Introduction. Infestation with the roundworm Ascaris lumbricoides is one of the most prevalent helminthic diseases belonging to the soil-transmitted helminths class. Infections are especially affecting children in tropical countries and low and middle-income countries but also may occur in developing countries where sanitation and hygiene are poor. We aim to present a case report to sound the alarm on this widespread pathology. Case presentation. We report the case of a 9-year-old boy with Down syndrome and duodenal stenosis admitted to our hospital with recurrent bouts of pancreatitis secondary to ascariasis. Child is living in poor sanitation conditions. The first episode of pancreatitis was at the age of seven. The abdominal ultrasound shows enlargement and heterogeneity of the head and body of the pancreas, and multiple images of "the strip sign" in the duodenum, suggesting the presence of Ascaris lumbricoides. Live worms were expelled several times. During the next two years, this child was admitted for similar episodes suggesting re-infection with the soil-transmitted helminths, repeated courses of albendazole were administered to the patient and to his close relatives contact. Conclusions. Ascaris lumbricoides infection is rarely a direct cause of mortality, but it contributes to overwhelming morbidity. Periodically repeated de-worming treatment and additional preventive measures such as improvements to water, sanitation and hygiene (WASH) could ensure high rates of eradication.
Objectives. Pediatricians face various challenges in different stages of celiac disease (CD) diagnosis. Whom to test is intensely debated because of CD's heterogenous clinical spectrum. The main purpose of the study was to identify symptoms or symptom associations that should initiate an active strategy of CD early diagnosis in Romanian children. Material and method. We conducted a prospective study in "Grigore Alexandrescu" Emergency Children's Hospital. From March 2013 until February 2014, 249 children with symptoms/signs at risk of CD were included. Results. CD was diagnosed in 11 (1/21 patients evaluated). One in 12.6; 16; 18; 18.5 and 18.5 children respectively with chronic diarrhea, low stature, growth failure, recurrent abdominal pain and constipation had CD. Certain symptom associations increased the risk: classical symptom associations (chronic diarrhea and weight loss), as well as other associations: recurrent abdominal pain and weight loss, constipation and weight loss, constipation and refractory iron deficiency anemia. Conclusion. Active screening among patients with symptoms and especially symptom associations at risk of CD would improve diagnosis rates in pediatric CD.
Obiective. Medicii pediatri întâmpină provocări variate în diferite etape ale diagnosticului de boală celiacă (BC) la copil. Pe cine să testăm este în continuare un subiect disputat din cauza tabloului clinic heterogen. Scopul principal al studiului de faţă a fost de a identifica simptome sau asocieri de simptome care ar trebui să ridice suspiciunea şi să iniţieze demersuri pentru diagnostic precoce de BC la copil. Material şi metodă. Am efectuat un studiu prospectiv în cadrul secţiilor de Pediatrie ale Spitalului "Grigore Alexandrescu", în perioada martie 2013-februarie 2014. Au fost incluşi 249 de copii cu simptome/semne sugestive pentru BC. Rezultate. Au fost diagnosticaţi cu BC 11 pacienţi (1 din 21 de pacienţi evaluaţi). Pentru unul dintre 12,6; 16; 18; respectiv 18,5 dintre copiii cu diaree cronică, hipostatură, deficitul creşterii, dureri abdominale recurente şi constipaţie s-a stabilit diagnosticul de BC. Anumite asocieri de simptome au crescut acest risc: asocieri clasice (diaree cronică şi scădere în greutate), dar şi alte asocieri: dureri abdominale recurente şi scădere în greutate, constipaţie şi scădere în greutate, constipaţie şi anemie persistentă, refractară la tratament. Concluzii. Căutarea activă în rândul pacienţilor cu simptome şi, mai ales, asocieri de simptome la risc de BC ar îmbunătăţi depistarea şi ar creşte frecvenţa cu care este stabilit diagnosticul la copil.
Congenital obstructive Uropathies are a leading cause of Chronic Kidney Disease in children. The gold-standard for renal functional imaging is Diuretic Renal Scintigraphy. Different alternatives to Renal Scintigraphy have been suggested, many of them based on Magnetic Resonance Imaging (MRI). The accurate morphologic details of MRI with its more specific application - MR-Urography are well known. The prospect of adding functional information is very attractive, as it will make the MRU a comprehensive “all in one” examination for obstructive uropathies. We chose to investigate DCE MR urography and DTI as tools for the evaluation of congenital obstructive uropathies. Also, we suggest a different technique that describes the urinary flow in the collecting system – phase contrast imaging of the urinary flow in the renal pelvis. Therefore we performed three different studies, all with different sets of patients.
Objectives – To provide preliminary data on practice of stress perfusion cardiovascular magnetic resonance (CMR) in a single center in Romania. Methods – We retrospectively reviewed the clinical files and CMR reports of patients who underwent stress perfusion CMR in our institution between January 2018 and December 2020. Results – A total of 1036 patients underwent CMR examinations during this period in our institution. Of these, 120 patients had stress perfusion CMR. The most common indication was the assessment of myocardial ischaemia in patients with established coronary artery disease (CAD) (77 patients, 64.16%), with either a history of myocardial infarction or previous coronary revascularization, or with intermediate lesions on invasive coronary angiography (ICA). The other indications consisted in detection of ischaemia in patients with suspected CAD (36 patients, 30%), characterization of the substrate of ventricular arrhythmia (5 patients, 4.16%) and assessment of the etiology of dilated cardiomyopathy (DCM) (4 patients, 3.33%). All patients had vasodilator stress with adenosine and an adequate stress response was obtained in 113 patients (94.16%). There were 21 patients (18.58%) with an abnormal stress test and patients with intermediate lesions on ICA had the highest prevalence of positive reports (24.32%). Sixty-three patients had myocardial fibrosis (52.5%): 49 patients (40.83%) had subendocardial (ischaemic) scars, while 14 patients (11.66%) had non-ischaemic scars. There were no serious adverse events related to the procedure. Conclusions – This is the first report in Romania on the use of stress perfusion CMR in clinical practice. We report our experience on stress efficiency, acquisition protocol, artifacts, prevalence of positive tests and safety. Most stress CMRs were requested in patients with established CAD.
The relation between influenza subtype and age, clinical symptoms, diagnosis, and clinical course was reviewed in hospitalised children in winter season annually since 2005 to 2014 respectively. The diagnosis of influenza was made by rapid diagnostic test kit or PCR test. The clinical features in each type of influenza were evaluated according to respiratory (R: pneumonia), neurological (N; seizure, abnormal behaviour), encephalopathy (E), and other symptoms (O;persistent fever, dehydration, gastroenteritis and others). The differential test for 2009 H1N1 was not performed in 2013-14 season. Results 292 (180 boys, and 112 girls) cases were admitted due to influenza antigen positive disease in this study period. Seasonal type A was 128 (R; 45, N44, E;5, O;33), 2009 H1N1 was 95 (R:55, N;23, E;3, O;14), and type B was 69 (R;27, N;21, E;2, O;19) cases. 2009 H1N1 virus was detected only in2009-10 and 2010-11 seasons. The age distribution (0y/1-5y/6-10y/ 11y-) of these children was 26/64/32/6 in seasonal A, 10/24/40/ 21 in 2009 H1N1, and 1/33/29/6in type B. All children recovered and discharged without major complication. In respiratory disorder, percutaneous Oxygen saturation at admission was lower in 2009 H1N1 (median 88%) than seasonal A (96) or B (98), but total admission period was not longer. Conclusion Rapid diagnostic kit is useful to know the origin of fever when patient should be admitted. The results support to understand the clinical picture of age related symptoms.
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