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Malabsorption syndrome encompasses a variety of gastrointestinal disorders that impair nutrient absorption in children, presenting wide range of clinical manifestations. This study focused on characteristics of the clinical manifestations and underlying etiologies of malabsorption syndrome in pediatrics population. Material and methods: A prospective cohort study was conducted involving 29 children presenting with symptoms suggestive of malabsorption syndrome. Clinical data, including symptoms, growth parameters, and nutritional status, laboratory both at the time of admitting and during treatment were collected. Diagnostic investigations included serological tests, stool analysis, imaging studies, and histopathological examination. Results: The most frequent clinical manifestations were abdominal symptoms (85%), respiratory infections (65 %), anemia (45 %) and vitamin deficiencies (58%). Celiac disease (51%), cystic fibrosis (32%), and Cow’s milk protein allergy (17%) were the leading causes. Conclusions: Serological tests are important for celiac disease diagnosis, while stool analysis is used to identifying lactose intolerance and infections. Diarrhea and weight loss are prevalent clinical manifestations of pediatric malabsorption syndrome.

Diarrhea is a leading cause of illness and death in children under five years old. Severe cases of diarrhea, particularly those resulting in dehydration, are a major factor in high mortality rates. Rotavirus is a significant pathogen contributing to dehydrating diarrhea and hospitalizations in children under five. The aim of this study was to investigate the role of vaccination in preventing the progression of gastroenteritis, with a focus on rotavirus-induced gastroenteritis. Material and methods: The present study was conducted within the Pediatric Department of The Emergency Clinical Hospital “St. Apostle Andrew” in Constanța, including 307 patients diagnosed with acute gastroenteritis during the period of January 1 and December 31, 2023. Results: The prevalence declined with age: 183 infants, 67 patients were between 1 and 3 years old, 42 were aged 3 to 7, and the smallest group, 15 patients, were between 7 and 16 years old, and 201 of the 307 children did not receive the Rotarix or Rotateq vaccines, while 106 patients completed the full vaccination regimen. As for the etiology of the disease, 160 patients were diagnosed with acute viral enterocolitis, with 142 cases attributed to Rotavirus. An increase in dehydration and electrolyte imbalances was observed in subjects who had not received the preventive Rotavirus vaccine. Conclusion: The role of the vaccine in preventing the severe progression of gastroenteritis, particularly that caused by Rotavirus, is highlighted by the reduced frequency of dehydration, electrolyte imbalances, and shorter hospital stays in patients who received the Rotarix/Rotateq vaccine.

(1) Background: Vaccination represents one of the most successful interventions worldwide in the field of public health. Immunization is one of the measures with the best results, being extremely efficient compared to all associated costs. Being a preventive measure, immunization relies entirely on the acceptance, understanding, and trust of those who use this service. The purpose of this study is to gather as much data as possible regarding the general opinion parents have regarding vaccines and the vaccination of their children; (2) Methods: For the purpose of this study, a cross-sectional survey was used through the application of a questionnaire employed as a research instrument, consisting of 35 questions. The questionnaires were physically distributed to family medicine cabinets for parents to complete, and the data collection period was throughout the months of May, June, and July of 2022. A total of 200 questionnaires were obtained, and their results were analyzed; (3) Results: The study was conducted on 200 respondents. Approximately two-thirds of the surveyed parents believe that all vaccines are necessary and of great importance. The reasons why parents do not accept certain vaccines were also evaluated within the questionnaire. Many respondents agreed that fear of possible severe adverse effects, as well as lack of correct information about vaccines, are the main issues leading to vaccine refusal. With the data we have gathered, we were able to track the general opinion of parents regarding vaccination, their level of information, the risks they express concern about, the relationship between parents and doctors regarding the vaccination process of their child, as well as their level of confidence in the effectiveness of vaccines; (4) Conclusions: From the general opinion on vaccines, it emerges that they are considered highly important and necessary by the majority of parents. Almost all respondents are interested in accumulating as much information as possible about vaccination. The majority of parents have adhered to vaccination norms, and their children either have received vaccines from the National Immunization Program (NIP) or are scheduled to receive them. The risk of adverse effects remains the primary concern of parents. Parents’ trust in vaccination continues to be a key element in understanding their attitude towards the entire immunization process.

Corticosteroid-induced diabetes is a significant complication in pediatric patients receiving steroid therapy for various medical conditions. This article reviews the pathophysiology, diagnosis, and management of corticosteroid-induced diabetes in children. Key therapeutic strategies include lifestyle modifications, pharmacologic interventions, and careful monitoring of blood glucose levels. Emphasis is placed on individualized treatment plans tailored to the child's specific needs and underlying condition. The article also discusses the importance of interdisciplinary collaboration among healthcare providers to optimize outcomes and minimize long-term complications. Early recognition and proactive management are critical in improving the quality of life for affected children.

The autoimmune process that induces type 1 diabetes can also affect other organs, leading to the development of additional autoimmune diseases in patients, thus hindering diabetes control. The most common comorbidities include autoimmune thyroid diseases and celiac disease. Globally, this subject is increasingly drawing the attention of researchers, given the magnitude and severity of the association between autoimmune diseases and type 1 diabetes. The aim of the present study is to assess the prevalence of autoimmune diseases, with the primary focus on celiac disease, associated with type 1 diabetes in children and adolescents, as well as their impact on the progression of type 1 diabetes. Material and methods: The present study was conducted within the Pediatric Section, Pediatric Diabetology Department of the Emergency Clinical Hospital “St. Apostle Andrew” in Constanța, including 15 cases diagnosed with type 1 diabetes in children during the period 2017-2022. Results: The patients included in the study are aged between 1 and 13 years highlighting the age group of 3-6 years as the most commonly encountered. The most commonly encountered HbA1c values are in the range of 10-12%, accounting for 53% of the total, we can thus observe a prevalence of high and very high HbA1c values. In order to confirm the diagnosis of type 1 diabetes, specific antibodies were sampled, 97% of patients being tested positive for at least one antibody. Conclusions: The association between diabetes mellitus and another autoimmune disease is encountered at a relatively high percentage. Higher levels of HbA1c at the onset of type 1 diabetes have been associated with an increased risk of long-term complications.

Background: In the pediatric intensive care unit (PICU), sepsis, sepsis syndromes, septic shock, and multiorgan system failure are frequently encountered and are considered important conditions; Methods: This is a retrospective, observational study over a period of 3 years, that is aimed to investigate the predictive role of lactate levels at admission in order to evaluate disease progression of pediatric patients with septic shock syndrome with the role to identify whether lactate levels at admission could serve as a significant predictor of adverse outcomes. The sample consisted of 21 patients between 1 and 36 months, diagnosed and treated for hemodynamic shock in a tertiary center; Results: The study found that lactate level at admission greater than or equal to 4.95 was associated with 32.5 times increased odds of serious evolution. The study also identified other potential predictors, such as lactate level 12 hours after admission, hemodynamic parameters, and demographic factors; Conclusions: These findings suggest that monitoring lactate levels at admission can provide important information to predict mortality and guiding treatment decisions in pediatric patients with shock syndrome.

Cystic echinococcosis (CE) is a neglected tropical parasitic disease linked with significant social and economic burdens worldwide. The scientific community has minimal information on echinococcosis in Romanian people, and hospital medical records are the only sources that may be used to investigate its status. A 7-year retrospective clinical study on pediatric patients with CE from Southeast Romania was performed, and 39 children and adolescents were included, aged 2–15 years old. They were hospitalized with cystic echinococcosis in the Pediatric Department and Pediatric Surgery Department of Constanta County Clinical Emergency Hospital “St. Apostle Andrew” between 1 January 2017 and 1 October 2024. Twenty-nine (74.36%) pediatric patients came from rural zones, and 10 (25.64%) had urban residences. In total, 28 children (71.79%) had contact with four different animals (dogs, goats, pigs, and sheep); only four were from urban zones, and they had contact only with dogs. Data regarding the length of hospital stay, cyst location, and complications were collected and analyzed. According to the medical files, the diagnosis was established using imaging techniques and serological tests for CE. IgE and IgG reported appreciable variations in correlation with all parameters, and significant differences (p < 0.05) were recorded. IgE levels considerably increased in cases of no animal contact, pulmonary involvement, complications, surgical treatment, and multiple hospitalizations. Moderate IgE values were recorded in cases of urban residences, pig and sheep contact, and hepatic involvement. The IgG concentration considerably increased with sheep contact and moderately increased in cases of rural zones, hepatic involvement, complications, and surgical treatment. The results show that incidental discovery, symptoms, complications, multiple dissemination, pulmonary involvement, and dog and pig contact increase the hospitalization time. Extensive data analysis supports our results. Our findings highlight the complexity of managing E. granulosus infections in children and evidence the importance of a multidisciplinary approach, combining early diagnostic tools, tailored medical therapy, and careful surgical intervention when necessary.

Exercise-induced bronchoconstriction (EIB) is a dysfunction of the respiratory tract consisting of transient airflow obstruction that occurs during or immediately after physical exercise, being the preferred term to define what was known for years as exercise-induced asthma. Symptoms develop when airways narrow as a result of physical activity. As many as 90 percent of people with asthma also have EIB, but not everyone with EIB has asthma. EIB is defined as the coexistence of at least two of the following symptoms: dyspnea, cough, wheezing, shortness of breath and chest pain, combined with the decrease of forced expiratory volume in one second (FEV1). Perception of these symptoms may restrain children’s ability and willingness to exercise. The pathophysiology of the process and the severity of bronchospasm depend on the level of ventilation, temperature and humidity of the inspired air. The mechanism is related to thermal hyperemia and congestion of small vessels in the bronchial wall. Most of the symptoms are non-specific, the differential diagnosis including chronic lung diseases and certain cardiovascular diseases or gastroesophageal reflux. For the diagnosis of this entity, a series of challenge tests can be used: at graded exercise, voluntary hyperpnea, methacholine, mannitol, hypertonic saline or histamine, FEV1 decreasing by 10-20% depending on the chosen test. Effective treatment includes preventive therapy – prior administration of a beta 2 agonist and/or antileukotriens, or regular CSI treatment in children with asthma that reduce the number of mast cells required for this type of response.

Vasculitis are disorders characterized by the presence of an inflammatory process in the blood vessel wall, resulting in damage or necroses of certain tissues or organs. Numerous clinical symptoms, ranging from acute localized hypersensitivity reactions to severe auto-immune systemic disorders that are incurable and life-threatening, can be attributed to the types and locations of affected arteries as well as the level of inflammation. Typical oral or facial symptoms of several forms of vasculitis can help in an early diagnosis of vasculitis. IgA vasculitis and Kawasaki disease (KD) are the two predominant types of pediatric vasculitis that involve the mouth, followed by ANCA vasculitis. Furthermore, SLE, a connective tissue disease, is one of the most prevalent autoimmune illnesses in children and can proceed rapidly across multiple organs or start mildly and gradually. Numerous more systemic conditions, such as infection, autoinflammatory disorders and neoplasia, can also primary or secondary localize in the oral cavity, infections being more frequent. Many various professionals, including dentists, family physicians, pediatricians, rheumatologists, hematologists, gastroenterologists, and otorhinolaryngologists, examine and treat children with oral symptoms. In 87.7% of patients overall and over 90% of patients with KD and IgA vasculitis (formerly known as Henoch-Schönlein purpura), cutaneous involvement was observed. Recurrent oral aphthous ulcers were present in all Behçet syndrome patients (1).

The most frequent hyperglycemic emergency is diabetic ketoacidosis (DKA), which puts individuals with diabetes mellitus at the highest risk of mortality that may be avoided. DKA affects people with type 1 diabetes more frequently than type 2, with 30% of occurrences in patients who have already been diagnosed with type 2 diabetes. High blood sugar level, ketosis and metabolic acidosis are symptoms of DKA. The aim of the study is to emphasize the main manifestation of type 1 diabetes which is diabetic ketoacidosis, as well as, to analyze the factors predisposing to recurrent episodes of diabetic ketoacidosis. Material and Methods. The retrospective study was conducted on a period between 2017-2022, including hospitalized children aged between 0-16 years with recurrent diabetic ketoacidosis within the Pediatric Clinic of Clinical Emergency Hospital “St. Andrew the Apostle” Constanta, aiming to analyze the factors predisposing to recurrent episodes of diabetic ketoacidosis according to age, sex, environment, socio-economic status, heredo-collateral antecedents, symptoms, personal pathological history, clinical and laboratory data. Results. It was observed that the incidence of episodes of diabetic ketoacidosis increased considerably since 2019, the maximum being recorded in 2020, while the lowest percentage is in 2017. During 2020–2021, the age group of 10–14 years presented. Genetic sex remains a nonmodifiable risk factor that is thought to play a role in terms of glycemic control, but also the occurrence of complications in patients with type 1 diabetes. It was shown that 37% of the causes of the recurrence of DKA episodes were found to be diet variation, 28% to be viral diseases, 26% to be insulin administration errors, 6% to be trauma, and only 3% to be Mauriac syndrome. Conclusions. Numerous research from the medical literature have supported the hypothesis that SARS-CoV-2 may be a catalyst for autoimmunity in the pathogenesis of type 1 diabetes, indicating a causal connection between the two illnesses. It has been established that diet non-compliance is the primary cause of recurrent episodes of ketoacidosis.

Introduction. Gut microbiota is a microecosystem with a dynamic complexity, influenced by multiple factors, with impact on the composition and long-term health. An imbalance in gut microbiota, often termed as ‘dysbiosis’, is associated with a wide variety of pediatric diseases, including allergies, diabetes mellitus, autoimmune diseases, autism spectrum disorders and celiac disease. The aim of the study is to emphasize the main clinical manifestations and to analyze the risk factors of gut dysbiosis in the first three years of life. Material and Methods. The retrospective study was conducted on a period between 2020-2022, including children aged between 0-3 years with intestinal dysbiosis, aiming to analyses the factors predisposing to imbalance in gut composition according to age, gender, environmental factors, personal medical history, clinical manifestations, and laboratory data. Results and Discussions. Main clinical manifestations of dysbiosis in the first three years of life are represented by abdominal pain, vomiting, irritability, diarrheal stools and stools with mucus. C-section represents a major risk factor for the occurrence of gut dysbiosis in infants. Low birth weight is a risk factor due to imbalance of intestine function and high susceptibility to dysbiosis. Infant formulas determine a low concentration of beneficial bacteria. Urban area represents an environmental factor with increased susceptibility of subjects for gut dysbiosis. Antibiotherapy in the first year of life is a factor which determines a low microbial diversity in infants. Conclusions. The interplay between intestinal microbiota, environment and host is a multidirectional relationship. Factors such as mode of delivery, type of feeding, weight, living conditions and antibiotherapy have an influence on the modulation of the microbiological milieu in the first three years of life, with impact on long-term health.

Aim of the study. This study aimed to evaluate malondialdehyde status and dyslipidemia in diabetic children. In children, type 1 diabetes mellitus (T1DM) is considered one of the most common chronic autoimmune diseases. The first step is detecting insulin deficiency expressed by hyperglycemia. The short- and long-term effects are significant and affect all body parts: blood vessels, eyes, kidneys, brain, heart, and nerves. Persistent hyperglycemia generates reactive oxygen species (ROS) / free radicals through metabolic abnormalities such as glucose autooxidation and non-enzymatic glycation. Materials and methods. This study included 50 children with T1DM with a mean age of 7.6 years. Important elements were evaluated to establish clear indicators of atherosclerotic activity (lipoperoxidation, protein oxidation, changes in the status of antioxidant defense systems, plasma oxygen radical absorbance capacity (ORAC), glycated hemoglobin (HbA1c), total cholesterol, and triglycerides). Results. Malondialdehyde (MDA) and lipid levels were correlated and significantly higher (0,87 ± 0.2 versus 1,8 ± 0,87 µmol/L, 66,33 +/-14,21 versus 43,33 +/- 7,2 respectively; P < 0.001), and a significant reduction in plasma total antioxidant capacity. Conclusions. MDA levels presented elevated values, indicating the negative connection between atherosclerotic risk factors and MDA. This important conclusion can be drawn every time a patient with type 1 diabetes presents LDL excess levels, therefore representing an increased lipid peroxidation resulting in higher MDA levels. From this point, the correlation between hyperglycemia (the main source of increased oxidative stress) in patients with poor metabolic control and MDA is not the only path to anticipate the risk of atherosclerotic complications.

Background: Vitamin D is an organic compound with an important role in bone metabolism and ability to modulate the immune function. Epidemiology research have recently suggested vitamin D’s role in the etiology of type 1 and type 2 diabetes in children. Vitamin D controls insulin secretion in pancreatic islets and insulin sensitivity in several peripheral metabolic organs by acting through the vitamin D receptor (VDR). Recent studies have reported an increased prevalence of vitamin D deficiency among patients diagnosed with type 1 diabetes. The aim of the study is to identify the correlation between vitamin D deficiency and the frequency, severity, and control of type 1 diabetes in children. Material and Methods: The retrospective study was performed on 40 subjects with type 1 diabetes, which associated vitamin D deficiency at the onset of the disease or during the investigation period, at Pediatric Clinic of Constanta County Clinical Emergency Hospital. The strategy used involved the collection of certain parameters from the observation sheets, in order to evaluate, compare and illustrate the correlation between vitamin D deficiency and type 1 diabetes. Results: Male subjects represented the majority of cases (55%). The seasonal incidence may be explained by exposure to a reduced amount of ultraviolet radiation in the cold season, which contributes to the decrease in the level of 25-hydroxyvitamin D. Viral infections had an increased incidence in the winter, which may contribute to the onset of type 1 diabetes. An optimal level of serum 25-hydroxyvitamin D was found in 17% cases, insufficient level in 63% cases and deficiency in 20% cases. In evolution, 24 cases had poor glycemic control, registering values higher than 7% of glycosylated hemoglobin. The dosage of 25 hydroxyvitamin D in these subjects indicated vitamin D deficiency in 7 cases and insufficiency in 17 cases. None of the patients with a glycosylated hemoglobin value >7 had an optimal 25-hydroxyvitamin D level. Out of 16 patients with optimal glycosylated hemoglobin values (

The gut microbiota (GM) plays a vital role in human health, with increasing evidence linking its imbalance to chronic kidney disease and end-stage kidney disease. Although the exact methods underlying kidney-GM crosstalk are not fully understood, interventions targeting GM were made and lay in three aspects: diagnostic, predictive, and therapeutic interventions. While these interventions show promising results in reducing uremic toxins and inflammation, challenges remain in the form of patient-specific GM variability, potential side effects, and safety concerns. Our understanding of GMs role in kidney disease is still evolving, necessitating further research to elucidate the causal relationship and mechanistic interactions. Personalized interventions focusing on specific GM signatures could enhance patient outcomes. However, comprehensive clinical trials are needed to validate these approaches’ safety, efficacy, and feasibility.

The most common inherited condition that results in death, particularly in those of Caucasian heritage, is cystic fibrosis (CF). Of all the young adults diagnosed with cystic fibrosis, 20% will develop hyperglycemia as a complication, later classified as a disease associated with cystic fibrosis. Impaired insulin secretion and glucose intolerance represent the primary mechanisms associated with diabetes (type 1 or type 2) and cystic fibrosis. Oxidative stress represents the imbalance between oxygen-reactive species and antioxidant defense mechanisms. This pathogenic mechanism is vital in triggering other chronic diseases, including cystic fibrosis-related diabetes. It is essential to understand oxidative stress and the significant impact it has on CFRD. This way, therapies can be individually adjusted and tailored to each patient’s needs. This review aims to understand the connection between CFRD and oxidative stress. As a subsidiary element, we analyzed the effects of glycemic balance on complications and their evolution over time, providing insights into their potential benefits in mitigating oxidative stress-associated complications.

Neonatal diabetes mellitus is a rare genetic disease that affects 1 in 90,000 live births. The start of the disease is often before the baby is 6 months old, with rare cases of onset between 6 months and 1 year. It is characterized by low or absent insulin levels in the blood, leading to severe hyperglycemia in the patient, which requires temporary insulin therapy in around 50% of cases or permanent insulin therapy in other cases. Two major processes involved in diabetes mellitus are a deformed pancreas with altered insulin-secreting cell development and/or survival or faulty functioning of the existing pancreatic beta cell. We will discuss the cases of two preterm girls with neonatal diabetes mellitus in this research. In addition to reviewing the literature on the topic, we examined the different mutations, patient care, and clinical outcomes both before and after insulin treatment.

Coronavirus disease 2019 (COVID-19) is a complex infectious disease caused by the SARS-CoV-2 virus, and it currently represents a worldwide public health emergency. The pediatric population is less prone to develop severe COVID-19 infection, but children presenting underlying medical conditions, such as diabetes mellitus, are thought to be at increased risk of developing more severe forms of COVID-19. Diabetic children face new challenges when infected with SARS-CoV-2. On one hand, the glycemic values become substantially more difficult to manage as COVID-19 is a predisposing factor for hyperglycemia. On the other hand, alongside other risk factors, high glycemic values are incriminated in modulating immune and inflammatory responses, leading to potentially severe COVID-19 cases in the pediatric population. Also, there are hypotheses of SARS-CoV-2 being diabetogenic itself, but this information is still to be confirmed. Furthermore, it is reported that there was a noticeable increase in the number of cases of new-onset type 2 diabetes among the pediatric population, and the complications in these patients with COVID-19 include the risk of developing autoimmune diseases under the influence of stress. Additionally, children with diabetes mellitus are confronted with lifestyle changes dictated by the pandemic, which can potentially lead to the onset or exacerbation of a potential underlying anxiety disorder or depression. Since the literature contains a series of unknowns related to the impact of COVID-19 in both types of diabetes in children, the purpose of our work is to bring together the data obtained so far and to identify potential knowledge gaps and areas for future investigation regarding COVID-19 and the onset of diabetes type 1 or type 2 among the pediatric population.