The "Viral" Form of Polyarteritis Nodosa (PAN)-A Distinct Entity: A Case Based Review.

Classic polyarteritis nodosa (PAN) is a vasculitis with systemic manifestations that is characterized by inflammatory and necrotizing lesions affecting medium and small muscular arteries, most frequently at the bifurcation of the vessels. These lesions lead to the formation of microaneurysms, hemorrhaging ruptured aneurysms, thrombosis, and, consequently, ischemia or organ infarction. Background and Objectives: We present a complex clinical case of a patient with a late diagnosis of polyarteritis nodosa with multiorgan involvement. Materials and Methods: The 44-year-old patient, in an urban environment, presented on her own in the emergency room for acute ischemia phenomena and forearm and right-hand compartment syndrome, requiring surgical decompression in the Plastic Surgery Clinic. Results: Significant inflammatory syndrome is noted, alongside severe normocytic hypochromic iron deficiency anemia, nitrogen retention syndrome, hyperkalemia, hepatic syndrome, and immunological disturbances: absence of cANCA, pANCA, anti Scl 70 Ac, antinuclear Ac, and anti dDNA Ac, as well as a low C3 fraction of the plasmatic complement system. The morphological aspect described in the right-hand skin biopsy correlated with the clinical data supports the diagnosis of PAN. Conclusions: The viral form of PAN seems to be individualized as a distinct entity, requiring early, aggressive medication.

PEX6 Mutation in a Child with Infantile Refsum Disease-A Case Report and Literature Review.

The aim of this paper is to describe the temporal progression and clinical picture of a 2-year-old child with infantile Refsum disease, as well as the diagnostic procedures performed; this case presented multiple hematologic, metabolic, and developmental complications and progressive disabilities. Genetic testing revealed a mutation of the PEX6 (Peroxisomal Biogenesis Factor 6) gene, and the metabolic profile was consistent with the diagnosis. Particularly, the child also presented altered coagulation factors and developed a spontaneous brain hemorrhage. The clinical picture includes several neurological, ophthalmological, digestive, cutaneous, and endocrine disorders as a result of the very long chain fatty acid accumulation as well as secondary oxidative anomalies. The study of metabolic disorders occurring because of genetic mutations is a subject of core importance in the pathology of children today. The PEX mutations, difficult to identify antepartum, are linked to an array of cell anomalies with severe consequences on the patient's status, afflicting multiple organs and systems. This is the reason for which our case history may be relevant, including a vast number of symptoms, as well as modified biological parameters.

The Significance of Low Magnesium Levels in COVID-19 Patients.

Magnesium is the fourth most common mineral in the human body and the second richest intracellular cation. This element is necessary for many physiological reactions, especially in the cardiovascular and respiratory systems. COVID-19 is an infectious disease caused by SARS-CoV-2. The majority of people who become ill as a result of COVID-19 have mild-to-moderate symptoms and recover without specific treatment. Moreover, there are people who develop severe forms of COVID-19, which require highly specialized medical assistance. Magnesium deficiency may play a role in the pathophysiology of infection with SARS-CoV-2. The primary manifestation of COVID-19 remains respiratory, but the virus can spread to other organs and tissues, complicating the clinical picture and culminating in multiorgan failure. The key mechanisms involved in the disease include direct viral cytotoxicity, endothelial dysfunction, and exaggerated release of inflammatory cytokines. The aim of this review was to summarize the available data regarding the role of magnesium in COVID-19 patients and its particularities in different clinical settings.

The Effects of the COVID-19 Pandemic on Mental Health: A Web-Based Study Among Romanian Adults.

Background In Romania, as in other parts of the world, the family doctor is the first to make contact with a healthy patient and is also the first to notice even the smallest pathological changes. In the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the patient's communication with the family doctor became even closer and some behavioral changes could be easily noticed. Objective To assess the symptoms of anxiety and depression in the Romanian population using social media platforms in the context of the COVID-19 pandemic. Methods We conducted an anonymous, web-based cross-sectional survey consisting of 31 questions related to general characteristics (age, gender, education, inhabitancy, residence, smoking status, and alcohol consumption) and adapted GAD-7 (7-item General Anxiety Disorders questionnaire) and PHQ-9 (9-item Patient Health Questionnaire). This questionnaire was sent to volunteers in an electronic format through a social network (Facebook, Twitter). The data collected were statistically processed using IBM SPSS v25.0 (IBM Corp., Armonk, NY). The inclusion criteria were age over 18 years and no history of chronic disease. The exclusion criteria consisted of the absence of a mental illness diagnosis. Results From the 1254 respondents, 1232 cases were selected for statistical analysis after applying the exclusion criteria. The mean age was 35.94 (SD = 11.4, 95%CI=10.9-11.9) with a minimum of 18 years and a maximum of 97 years. Eighty-four point nine percent (84.9%; N=1046) of all study participants are female and 79.13% (N= 975) live in the urban area. A total of 188 (15.25%) were diagnosed with COVID-19 of which 31 (16.66%) were male and 157 (15%) were female. N=170 (13.8%) reported moderate symptoms of anxiety during the last two weeks before the survey while N=96 (7.8%) had severe anxiety. Twenty-two point two percent (22.2%; N=274) of the participants reported moderate symptoms of depression while 10.1% (N=125) had moderately severe symptoms and 6.6% (N=81) could be diagnosed with severe depression. A greater likelihood of screening for depression diagnosis was associated with ages between 25 and 34 years (OR=0.90, 95%CI=0.86-0.94, P<.001), 35 and 44 years (OR=0.88, 95%CI=0.84-0.93, P<.001), and 45 and 54 years (OR=0.87, 95%CI=0.82-0.92, P<.001). Also, a tendency was observed for women to be more prone to high levels of anxiety (OR=1.21, 95%CI=1.08-1.35, P< .001) and depression (OR=2.16, 95%CI=1.51-308, P< .005). Conclusions Regarding the high prevalence of depression and anxiety, especially in women, appropriate measures for the risk categories should be applied. In the new social context created by the COVID-19 pandemic, screening for psychiatric and psychological disorders should be performed by telemedicine.

[Contributions to the implementation of screening tests for assessing the neuropsychic development in children]. / Contributii la implementarea unui test screening de apreciere a dezvoltarii neuropsihice la copil.

UNLABELLED: Currently, in Romania the general practitioner does not use screening tests to detect the developmental problems in children. That might be the reason why many cases are diagnosed too late. AIM: To evaluate the impact and the usefulness of a screening tool for neurodevelopmental disorders in primary care. MATERIAL AND METHODS: This trans-sequential study was carried out a on a series of 324 children under the age of 5 in the interval January 2007-December 2010. The neurodevelopmental status of the children was assessed by two methods: routine clinical assessment, and ASQ screening tools. RESULTS: Compared to routine assessment, by which 33 children (10,2%) with development delays have been detected, the use of parent-addressed questionnaires raised the detection percentage to 12% (6 more children). The use of parent-addressed questionnaires also improved the doctor-patient communication, increased the degree of parental involvement in their child's development stimulation, especially with regard to the malfunctions in verbal and cognitive behavior. CONCLUSIONS: The use of validated screening tests is a goal for improving the primary care practice.

[Clinical and epidemiologic aspects of overweight and nutritional habits of schoolchildren and teenagers]. / Aspecte clinico-epidemiologice ale excesului ponderal si particularitati nutritionale la copilul si adolescentul de vârsta scolara.

UNLABELLED: Obesity is a complex, pluricausal disease that develops through the interaction of social,'behavioural, cultural, physiological, metabolic and genetical causes. MATERIAL AND METHODS: The study was conducted on 1764 school age children from Iasi city. Data was collected by measuring their weight, height and arterial pressure. 283 children were diagnosed with weight excess and have been questioned about their nutritional habits and life quality. RESULTS: It has been concluded that 50.17% of the children were breastfed in the first months of life. The weight excess was frequently correlated with: irregular meal schedule (57.59%), roast meal cooking (69.61%), eating white bread (77.38%), predilection for fat meat (66.78%), processed cheese and butter (69.25%), french fries (68.19%), everyday dessert (62.89%), highly concentrated sweets (cookies, chocolate) (63.95%), biscuits, snacks, chips (73.85%) and sweet juices (66.42%). Inactivity was also an important factor, often associated with weight excess, considering that 60.42% of the children spend their spare time watching TV or playing computer games and only 32.86% of the children practice sport during their spare time. CONCLUSIONS: Obesity and overweight are pathologies with increasing incidence in our country and they are caused by a combination between genetical factors and, more important, nutritional habits and the amount of time dedicated to physical exercise.

[Correlations between the level of bacterial resistance and the rate of clinical efficiency in the therapy of community-acquired respiratory tract infections]. / Corelatii intre nivelul rezistentei bacteriene si rata de succes clinic in terapia infectiilor de tract respirator comunitare.

The aim of the study is to evaluate the efficiency of the first-line antibiotic treatment of the community-acquired respiratory tract infections in a population of young adults from an urban setting and to establish the pattern of antibiotic resistance of the germs involved. The bacteria most frequently identified have been: S. pneumoniae, H. influenzae, M. catarrhalis, atypical agents also being suspected. Antibiotic treatment has been chosen accordingly to the recent guidelines, total clinical remission rate being of 91.08%, despite the increasing resistance for the commonly used antibiotics; a close monitoring of the phenomenon is mandatory.

[Assessment of complications of excess weight in school-age children and adolescents]. / Evaluarea complicatiilor excesului ponderal la copilul si adolescentul de vârsta scolara.

UNLABELLED: Due to the higher incidence of children obesity, in the last decade, the scientific community as well as mass media have increased their interest towards obesity and eating habits. MATERIAL AND METHOD: The study has been made on a number of 108 pediatric patients with intercurrent affections that has been diagnosed with obesity or weight excess between 2005 and 2008. The evaluation of the pacients has been done with the use of anamnesis, full clinical examination and biochemical investigations. RESULTS: The case repartition based on body mass index has revealed that 46.29% of the pacients have excess weight and 53.70% suffer from obesity. The biochemical alterations have shown the following: regarding the glucidic metabolism--21 cases with impaired basal glycaemia, 5 cases with low glucose tolerance and 2 cases with diabetes mellitus type 1; regarding the lipidic metabolism--39 cases with modifications of triglycerides, of cholesterol fractions or of both categories. Also, we found the X metabolic syndrome in 20 of the studied cases, hyperuricaemia in 13 cases, hepatic steatosis in 10 cases and arterial hypertension in 34 of the cases. Almost half of the interviewed subjects have accused different types of psycho-behaviour changes. CONCLUSIONS: From the investigated complications, the dislipidemic syndrome, arterial hypertension and glucidic metabolism disorders have had an important place and have completed the metabolic syndrome picture in an important number of cases.

[Severe hypoglycemia in children and adolescents suffering from type 1 diabetes mellitus]. / Hipoglicemiile severe la copilul si adolescentul cu diabet zaharat de tip 1.

UNLABELLED: Hypoglycemia is the main fear of diabetic children and their parents. Severe hypoglycemia and diabetes ketoacidosis are medical emergencies that concern a patient's life prognosis. AIM: To determine the rate of occurrence of severe hypoglycemia and identification of the latter's causes. MATERIAL AND METHOD: The study was carried out on a group of 84 children and adolescents suffering from type 1 diabetes, whom were investigated to determine the rate of occurrence of severe hypoglycemia episodes in the last 12 months, to identify their risk factors and to try to establish a relation between the onset of hypoglycemia and certain parameters like age, duration of disease, insulin therapy, metabolic control. RESULTS: 23 of the 84 patients reported at least one severe hypoglycemia in the last 12 months. 47% of the cases of hypoglycemia were caused by the patient's failure to observe the meal timetable, which led to delays in the carbohydrates intake, 19% were due to a high physical effort and 14% by excessive insulin administration. Most of the patients with severe hypoglycemia, that is 20 if 23, were on a multiple insulin injection treatment. As concerns the blood sugar balance, the mean Hb A1c values were between 6.4% and 9.1%, the severe hypoglycemia episodes occurred both in patients with very good metabolic control and in those with poor blood sugar balance. CONCLUSIONS: Severe hypoglycemia occurred in 27.3% of the children and adolescents suffering from type 1 diabetes, the most frequent cause revealed by this study being the delay in the carbohydrates intake. The prevention of this acute metabolic complication by a continuous medical education of diabetic patients is essential.

[Clinical and epidemiologic aspects of attention deficit hyperactivity syndrome (ADHD) in ambulatory practice]. / Aspecte clinice si epidemiologice ale sindromului hiperkinetic cu deficit de atentie (ADHD) în practica de ambulator.

The purpose of the study was to determine the prevalence and to describe the clinical presentations of Attention Deficit Hyperkinetic Syndrome in the pediatric patients of the Outpatient Specialty Clinic of the "Sf. Spiridon" University Hospital of Iasi (a pediatric neuro-psychiatry practice and a general pediatric practice). The studied group consisted of 51 children and adolescents ages 2 years 6 month-18 years of age (urban environment 34 children--66%, rural environment 17 children--34% ; male gender 36 children--70%, female gender 15 children--30%). The pediatric patients represented a prevalence of 1.9% of the Attention Deficit Hyperkinetic Syndrome having the main features: motor and psychological instability, lack of attention, negativism, impulsivity, and social and school integration difficulties. The existence in 40% of cases of family problems (couple pathology, parents with psychiatric disorders, alcoholism, etc) proves the importance of the family patterns description in the apparition and evolution of Attention Deficit Hyperkinetic Syndrome. The study performed underlines the existence of the Attention Deficit Hyperkinetic Syndrome, the necessity of multi-disciplinary intervention with the purpose of precise and on-time diagnosis of this syndrome, to ensure a better integration of these children and teenagers in the social and school environment.

[Headache in children and adolescent in ambulatory practice]. / Cefaleea la copil si adolescent in practica de ambulator.

Headache in children and adolescent represents one of the most frequent and potentially severe pathological conditions, requiring a paediatric consult. The purpose of the study was to establish the headache prevalence from the total paediatric consultations in ambulatory practice as well as to establish the main etiological causes of the headache. The study, including 400 children and adolescents (M/F ratio=150/250, U/R ratio=290/110) with headache selected from 3100 cases between 2003 and 2004, in two practices (one general paediatric office and one paediatric neuropsychiatry office) from the Outpatient Clinic of the "Sf. Spiridon" Hospital of Iasi, has shown a prevalence of headache of 12.9%, the most affected age group being that of 5-12 years (52.5%). The etiologic study proved a high frequency of trauma 46.25%, ophthalmologic diseases 13.28%, psychogenic headache 10.75%, migraine 10%, general causes (infections, anaemia, hypoglycaemia) 9%, ENT causes 6.25%, intracranial causes 0.75%. The study confirms the necessity of a multidisciplinary approach, most causes being benign and the prognosis favourable in most cases.

[Can the child with congenital heart disease have a normal life-style?]. / Copilul cu malformatie congenitala de cord poate avea un stil de viata normal?

Is it possible for the child with Congenital Heart Disease to have an adequate life-style? The life-style of the child mainly depends on the life-style of his/her family. Consecutively, the parents themselves must adopt a healthy life-style to be a good example for their children; on the other side, certain restrictions (hyponatremic regimen, the limitation of the physical activity) must be shared among entire family, the education of the parents being essential. To accomplish this, there must be an interdisciplinary team, including the GP, the cardiologist, the psychotherapist and the physiotherapist. This article discusses the factors influencing the life-style, their dependence on the family social status, on the diagnosis, on the child's age. The psychotherapeutic approach becomes very important at puberty. There is also essential the transition to the adult life, so these children will benefit of maximum of choices in life.

[The study of two immunological markers in patients with type-1 diabetes and in their first degree relatives]. / Studiul a doi markeri imunologici la pacientii cu diabet de tip 1 si la rudele de gradul I ale acestora.

UNLABELLED: The prediction of diabetes mellitus is mostly based on the existence of plasma markers. The aim of this preliminary study was to determine islet cell antibodies (ICA) and glutamic acid decarboxylase antibodies (GADA) in 28 diabetic children (12 of them having an evolutive disease of 1 year and 16 at the beginning of the diabetes) and to 47 of their first-degree relatives. There have been determined the levels of these two autoantibodies using the ELISA technique. RESULTS: To 17 of the patients with type I diabetes have been found high levels of GADA (60.7%) while 8 cases have positive ICA (28.5%). For the patients whose disease was diagnosed 1 year ago there have been found differences between the patients with and without antibodies regarding the level of the average values of Hb A1c, the daily insulin needs and the remission period. From the tested parents (a total of 25), 7 was GADA positive (28%), 6 had both antibodies present (24%) and one mother was ICA positive (4%). 9 of the brothers and sisters of the diabetic patients had high levels of GADA and 2 had both antibodies present. To the first-degree relatives with autoantibodies must be determined other plasma markers too (IAA, IA-2A) as well as genetic markers (HLA typing). CONCLUSION: The use of plasma markers is recommended as a first step in discovering the relatives with potential risk of developing the disease.

[Aspects of the children's candidiasis in outpatient practice]. / Aspecte ale candidozelor la copil în practica de ambulator.

Candidiasis are conditions caused by fungi from Candida genus. The most frequently involved in humans pathology is Candida albicans, which, even if is in balance with endogenous bacterial flora, became pathogenic in certain conditions. The hereby study aims to evaluate retrospectively on a period of 5 years (1999-2003), an group of 101,000 children aged 14 days-18 years, the prevalence of candidiasis, the clinical aspects determined in pediatric population diagnosed and treated in the paediatric offices of the outpatient clinic of "Sf. Spiridon" Hospital, as well as the risk factors of these diseases. From 3806 positive samples for Candida, 2650 (69%) have presented signs of pathogenicity of a significant intensity of colonization. 65% of samples have been observed in female gender, 35% in male gender, 58% of cases from urban areas, 42% from rural environment. The concordance of the lab results having significant values with the manifest clinical symptoms was 85% for the nasal and pharyngeal exudates; 93% for the examination of the stools and 95% for vaginal secretions. The most frequent clinical aspects were oropharyngeal candidiasis (39%), mycotic esopharyngitis (0.4%), enterocolitis (15%), mycotic colitis (22%), vulvovaginitis (25%). The most frequent risk factors for the appearance of candidiasis have been repeated or prolonged antibiotic treatments (90% of cases), diabetes mellitus (0.3% cases), steroid therapy (0.2% cases), deficient hygiene (5% cases), diet rich in carbohydrates (9%). This study confirm that Candida albicans can become pathogenic producing signs and symptoms of disease in certain conditions, the most important factor being prolonged or repeated antibiotic treatment.

[Clinical aspects of hypertension in children with aortic coarctation]. / Aspecte ale hipertensiunii arteriale în coarctatia de aorta la vârsta copilariei.

UNLABELLED: Our study is focused on blood pressure before and after repair of aortic coarctation in childhood. METHODS: A group of 26 children (13 boys, 13 girls, range 1-18 years, of which 12 operated: 9 boys and 3 girls) was studied, blood pressure being followed before and after operation. The recorded blood pressure was compared to normal values for age and height. RESULTS: Before the surgical treatment blood pressure being above normal in all cases, the figures were: "high normal"--6 cases, significant--8 cases and severe hypertension--12 cases. After surgery: 75% normal blood pressure, 25% hypertension (variable degrees). CONCLUSION: Hypertension in aortic coarctation varies from "high normal" to severe. Hypertension got worse during pregnancy in an unoperated girl. In most of children, blood pressure decreased after surgical treatment, being normal in 75% of all cases, in one year after surgery. Persistence of a severe hypertension after surgery signifies presence of an underlying lesion unrecognised yet.

[Abnormal positions of the heart. An analysis on 1039 cases]. / Anomalii de pozitie ale inimii. O analiza pe 1039 cazuri.

The aim was to study the impact of the cardiac malpositions into the group of the 1039 congenital heart diseases registered in the Pediatric Outpatient Department of "Sf. Spiridon" hospital. All patients were investigated noninvasively using clinical examination, electrocardiogram, routine Roentgenogram, two-dimensional and Doppler echocardiography, abdominal echography and, only in two cases, cardiac catheterisation. 23 (2.21%) from 1039 congenital heart diseases registered were cardiac malpositions: dextroposition--3 cases (13.04%), dextrocardia--7 cases (30.43%) and situs inversus--13 cases (56.52%). Most of the children were boys (65.21%), 70% from all cases coming from urban area. Only 3 children had structural cardiac anomalies: two cases with dextrocardia (one with atrial septal defect and one with atrioventricular canal) and one with situs inversus and tetralogy of Fallot, two of them suffering surgical correction. Psychological impact was the main problem of these children, especially during the adolescence, except the two cases with structural cardiac abnormalities who needed following and surgical treatment.

[Early detection of diabetic nephropathy in children and teenagers with type I diabetes]. / Depistarea precoce a nefropatiei diabetice la copilul si adolescentul cu diabet de tip.

Microalbuminuria (MA) is a noninvasive marker which has to be effected for all the patients in order to watch the appearance of the kidney disease. The aim of this study was the identification of the MA and of its associated factors within a lot of 110 children and teenagers suffering from type 1 diabetes mellitus. Persistent MA (the incipient diabetic nephropathy) was detected in the case of 10 patients (9%) and the intermittent one at 13 of them (11.8%). In all the cases, a poor glycemic control was associated, the average of the Hb A1c being higher than 10%. The progression of MA was associated with high blood-pressure values in the case of 2 patients and other chronic complications were present at 15 of them. In conclusion, we detected MA in 20.8% of the patients and its prevalence was significantly associated with poor glycemic control.

[Atrio-ventricular canal: possibilities of recovery]. / Canal atrio-ventricular comun. Posibilitati de recuperare.

UNLABELLED: The evolution and prognosis of the atrioventricular canal (AVC) depend very much on the clinical type of the disease and its recovery is sometimes an extremely difficult problem. METHODS: The evolution of the 24 cases with atrioventricular canal (10 boys and 14 girls), registered in the files of pediatric cardiology consulting room from the Outpatient Department of the "Sf. Spiridon" Hospital from Iasi, has been studied. According to the state of the patients and, especially, with the parents' permission, these children were sent to Cardiovascular Surgery, for corrective surgical treatment. Before that, they had received a medical treatment for the cardiac failure (digitals, diuretics) and for the pulmonary hypertension (beta-adrenergic blockers, renin angiotensin inhibitors) and they continued this treatment for 1-2 years after the surgical correction. RESULTS AND DISCUSSIONS: This sample included: 9 cases with AVC-complete type; 1 case with AVC-intermediate type; 14 cases with AVC-partial type (13 cases with atrial septal defect-ostium primum + mitral valve cleft and 1 case with left ventricle to right atrium type IIa communication). Only 7 of the 10 children with AVC partial type were surgically corrected, and in all cases the evolution was positive. Three of the nine cases with AVC complete type were investigated in Cardiovascular Surgery in our country, all of them considered without surgical solution. For one of the cases with AVC--complete type and pulmonary stenosis, considered also without surgical solution, a palliative systemic-to-pulmonary artery shunt was made, for the improvement of the pulmonary circulation. CONCLUSIONS: 1. AVC partial type could be recovered in the best conditions in the clinics of cardiovascular surgery in our country. 2. AVC--complete type didn't have, in our cases, surgical solution, either in our country or abroad. 3. For the special situation of the AVC complete type with pulmonary stenosis, the only treatment possible was palliative, performed to increase the pulmonary artery blood flow.

[Recurrent abdominal pain and genital diseases in young girls]. / Relatia dintre durerile abdominale recurente si afectiunile genitale la fete--studiu clinic.

Recurrent abdominal pain represents one of the most frequent syndrome met in pediatrics pathology at all ages, sometimes raising difficulties in establishing the diagnosis. One of the most frequent causes of recurrent abdominal pain is the genital disease at young girls. A retrospective study realized on a 10,000 girls lot, consulted in pediatrics offices from St. Spiridon Hospital of Iasi, between 1999-2001, emphasized the presence of recurrent abdominal pain and genital pathology at 300 young girls, that is 25% of the cases with genital diseases and 12% of the cases recurrent abdominal pain. Genital pathology means represented by: dysmenorrhea in 36% of cases, pelvic inflammatory disease in 26.67% of cases, functional ovarian cyst in 6% of cases, ovarian tumors in 0.33% of cases, ectopic pregnancy in 0.33% of cases, vulvovaginitis in 27.67% of cases. The most affected age was 13-16. The study of those diseases related to a genital pain diagnosed as responsible, ethiologically, for the recurrent painful abdomen, confirmed the existence of a very tight correlation between the genital pathology and the general one.