Brachial and subclavian arteries aneurysms due to tuberous sclerosis complex mechanisms - case report and literature review.

INTRODUCTION: Tuberous sclerosis complex (TSC) is a rare autosomal dominant condition characterized by cutaneous, cerebral, and other multiorgan involvement. Aneurysms due to TSC pathogenic mechanism are rarely present, mainly aortic, renal, or intracranial and very few associated with peripheral circulation. A TSC patient, aged 31 years, who developed brachial and subclavian arteries aneurysms is presented. The question of a random association of the aneurysms with TSC versus aneurysms within pathogenic released mammalian target of rapamycin (mTOR) pathway effect was raised. CASE PRESENTATION: Patient's file, available from the age of six months, was analyzed for demonstration of the TSC diagnosis. Patient was examined, and cerebral magnetic resonance imaging (MRI) was repeated. Surgery and angiographic reports and images were reviewed. Pathology of the aneurysmal wall available from surgery was reexamined and special stainings and immunohistochemistry markers were applied. Genetic characterization of the patient was performed. Definite TSC was diagnosed based on major criteria [ungual fibromas, shagreen patch, cortical tubers, subependymal nodules (SENs), subependymal giant cell astrocytoma (SEGA)], minor criteria (confetti skin lesions, dental enamel pits, gingival fibromas), genetic result showing heterozygous variant in exon 8 of TSC1 gene (c.733C>T-p.Arg245*). Pathology analysis revealed markedly thickened aneurysmal wall due to smooth muscle cells (SMCs) proliferation in media and neoformation vessels with similar characteristics in the aneurysmal wall. DISCUSSIONS AND CONCLUSIONS: This is a rare case with aneurysms related to TSC, with an exceptional peripheral localization. Pathology exam is the key investigation in demonstrating the TSC-related pathogenic mechanism. A literature review showed 73 TSC cases presenting aneurysms published until now.

Perinatal Exposure to HIV Infection: The Experience of Craiova Regional Centre, Romania.

BACKGROUND AND OBJECTIVES: HIV infection in pregnant women can be responsible for a number of consequences during pregnancy, such as: maternal anaemia, miscarriage, low birth weight, and preterm birth. The objectives of this study were to determine the maternal-foetal transmission rate of HIV among pregnant women living with HIV from Craiova Regional Centre in order to assess the risk factors for mother-to-child transmission of HIV and to identify the characteristics of newborns perinatally exposed to HIV. MATERIALS AND METHODS: A retrospective study was conducted between 1 January 2011 and 31 December 2020, including children born to HIV-positive mothers. RESULTS: The studied group included 138 newborns and was divided into two subgroups: group A, which included 10 HIV-infected infants; and group B, which included 128 uninfected infants. The mother-to-child transmission rate was 3.5% for women to whom all prophylaxis standards were applied. We found a statistically significant correlation between the level of maternal HIV viremia and perinatal HIV transmission (p = 0.01). Preterm birth and low birth weight were associated with perinatal transmission of the infection. CONCLUSIONS: Perinatal transmission of HIV infection during our study was associated with inconsistent application of screening for HIV infection among pregnant women, lack of antiretroviral therapy, poor adherence to treatment, and detectable HIV viral load during pregnancy.

Electrochemical monitoring of bronchial inflammation in pediatric athletes: A prospective study.

The assessment of inflammation by accessible, reproducible and especially non-invasive methods is one of the main goals for numerous medical specialties. One variable for assessment is the fraction of nitric oxide in exhaled air (FeNO), which correlates with the inflammatory syndrome of the airways. The objective of the present study was the biochemical evaluation of FeNO in children practicing sports in Oltenia, Romania. Between January and December 2018, children practicing sports (football, track and field, judo, fencing, handball, volleyball and basketball) were enrolled in the study. The FeNO values were compared with the asthma history and with the spirometric evaluation. A total of 23 children without a previous asthma diagnosis exhibited positive spirometry results. The prevalence of the disease was 3.6% in the cohort, and FeNO dosing showed higher values in the group at risk in children diagnosed with asthma, compared with that in children without this diagnosis. The children who performed outdoor sports (soccer, and track and field) had higher electrochemical levels of nitric oxide compared with those who performed indoor sports (mean, 29.70 vs. 20.56; P<0.0005), which led to the hypothesis that these children had an increased risk of developing bronchospasm. FeNO dosing can thus be a useful and easy-to-use tool in practice for assessing bronchial inflammation in children practicing various types of sports. The spirometric data of undiagnosed asthma patients from the present study may indicate that the disease is still underdiagnosed within Romania.

Status thymicolymphaticus: real or fake?

Sudden infant death syndrome (SIDS) is the sudden, unexpected death of an infant less than one year of age that remains unexplained after a full investigation. SIDS is the most frequent cause of death of infants between two weeks and one year of age, explaining 35% to 55% of all deaths in this age group. We report a newborn male who died soon after birth. The newborn was cyanotic, bradycardic at first, and then asystolic; without any vesicular murmur, apneic, low amplitude thorax movements, even under conditions of positive pressure ventilation on the endotracheal tube. The microscopic aspect thymus highlighted a corticomedullary ratio quite high in favor of the cortical, rich in lymphocyte population, with the dilated subcapsular sinuses. In this report, we considered that cardiorespiratory failure, which was the immediate cause of death, could have been caused by the thymus hypertrophy. This hypertrophy can be a complication of an intrapartum preexistent condition, most probably of hepatic nature.

Aspiration pneumonia in an infant with neurological sequelae - case report.

Aspiration pneumonia is a frequent cause of morbidity and mortality in children with neurological deficits. We present the case of a 4-month-old infant from the Foster Care Center, with severe psychomotor retardation, blindness, and associated cardiac malformation, who was admitted to the Pediatrics Clinic of the Emergency County Hospital of Craiova, Romania, presenting aspiration pneumonia and moderate respiratory insufficiency. Under sustained, early instituted treatment, the evolution was towards death. The chest radiography and histopathological examination of the pulmonary tissue confirmed the diagnosis. The neurological impairment was not only a favoring factor for aspiration, through the deglutition disorders, but it was also an aggravating one, through the bacterial colonization of the lungs.

Brain abscess of unknown etiology in a 2-year-old child: a case report.

We present a case of brain abscess necroptically discovered in a 2-year-old child hospitalized in the Pediatrics Clinic of the "Filantropia" Municipal Hospital, Craiova, Romania. The family, with a poor financial situation, reports previous episodes that may be interpreted as comitial crises. Clinically speaking, he presents a height-weight hypertrophia, vitamin D loss rickets, and psychomotor retardation. At the objective examination, we found a weight of 10 500 g (!), second and third degree mesocardiac systolic beat and cardiomegaly in the thorax-cardiac-pulmonary X-ray examination. Despite the intensive treatment, death occurs few hours after hospitalization. During the autopsy, there is observed a partial dehiscence of the cranial arch sutures, with a 6/5 cm ovalary cavity in the parietal lobe, containing approximately 200 mL of yellow-green serous liquid, with uneven walls, but with no hemorrhagic or puss infiltrates. The heart is enlarged (in comparison to the general somatic development) of 9/7/4 cm, without any cardiac malformations. The microscopic examination showed degenerative neuronal and ischemic lesions on the left-brain hemisphere. Comparing to the data from specialty literature, we consider it as a yellow brain softening (according to Rokitansky's classification), most probably of an embolic cause.

Inflamed molluscum contagiosum in a 6-year-old boy: a case report.

The precise prevalence of molluscum contagiosum (MC) is still unknown. The pediatric studies showed a cumulative incidence of 17% in children less than 15 years, but there are no studies available for Romania. The papular skin lesions are generally less than 5 mm, but the immunocompromised patients may develop large uncommon lesions. The pediatric cases are located mostly on the limbs, trunk or the face. The lab investigations are not usually required because the clinical features are typical. A biopsy followed by a light microscopy may help in some cases. We are presenting the case of a 6-year-old boy suffering from MC since almost a year. When examined in our clinic, the child developed 2 to 4 mm dome-shaped flesh-colored papules with central umbilication on his trunk diagnosed as MC. The microscopic examination revealed bud-like proliferation of the epidermis, molluscum bodies and moderate chronic inflammation of the dermis. In about one month of treatment, all the lesions disappeared without other local or general complications.

Meckel's diverticulum in children, clinical and pathological aspects.

Meckel's diverticulum (MD) represents one of the most common malformations of the digestive tract, being a vestige of the proximal end of omphalo-mesenteric duct, which normally obliterates and atrophiates between the sixth and ninth week of intrauterine life. It is estimated that 2-4% of people are carriers of this malformation. The interest in this organ study lies in the fact that it presents its own non-specific pathology, mimicking a cecal, colon or small intestine pathology. It seems that most MD cases are asymptomatic (AS MD), being arbitrary discovered during surgeries, whereas only a small part are being symptomatic (S MD). MD may be clinically expressed at any age but it is more common in children. In our study, we evaluated a group of 44 children, aged between 0 and 16 years, diagnosed with AS MD (15 cases) or S MD (29 cases). Of the 29 S MD cases, 14 had intestinal obstruction, seven cases showed lower gastrointestinal bleeding, five cases presented acute inflammation (diverticulitis) and three cases were complicated with peritonitis; 15 cases of AS MD were discovered during surgical interventions for acute appendicitis (14 cases) or inguinal hernia (one case). Most cases of MD were recorded between 1-4-year-old and 7-16-year-old.

Vertical transmission of HIV/TB in newborns: a case report.

We are presenting the case of a 19-day-old newborn with HIV-seropositive mother, under antiretroviral treatment since birth, who is admitted in the ICU (Intensive Care Unit) of the 1st Pediatric Clinic at the Emergency County University Hospital in Craiova, Romania, in critical general condition, with severe respiratory insufficiency. The examination of the tracheal and bronchial secretion revealed positive BK (bacillus of Koch). We considered it was an HIV/TB co-infection, the tuberculostatic treatment was instituted, but the evolution was towards exitus in the 11th day after admission.