Background: Atrioventricular septal defect (AVSD) is a cardiac malformation that accounts for up to 5% of total congenital heart disease, occurring with high frequency in people with Down Syndrome (DS). We aimed to establish the surgical challenges and outcome of medical care in different types of AVSD in children with DS compared to those without DS (WDS).Methods: The study included 62 children (31 with DS) with AVSD, evaluated over a 5 year period.Results: Complete AVSD was observed in 49 (79%) children (27 with DS). Six children had partial AVSD (all WDS) and seven had intermediate types of AVSD (4 with DS). Eight children had unbalanced complete AVSD (1 DS). Median age at diagnosis and age at surgical intervention in complete AVSD was not significantly different in children with DS compared to those WDS (7.5 months vs. 8.6). Median age at surgical intervention for partial and transitional AVSDs was 10.5 months for DS and 17.8 months in those without DS. A large number of patients were not operated: 13/31 with DS and 8/31 WDS.Conclusion: The complete form of AVSD was more frequent in DS group, having worse prognosis, while unbalanced AVSD was observed predominantly in the group without DS. Children with DS required special attention due to increased risk of pulmonary hypertension. Late diagnosis was an important risk factor for poor prognosis, in the setting of suboptimal access to cardiac surgery for patients in Romania. Although post-surgery mortality was low, infant mortality before surgery remains high. Increased awareness is needed in order to provide early diagnosis of AVSD and enable optimal surgical treatment.

Background: Urinary tract infections (UTI) are common in children worldwide. Congenital anomalies of kidney and urinary tract (CAKUT) increase the risk of UTI and consequently antibiotic resistance. Antibiotic resistance represents an important public health issue worldwide. We aimed to evaluate the local trend in terms of bacterial uropathogen resistance in the western part of Romania in children with CAKUT and UTI. Methods: 252 children with CAKUT were admitted to our hospital over a five-year period. Of them, 91 developed at least one UTI episode, with a total number of 260 positive urine cultures. We collected data about age at diagnosis of CAKUT, sex, origin environment, type and side of CAKUT, number of UTIs, type of uropathogen, and uropathogens antibiotic resistance. Results: Distribution of uropathogens was Escherichia coli (38.84%), Klebsiella spp. (21.15%), Enterococcus spp. (15.76%), Proteus spp. (8.07%), Pseudomonas spp. (8.07%), Enterobacter spp. (2.3%), other Gram-negative bacteria (2.3%), and other Gram-positive bacteria (3.45%). High antibiotic resistance was detected for ampicillin, amoxicillin, and second-generation cephalosporins. Escherichia coli presented high resistance for cefepime and ceftriaxone. Pseudomonas spp. remained susceptible to amikacin, quinolones, and colistin. Vancomycin, teicoplanin, linezolid, and piperacillin/tazobactam remained effective in treating Gram-positive UTI. Conclusions: High antibiotic resistance was identified for frequently used antibiotics. Lower antibiotic resistance was observed for some broad-spectrum antibiotics. Understanding uropathogens’ antibiotic resistance is important in creating treatment recommendations, based on international guidelines, local resistance patterns, and patient particularities.

Background and aimsAcute accidental poisoning represent o major cause of morbidity and also sometimes mortality among young children and teenagers. In preschool age, poisoning seems to be mainly accidental. The child needs to explore, but also has a specific curiosity which leads to accidental ingestion on unattended pills or different household products. Parasuicidal behaviour or suicidal attempts remain prerogative for teenage period, especially in disorganised families or in case of psycho-affective inappropriate environment for child development.This study aims to alarm for the constantly increasing number of cases of acute accidental poisoning and to identify risk factors.MethodsThe present paper represents a retrospective study of 225 paediatric patients admitted in Emergency Children Hospital ‘Louis Turcanu’ Timisoara between 2013 and 2015 for acute accidental poisoning. We used Microsoft Excel for analysing data.ResultsOf a total of 406 patients admitted on Toxicology Department, more than half (225) were accidental events and mainly non-drug poisonings (67,5%). Accidental/Voluntary poisoning ratio was 1,24:1 with a slightly predominance in boys for accidental poisoning with male : female ratio is 1,27:1. The majority of accidental poisoning cases (58%, 130 cases) occurred in small childhood (under 3 years of age) due to the lack of child surveillance or/and inappropriate use or storage of household products, fuel or unsupervised medication. Carbon monoxide poisoning shows homogenous distribution by age group, while nitrite poisoning is typical for toddler. Analysing environmental origin we showed a mild frequency in rural versus urban environment.ConclusionsAccidental poisonings represent a frequent reason for hospital presentation and/or admission. Risk factors include inappropriate environment, young parents, disorganised families, insufficient child surveillance for small age, curiosity, ADHD behaviour. We support ‘Keep away from child’ sign on each harmful product or medication and awakening parents of accidental harmful poisoning in a carelessness moment.

Human immunodeficiency virus (HIV) is a lentivirus that is transmissible through blood and other body fluids. During the late 1980s and early 1990s, an estimated 10,000 Romanian children were infected with HIV-1 subtype F nosocomially through contaminated needles and untested blood transfusions. Romania was a special case in the global acquired immunodeficiency syndrome (AIDS) pandemic, displaying the largest population of HIV-infected children by parental transmission between 1987–1990. In total, 205 HIV-infected patients from the western part of Romania were analyzed in this retrospective study. Over 70% of them had experienced horizontal transmission from an unknown source, while vertical transmission was identified in only five cases. Most patients had a moderate to severe clinical manifestation of HIV infection, 77.56% had undergone antiretroviral (ARV) treatment, most of them (71.21%) had experienced no adverse reactions and many of those with HIV (90.73%) had an undetectable viral load. Renal impairment was detected in one third of patients (34.63%). Patients born before 1990, male patients, patients diagnosed with HIV before the age of 10, and those undernourished or with renal impairment had a shorter average survival time than the group born after 1990, female patients, patients receiving ARV treatment, patients with a normal body mass index (BMI) and those without renal impairment. Periodical monitoring of the estimated glomerular filtration rate (eGFR) level, as well as the detection of protein excretion, should be taken into consideration worldwide when monitoring HIV-positive patients; this in order to detect even asymptomatic chronic kidney disease (CKD), and to manage these patients and prolong their lives.

or inadequate intake. Children with feeding problems also tended to eat less than children without feeding problems. There was a trend towards more feeding problems in patients with chromosomal abnormalities or other associated anomalies. Conclusion Feeding disorder is often and frequent long-term sequel in children after neonatal or early infancy heart surgery. Patients with chromosomal and associated anomalies and those who underwent multiple cardiac surgeries are at risk of developing feeding difficulties and later feeding disorders. These patients need to be selected for preventive strategies and nutritional intervention should be offered in order to increase the caloric intake of the child and to develop a sound feeding relationship in the family.