with Ceftriaxone and Gentamicin and medications for fever in paediatric service in Hunedoara without effect. After starting antibiotic treatment the patient had an erythematous rash on the trunk. Results In our service the physical examination revealed fever, hyperemia of both eyes, cervical and inguinal lymphadenopathy, throat congestion, red lips, strawberry tongue, swelling of knees and hands and feet fingers, and exanthema of palms and soles with scaling. Laboratory investigations revealed a biological inflammatory syndrome with elevated erythrocyte sedimentation rate, high level of C-reactive protein and fibrinogen, leukocytosis, important thrombocytosis(>1mil/mm 3 ), normochromic microcytic anaemia, and elevated alanine aminotransferase. Immunological investigations were negative. Serological investigations revealed a positive value of Cytomegalovirus IgM antibody. Clinical features presented by the patient meet the diagnostic criteria of KD in the second phase of evolution. We decided administration of IVIM with a dose of 2 g/kg over 10 hours. Fever resolves but echocardiography reveals a right coronary artery aneurysm. The patient receives Aspirin in anti-inflammatory high dose (100 mg/kg/day) for 10 days, after which it is recommended maintenance dose. Echocardiographic reevaluations indicate progressive remission of the aneurysm. Conclusions Particularities of the case: thrombocytosis>1 mil/mm 3 , criteria that is not listed among predictors of treatment response, but in our experience we had a case with important thrombocytosis in KD with unfavourable outcome; delayed administration of IVIM due to the difficulty of diagnosis; occurrence of coronary aneurysm in subacute phase.

In the accordance of readers, we are introducing a new chapter in Journal, which will consist in Clinical Scenarios for Medical Students. First clinical scenario is presented by associate professor Sur Genel and his team: a 12-year-old girl diagnosed with a combination of four autoimmune diseases: autoimmune hepatitis, thyroiditis, celiac disease and type 1 diabetes mellitus.

In order to make the appropriate treatment is necessary an accurate diagnosis. This is also true for upper gastrointestinal bleeding in children. It is not always easy to sustain the diagnosis, but using current methods we can reach etiologic diagnosis. After diagnosis the best treatment options are choosing. These must be both efficient and with fewer side effects. Upper gastrointestinal hemorrhage treatment takes into account two situations: patients with hemodynamic instability with large blood loss and patients with hemodynamic stability. Patients with important upper gastrointestinal bleeding with hemorrhagic shock need resuscitation and should be stabilized prior to endoscopy.

Acute gastrointestinal bleeding in children is a common emergency. Gastrointestinal bleeding may involve any part of the digestive tract from mouth to anus. Causes of gastrointestinal bleeding in children are multiple and can be grouped according to the involved portion of the digestive tract and age.

Premise: According to the International Diabetes Federation (IDF) consensus worldwide 2013 the metabolic syndrome is a cluster of the most dangerous heart attack risk factors: diabetes and raised fasting plasma glucose, abdominal obesity, high cholesterol and high blood pressure. It is known that about 20-25% of the world population has metabolic syndrome. The risk of dying through complications such as heart attack or stroke is two to three times higher than the general population. Platinum standard definition (IDF) proposed for including metabolic syndrome in addition to other measurements determination of pro-inflammatory status. Objectives: Identifying inflamation and its severity using inflamatory markers: C-reactive protein fibrinogen and leukocytes. Assesment of these markers considering the diversity of metabolic syndrome elements. Material and method: We performed a study that enrolled 152 patients registered to a family physician and diagnosed with metabolic syndrome. The subjects included in study were divided in two groups: group A-78 subjects diagnosed with metabolic syndrome that was defined by 3 elements: abdominal obesity+arterial hypertension+diabetes mellitus; group B-74 patients diagnosed with metabolic syndrome based on 5 elements: abdominal obesity+arterial hypertension+diabetes mellitus+decreased high density lipoprotein+increased triglycerides. We also established a control group-30 healthy people to compare inflammatory markers values. Results: We observed increased values of CRP fibrinogen and leukocytes for group B in comparison to group A: 0.9±0.8 mg/dl vs 0.79 ± 0.8 mg/dl (p=0.02, significantly statistic)Fibrinogen increased in group B significantly in comparison to group A (442,35 versus 365,8 p=0,0006. Leukocytes level was less responsive in patients with metabolic syndrome; leukocytes value was higher for group B, but not significantly statistic. Conclusions: Inflammation in patients with metabolic syndrome depends on the number and association of elements that define this entity, being more accentuated for subjects who associate more elements.

The prevalence of allergic diseases is increasing worldwide in last decades.The ISAAC (International Study of Asthma and Allergies in Childhood) study suggested that the prevalence of allergy is between 6 and 12% in children. The natural history of allergic manifestations characterized by an age-related sequence of clinical symptoms and conditions is known as allergic march.Thus allergic march represents the evolution from cow’s milk protein allergy and atopic dermatitis to allergic rhinitis and asthma. Peak incidence of atopic dermatitis and cow’s milk protein allergy is found in the first two years of life. These children are at increased risk of developing other allergic diseases such as asthma and allergic rhinitis. Gastrointestinal and skin manifestations in association with respiratory and sometimes systemic events have an important impact on child development in terms of weight, stature and psychomotor, and later on the social integration of the patient .It is important to highlight natural evolution of allergic diseases both to predict a child’s risk with atopic dermatitis to develop allergic rhinitis or asthma, and also to establish timely therapeutic measures to influence or stop the development of allergic manifestations.

Cystic fibrosis is a clinical entity with multiple representations. Despite acquired knowledge, there is still unknown information about this disease. We tried to define the relationship between classes of mutations and clinical manifestations. We also tried to structure clinical manifestations depending on the most commonly found mutations, not minimizing intervention of environmental factors and modifier genes. We found that patients from the same family with the same mutation had different clinical manifestations, thus highlighting intervention of environmental factors and modifier genes. Diagnosis of cystic fibrosis is not easy because there are sometimes symptoms blurred, sometimes suggestive, but support the diagnosis by laboratory methods is not always possible. It is important that this condition be diagnosed as early as possible, even at birth, in order to prevent complications of the disease.

Allergic diseases are common hyper-immune disorders. Atopic dermatitis (AD) has a higher prevalence in industrialized countries. It has been suggested that association between genetic factors, environmental factors and gut microbiota would be major triggering factors for the development of atopic dermatitis. Hygiene hypothesis by a lack of early childhood exposure to diverse microorganism increases susceptibility to atopic dermatitis and other allergic diseases. Recent studies have demonstrated the complex interrelationship between skin barrier, genetic, environmental, pharmacologic, psychological and immunologic factors that contribute to the development and severity of AD. The current review will examine the immunological mechanism that contributes to AD as well as immunologic triggers involved in the pathogenesis.

Liver injury in celiac disease may evolve from reactive hepatitis to autoimmune hepatitis. Our case is a reactive hepatitis evolves parallel with celiac disease activity. If the patient does not follow the gluten free diet both manifestations of celiac disease and reactive hepatitis will appear. Reactive hepatitis manifestations can be rectified after 6-12 months of gluten-free diet.

Cystic fibrosis (CF) is the most common autosomal recessive disease in Caucasians. The dysfunction of Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) causes the disease by disrupting epithelial salt and water transport. Characteristic manifestations of the disease such as chronic respiratory infections, pancreatic enzyme insufficiency, and infertility are caused by the accumulation of mucus in the ducts. Nowadays nearly 2000 CFTR mutatioans are known. The most common mutation is F508del. F508del/F508del mutation is not always accompanied by severe manifestations. The clinical expression is different among patients, taking into account the mutations and another factor, among them, enviromental and modifier genes. In the case of rare mutations symptoms vary from patient to patient being influenced by environmental factors and modifier genes. We present a case with a less common combination of mutations and an atypical clinical presentation.

Hypertension is the most prevalent cardiovascular disease in the world. Because of associated morbidity and mortality it is in one of the most important public health problems. Hypertension is the most important cause of heart failure with low or preserved ejection fraction. If hypertension develops concomitant with diabetes mellitus treatment problem of the two diseases becomes more complex. It is known that beta-blockers may induce type 2 diabetes, but those of new generation such as Nebivolol do not have this effect. There are many drugs with proven efficacy in lowering blood pressure, but the optimal treatment to prevent progression to heart failure is uncertain. Beta-blockers are a class of drugs with benefits both on hypertension and in heart failure. Drugs of this class have different pharmacological properties in terms hemodynamic and cardiovascular. Nebivolol is a beta-blocker that causes vasodilatation mediated by nitric oxide release. This medicine lowers blood pressure, prevents endothelial dysfunction and improves coronary flow reserve and diastolic function independent of ventricular geometry changes. Action of nebivolol is superior to classic beta blockers by reversibility of subclinical changes in the left ventricle before the onset of heart failure. In the early stages of heart failure with preserved ejection fraction the management is not yet established. Therefore it is important to know that in these situations nebivolol has beneficial ef fects.

Based on the results of personal research authors looked to see which risk factors can be influenced in hypertension determinism. It is known that the genetic factor is present in 20-40% of patients. But this genetic factor does not validate unless, other factors interfere to allow the occurrence of hypertension. The factors which can be influenced significantly are those related to the individual's lifestyle. The lifestyle can accelerate the occurrence of hypertension or on the contrary stop the development of hypertension. Factors that can be influenced are: consumption of salt, consumption of fatty foods, alcohol, smoking and sedentary behavior. To influence the real prevalence of hypertension prevention measures should start in childhood. People should act on the principle "it is easier to prevent than to treat". At the same time this principle is beneficial both economically and individually. Unfortunately, most studies use persons in older age, so the comorbidities are more frequent and the cardiovascular complications occurred already. In future will be diagnosed young people at risk of developing hypertension and monitored to lead a normal life.

Malignancies associated with rheumatic diseases are more common than healthy individuals. What is actually the cause of increased malignancies in rheumatic diseases: autoimmunity, inflammation, immune regulation deficits? There was no a clear answer, but malignancies associated with rheumatic diseases is a certainty. Medication is also involved in the development of malignancies. Therefore we decided to address the involvement of rheumatic diseases medication in malignancies development.

Although it is not common, impairment of eye in autoimmune inflammatory diseases can become very severe by its evolution and complications. Often eye disorders within the autoimmune inflammatory diseases are not correctly diagnosed. These disorders are usually diagnosed as independent entities and thus local corrective treatment is the only applied. In these situations the evolution of uveitis can be toward blindness. The case presented by us unfortunately fits into this typology of local treatment with repeated surgical interventions without encouraging results. At time of diagnosis the patient completely loses sight in one eye and at the other it dropped to below 50%. In 1907 Rudyard Kipling got the Nobel Prize for his novel'' The Light That Failed'', whose main character lost view but from other reasons than our patient.

Celiac disease is a clinical entity that is not difficult to diagnose when it shows the classic symptoms. It was found that there are other forms of celiac disease that are difficult to diagnose because of atypical manifestations. The aim of this study is to describe the prevalence of different forms of celiac disease in accordance with ‘The Oslo definitions for celiac disease and related terms’ and therapeutic perspectives of this disease.

Type 2 diabetes is a chronic disease widespread in the world. Currently it is believed that there are over 500 million diabetics in the world and their number increases every year. This increase is primarily due to unhealthy eating habits, sedentary lifestyle, obesity and stress. In an OMS report stated that ‘’individuals live dangerously’’, this for failure to comply of the minimum precepts regarding lifestyle. Correct monitoring of the diabetic patient for preventing complications is an important aspect in the disease evolution. Methods that allow an accurate monitoring of diabetes include glycosylated hemoglobin, self-monitoring of blood glucose and continuous glucose monitoring with a system that measures interstitial glucose concentration. It is considered that the determination of glycosylated hemoglobin is the gold standard in monitoring diabetic patients, but the other two methods provide complementary information.

Urticaria and angioedema are common diseases in children and adults. Erythematous swelling of the deeper cutaneous and subcutaneous tissue is called angioedema. Urticaria is characterized as the appearance of erythematous, circumscribed, elevated, pruritic, edematous swelling of the upper dermal tissue. Urticaria may occur in any part of the body, whereas angioedema often involves face, extremities or genitalia. Urticaria is considered acute if symptoms are present for less than 6 weeks. In chronic urticaria symptoms are longer than 6 weeks. Acute urticaria has been reported to be the common type in childhood and chronic urticaria is more frequent in adults. Urticaria and angioedema are a frequent cause of emergency room visit but few patients need to be admitted. The basic mechanism involves the release of diverse vasoactive mediators that arise from the activation of cells or enzymatic pathways. Histamine is the best known of these substances, and response consisting of vasodilatation (erythema), increased vascular permeability (edema) and an axon reflex that increases reaction. The most common etiological factors for angioedema and urticaria have been identified as infection, physical urticaria, food allergy, drug adverse reaction, parasitic infestation and papular urticaria. The aim of this study is to define, describe and discuss etiology, diagnostic, treatment and severity.