Background: Acute liver failure (ALF) is a rare disease, associated with high mortality, despite optimal medical therapy without emergency liver transplantation. Knowing the possible cause of ALF plays a vital role in the management, as the child could benefit from effective specific therapies in emergencies. Methods: We have analyzed the etiology and outcome of ALF in children followed-up in a tertiary care hospital between January 2012–December 2018. The patients were grouped into different age categories: neonates (0–1 month), infants (1–12 months), children (1–14 years), and teenagers (14–18 years). Results: 97 children (46 males, 47.42%, the mean age of 7.66 ± 8.18 years) were admitted with ALF. The most important causes of ALF were in neonates and infants, infections (72.72%), and metabolic disorders (43.47%), in children and adolescents were the toxic causes (60% and 79.41%). The mortality rate was 31.95% (31 patients), mainly in ALF due to infections or metabolic disorders. Conclusions: In neonates and infants, the main causes of ALF were infections and metabolic diseases, while in older children and teenagers, were toxin-induced liver injuries. The mortality among neonates and infants was significantly higher than in other ages. Early recognition and immediate therapeutic intervention could improve the outcome of these patients.

Introduction: Acute liver failure (ALF) is a syndrome defined by jaundice, coagulopathy (INR > 1.5) and hepatic encephalopathy in patients with no evidence of prior liver disease. Toxins and drugs are a frequent cause of ALF in children. Material and methods: The aim of our study was to establish the causes of toxic ALF in children followed up in our hospital in the period of January 2000 to August 2018. We retrospectively studied all hospital records of patients who developed ALF after mushroom/drug exposure and had been admitted to our hospital, the main pediatric toxicology center in northwestern Romania. Results: In the last 18 years, 123 patients were admitted to our clinic with toxic ALF (89 patients secondary to mushroom ingestion and 34 patients after drug exposure). In the 2000-2012 period accidental mushroom poisoning was the leading cause of toxic ALF. Unfortunately, during the last years, voluntary drug ingestions have increased dramatically. The most commonly incriminated drug was acetaminophen (52.94%). Conclusions: ALF in mushroom poisoning is associated with a high mortality in children, despite optimal medical therapy. This etiology was one of the most important causes of death in our cohort. The difficulty in accessing emergency liver transplantation is an obstacle common to many Eastern European pediatric centers. Fortunately, in the last 5 years the incidence of mushroom intoxications has decreased in our area. It is worrying that over the last few years there has been an increased incidence of toxic ALF after drug exposure (for suicidal purposes or due to lenient regulations for prescribing hepatotoxic medications).

Toxic liver injury can vary from asymptomatic increases in biochemical parameters (hepatic function tests) to acute hepatitis and acute liver failure or death. Because this parameters changes only after the hepatocellular necrosis and changes are not proportional to the extension of the hepatic injuries, we need new biological markers to facilitate an early diagnosis, allowing a rapid and targeted therapeutical intervention. Our study aimed to analyse the changes in serum levels of some miRNAs after acetaminophen exposure in mice and their correlation with the severity of liver histopathological lesions. The serum level of miRNA-122 and miRNA-192 and the histopathological aspects were assessed at 30 minutes, 2 hours, and 24 hours after intraperitoneal administration of acetaminophen. Thirty minutes post-exposure, there were no significant differences regarding the necrosis score between the acetaminophen and control groups, but the miRNA-122 values varied significantly. The level of miRNA-122 had the highest increase after 2 hours, long before any change in the serum level of the usual markers. Regarding the expression miRNA-192, at 30 minutes post-exposure, there was an increase compared to the controls, but with a magnitude inferior to that recorded for miRNA-122 (0.62 vs. 2.1). Also, after 2 and 24 hours, the increase was much less significant than for miRNA-122. With a high specificity for hepatocytes and increased stability, the serum level of miRNA-122 is modified during the early stages, even before the histopathologic changes. All of these are the necessary attributes to be a biomarker of toxic hepatic injury. miRNA-192 cannot be considered a sensitive and specific enough biomarker to toxic liver injury. RezumatBoala hepatică toxică variază de la creșteri asimptomatice ale parametrilor biochimici (teste funcționale hepatice) la hepatită acută, insuficiență hepatică acută sau deces. Deoarece acești parametri se modifică numai după necroza hepatocelulară și modificările nu sunt proporționale cu extinderea leziunilor hepatice, avem nevoie de noi markeri pentru un diagnostic precoce și o intervenție terapeutică rapidă și țintită. Studiul nostru a analizat modificările nivelurilor serice ale unor microARN (miARN) după expunerea la acetaminofen la șoareci și corelația acestora cu severitatea leziunilor histopatologice hepatice. Modificările miARN-122 și 192 și aspectele histopatologice au fost evaluate la 30 de minute, 2 ore și 24 de ore după administrarea intraperitoneală de acetaminofen. La treizeci de minute după expunere, nu au existat diferențe semnificative ale scorului de necroză între lotul expus și martor, dar valorile miARN-122 au variat semnificativ. Nivelul miARN-122 a avut cea mai mare creștere după 2 ore, cu mult înainte de orice modificare a markerilor obișnuiți. În ceea ce privește miARN-192, la 30 de minute după expunere, a existat o creștere comparativ cu lotul martor, dar cu o magnitudine inferioară celei înregistrate pentru miARN-122 (0,62 față de 2,1). De asemenea, după 2 și 24 de ore, creș...

Objectives: In children, acute liver failure (ALF) is a severe condition with high mortality. As some patients need liver transplantation (LT), it is essential to predict the fatal evolution and to refer them early for LT if needed. Our study aimed to evaluate the prognostic criteria and scores for assessing the outcome in children with ALF. Methods: Data of 161 children with ALF (54.66% female, mean age 7.66 ± 6.18 years) were analyzed based on final evolution (32.91% with fatal evolution or LT) and etiology. We calculated on the first day of hospitalization the PELD score (109 children), MELD, and MELD-Na score (52 children), and King’s College Criteria (KCC) for all patients. The Nazer prognostic index and Wilson index for predicting mortality were calculated for nine patients with ALF in Wilson’s disease (WD). Results: PELD, MELD, and MELD-Na scores were significantly higher in patients with fatal evolution (21.04 ± 13.28 vs. 13.99 ± 10.07, p = 0.0023; 36.20 ± 19.51 vs. 20.08 ± 8.57, p < 0.0001; and 33.07 ± 8.29 vs. 20.08 ± 8.47, p < 0.0001, respectively). Moreover, age, bilirubin, albumin, INR, and hemoglobin significantly differed in children with fatal evolution. Function to etiology, PELD, MELD, MELD-Na, and KCC accurately predicted fatal evolution in toxic ALF (25.33 vs. 9.90, p = 0.0032; 37.29 vs. 18.79, p < 0.0001; 34.29 vs. 19.24, p = 0.0002, respectively; with positive predicting value 100%, negative predicting value 88.52%, and accuracy 89.23% for King’s College criteria). The Wilson index for predicting mortality had an excellent predictive strength (100% sensibility and specificity), better than the Nazer prognostic index. Conclusions: Prognostic scores may be used to predict the fatal evolution of ALF in children in correlation with other parameters or criteria. Early estimation of the outcome of ALF is essential, mainly in countries where emergency LT is problematic, as the transfer to a specialized center could be delayed, affecting survival chances.

Backround and aimsHousehold products are one of the most important category responsable for paediatric toxic exposure, especially in children younger then 6 years old. The aims of this study were to analize the epidemiological characteristics of paediatric exposures to packet and nonpacket forms of liquid detergents and to identify the most frequent clinical findings associated with this type of exposures.MethodsWe performed a five year retrospective study between January 1 st, 2012 and December 31 st, 2016 of all cases with liquid detergent poisoning admitted to the Toxicology Department in the Clinical Emergency Hospital for Children „Grigore Alexandrescu ’ from Bucharest.ResultsA total of 231 cases involving liquid detergents were recorded, including 166 cases of laundry liquid detergents and 65 exposures to other types of liquid detergents. The packet forms of laundry detergents were the most commonly identified (131 cases, 56.7%)Boys (131 cases) were more frequently exposed than girls (100 cases). Regarding the age, most patients belonged to the age group 1–5 years (190 cases, 82.25%), followed by patients younger than 1 year (23 de cases, 9.95,%), those aged 6 to 10 years (11 cases, 4.76%) and 11 to 18 years (7 cases,3.03% ). The mean age of the patients exposed was 2.7 years.85.7% of the patients were symptomatic after exposure, clinical manifestations depending on the route of exposure. In case of ingestion, gastrointestinal symptoms were most commonly noted. Vomiting were present in 180 cases (77.9%), causing acute dehydration in 36 cases. Dysphagia was noted in 41 of the analysed cases, abdominal pain in 11 cases and diarrhoea and hematemesis in 2 cases each. Coughing was noted in 25 patient (10.8%), of which 7 were diagnosed with chemical laryngitis and 9 with chemical pneumonia. Dermal exposure was associated to ingestion in 6 patients and determined oral irritation or oral burns and lips oedema.Ocular exposure occurred in 11 patients (4.76%) causing conjunctivitis, keratitis or corneal burns.ConclusionsExposures to packed forms of liquid laundry detergents were much more common than laundry detergents nonpacket or other types of liquid detergents exposures. Clinical manifestations depended on the route of exposure: ingestion, ocular or dermal and the severity of clinical effects ranged between no symptoms to severe form of hematemesis, acute dehydration and chemical pneumonia.