The Effectiveness of Different Eradication Schemes for Pediatric Helicobacter pylori Infection-A Single-Center Comparative Study from Romania.

INTRODUCTION: In Romania, studies on the pediatric population regarding H. pylori infection or bacterial resistance to antibiotics are limited. Eradication treatment of this infection still raises important problems in medical practice. This study aims to compare the effectiveness of three eradication therapies used against H. pylori infection in the pediatric population. METHODS: The prospective study enrolled children aged 6-17 years who were first diagnosed with H. pylori infection. Patients received a randomized treatment either the therapy with clarithromycin (CLR), the therapy with metronidazole (MTZ) or sequential therapy. The effectiveness of the eradication treatment was evaluated after 4-8 weeks from the end of the therapy by testing fecal antigen. RESULTS: 149 patients were enrolled over 18 months. The eradication rates were 49.5% for the treatment scheme with proton pump inhibitor (PPI) + amoxicillin (AMO) + MTZ, 26.7% for PPI + AMO + CLR and 23.8% for sequential therapy. MTZ therapy was superior to CLR therapy, but sequential therapy was not. Side effects were recorded for PPI + AMO + CLR with 39.6%, followed by sequential therapy 37.7%, and only 22.6% for PPI + AMO + MTZ. CONCLUSIONS: Therapy with MTZ can achieve a higher eradication rate as a first-line treatment in the case of H. pylori infection. Taking into account that Romania is in an area with increased resistance to CLR, MTZ therapy could be a promising alternative.

Combining Protein Expression and Molecular Data Improves Mutation Characterization of Dystrophinopathies.

Duchenne and Becker muscular dystrophy are X-linked recessive inherited disorders characterized by progressive weakness due to skeletal muscle degeneration. Different mutations in the DMD gene, which encodes for dystrophin protein, are responsible for these disorders. The aim of our study was to investigate the relationship between type, size, and location of the mutation that occurs in the DMD gene and their effect on dystrophin protein expression in a cohort of 40 male dystrophinopathy patients and nine females, possible carriers. We evaluated the expression of dystrophin by immunofluorescence and immunoblotting. The mutational spectrum of the DMD gene was established by MLPA for large copy number variants, followed by HRM analysis for point mutations and sequencing of samples with an abnormal melting profile. MLPA revealed 30 deletions (75%) and three duplications (7.5%). HRM analysis accounted for seven-point mutations (17.5%). We also report four novel small mutations (c. 8507G>T, c.3021delG, c.9563_9563+1insAGCATGTTTATGATACAGCA, c.7661-60T>A) in DMD gene. Our work shows that the DNA translational open reading frame and the location of the mutation both influence the expression of dystrophin and disease severity phenotype. The proposed algorithm used in this study demonstrates its accuracy for the characterization of dystrophinopathy patients.

Review of the measles epidemic in children from Central Eastern Europe in the third millennium.

Measles is an extremely contagious viral disease. Even though a safe vaccine exists for this disease, it remains one of the leading causes of mortality and morbidity in infants and young children. We aimed to create a retrospective descriptive study in which to analyze the evolution of the measles epidemic at the European level. The documentation was carried out using European Centre for Disease Prevention and Control (ECDC) and World Health Organization (WHO) statistics. At the same time, we present the epidemic's evolution in Romania, using data provided by the Romanian National Institute of Public Health and Ministry of Health. European statistical data indicate a high number of patients diagnosed with measles both among children and adults. All European countries benefit from the measles vaccination in the form of the measles-mumps-rubella (MMR) trivaccine included in their National Vaccination Programme. The vaccination schedule varies from country to country. In the vaccination scheme, most European countries include two doses of the MMR vaccine among the pediatric population. Romania registered a limited number of cases of measles between 1980 and 2015 following the introduction of the measles vaccination in the National Vaccination Programme. Since 2005, the Romanian vaccination schedule includes two doses of MMR trivaccine, administered at 12 months and at 6-7 years. After 2015, as a result of a significant decrease in the number of vaccinated children, Romania is facing a major increase in the cases of measles. Consecutively, a measles epidemic was declared in 2016 and an additional dose of mandatory MMR trivaccine was introduced at the age of 9 months. After 4 years of this schedule of administration, starting with August 2020, the additional dose of MMR administered during infancy has been discontinued. We propose an analysis of the factors that influenced the downward evolution of the measles epidemic in Romania at the beginning of the third millennium. Issues related to the limitation of interpersonal contact in the context of the social distancing imposed by the Sars-CoV-2 virus pandemic are discussed. We consider necessary a detailed documentation of the percentage of new disease cases that will appear in the pediatric population in the near future, in the context of the resumption of daily activity after the reopening of nurseries, kindergartens and schools.

A systematic review of lung function testing in asthmatic young children.

Asthma diagnosis is difficult in young children being mainly based on clinical signs and parents' history, which is sometimes difficult to obtain. Lung function testing may improve asthma diagnosis by objectively assessing its main features, airway obstruction, spontaneously reversible or after use of a bronchodilator drug, ventilation inhomogeneity during an acute bronchoconstriction and airway hyperresponsiveness. In young children that cannot cope with classical tests, it is important to use and develop simple, short lasting methods, made in spontaneous ventilation without active cooperation. Such techniques are a measurement of respiratory resistance by forced oscillations or the interrupter technique, of specific airway resistance by plethysmography and capnography. All these parameters are sensitive to the presence of an airway obstruction and to a bronchodilator or bronchoconstrictor agent, but their cutoff values in differentiating between asthmatic and healthy children as well as their specific indications in asthma management remain to be established.

Asthma Control Assessment in Children: Correlation between Asthma Control Test and Peak Expiratory Flow.

OBJECTIVES: To assess the correlation between asthma control test and peak expiratory flow measurements in children and the impact of certain factors influencing asthma symptoms perception over their correlation. METHODS: A prospective study including 54 patients aged 5 to 18 years old, who have been diagnosed with asthma in "Victor Gomoiu" Children's Clinical Hospital between May 2012-November 2013, was initiated. For each patient a personalized asthma monitoring plan was designed. This presumes many evaluations assigned to assess the asthma control status. These evaluations consist in counting of asthma symptoms using ACT (Asthma Control Test) and evaluation of pulmonary function using PEF measurement (peak expiratory flow) and spirometry. In each patient factors known to have an influence on asthma symptoms perception (small age, overweighting and allergic rhinitis) were searched. Finally, the correlation between ACT value and PEF variation and how this correlation is influenced by these factors were assessed. RESULTS: From all 54 included patients a total of 113 evaluations moments were recorded. The assessment of correlation between ACT score and PEF variation for all evaluations showed a strong correlation overall (p<0.01). The correlation is stronger in the small age group (5 to 6 years: p<0.01) than in the older age group (6 to 11 years: p=0.014, >12 years: p=0.03). ACT does not correlate with PEF variation in the overweight patients subgroup (p=0.226). We found the percent of overweight equal to 8.57% in the small age subgroup (5 to 6 years), 26.78% in the 6 to 11 years old group and 31.81% in the over 12 years old patient group. ACT is correlated with PEF variation in both the allergic rhinitis and non allergic rhinitis subgroups (p<0.01). CONCLUSIONS: ACT is correlated with PEF variation overall. Their correlation is not influenced by small age and the presence of allergic rhinitis, but is influenced by overweighting.

Postinfectious arthritis in pediatric practice.

ABSTRACT: Postinfectious arthritis is a relatively often encountered in pediatric practice. The authors present the most important data concerneing this pathology, with up to date informations exemplifying with case presentations. Clinical cases bring to attention the most common forms of postinfectious arthritis (reactive arthritis, postinfectious arthritis bacterial, viral, spirochete, and so on). Although highly studied and commonly found in current pediatric practice, arthritis occurring after infections remains controversial entities, especially regarding terminology. While, according to some authors, postinfectious arthritis belongs to the large group of reactive arthritis, by other authors, these joint events are independent entities.

The role of ¹³C-methacetin breath test for the non-invasive evaluation of nonalcoholic fatty liver disease.

BACKGROUND & AIMS: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in many parts of the world. The ¹³C-methacetin breath test (MBT), a microsomal liver function test, enables quantitative evaluation of cytochrome P450-dependent liver function involved in NAFLD pathogenesis. The aim of our study was to evaluate the efficacy of MBT in differentiating patients with non-alcoholic steatohepatitis (NASH) from patients with simple steatosis (SS) and its ability to predict significant fibrosis in NAFLD patients. METHODS: We performed MBT in 64 patients with histologically proven NAFLD (ranging from SS to severe steatohepatitis) and in 20 healthy controls. Brunt scoring system for histological evaluation of NAFLD served as a reference. The correlation between MBT parameters and liver biopsy was tested using Spearman's coefficient. The overall validity was measured using the area under the receiver operating characteristic curve (AUROC) with 95%CI. RESULTS: ¹³C-MBT is a good tool for identifying patients with histologically proven NASH, with an AUROC of 0.824, 95% CI (0.723-0.926), a sensitivity of 95% and a specificity of 74%. The diagnosis accuracy of ¹³C-MBT for significant fibrosis (F ≥2) has a validity of 91% (95% CI, AUROC = 0.830-0.989) with higher sensitivity (90%) and specificity (81%). ¹³C-MBT values predicted better F3 or F4 fibrosis (AUROC were 0.936 and 0.973). CONCLUSION: Due to the impairment of microsomal function which occurs in NAFLD, ¹³C-MBT could be a reliable diagnostic and follow-up test for NAFLD patients.