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Cristina Oana Mărginean

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Articole semnate de acelasi autor in Revista Romana de Pediatrie:

GASTROENTERITA ACUTA CU CLOSTRIDIUM DIFFICILE LA UN COPIL MIC CU INTOLERANTA EREDITARA LA LACTOZA

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Revista Romana de PEDIATRIE | Volumul LXV, Nr. 2, An 2016
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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GASTROENTERITA ACUTA CU CLOSTRIDIUM DIFFICILE LA UN COPIL MIC CU INTOLERANTA EREDITARA LA LACTOZA

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REZUMAT

Acute gastroenteritis with Clostridium difficile is insufficiently studied in the specialty literature due to its small incidence at this age, with increased rates of morbidity and mortality. We present the case of a 1 year and 10 month-old child, diagnosed with hereditary lactose intolerance in the neonatal period, admitted in the Pediatrics Clinic I, Targu-Mures, for vomiting, loss of appetite, decreased consistency stools, with a bed smell, with bacterial infection signs in the blood tests and slowly favorable evolution under treatment with cephalosporin. The patient is readmitted after 1 day from discharge with the reappearance of bad smell stools and loss of appetite, with unfavorable evolution after administering a 3rd generation cephalosporin, thus we raise the suspicion of infection with Clostridium difficile, confirmed by the identification of toxins in the stools, with favorable evolution under treatment for anaerobe germs (metronidazole). The particularity of the case consists in the development of a gastroenteritis with Clostridium difficile in a small child (1 year and 10 months), known with retardation in the neuro-psychomotor and language development, repeated episodes of hypoglycemia, with hereditary lactose intolerance which represented a challenge in establishing the diagnosis.

Cuvinte cheie: Clostridium difficile, child, gastroenteritis, hereditary lactose intolerance

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ACUTE GASTROENTERITIS WITH CLOSTRIDIUM DIFFICILE IN A SMALL CHILD WITH HEREDITARY LACTOSE INTOLERANCE

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Revista Romana de PEDIATRIE | Volumul LXV, Nr. 2, An 2016
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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HIGHLIGHTS

National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

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ACUTE GASTROENTERITIS WITH CLOSTRIDIUM DIFFICILE IN A SMALL CHILD WITH HEREDITARY LACTOSE INTOLERANCE

, , , and

ABSTRACT

Acute gastroenteritis with Clostridium difficile is insufficiently studied in the specialty literature due to its small incidence at this age, with increased rates of morbidity and mortality. We present the case of a 1 year and 10 month-old child, diagnosed with hereditary lactose intolerance in the neonatal period, admitted in the Pediatrics Clinic I, Targu-Mures, for vomiting, loss of appetite, decreased consistency stools, with a bed smell, with bacterial infection signs in the blood tests and slowly favorable evolution under treatment with cephalosporin. The patient is readmitted after 1 day from discharge with the reappearance of bad smell stools and loss of appetite, with unfavorable evolution after administering a 3rd generation cephalosporin, thus we raise the suspicion of infection with Clostridium difficile, confirmed by the identification of toxins in the stools, with favorable evolution under treatment for anaerobe germs (metronidazole). The particularity of the case consists in the development of a gastroenteritis with Clostridium difficile in a small child (1 year and 10 months), known with retardation in the neuro-psychomotor and language development, repeated episodes of hypoglycemia, with hereditary lactose intolerance which represented a challenge in establishing the diagnosis.

Keywords: Clostridium difficile, child, gastroenteritis, hereditary lactose intolerance

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EVALUAREA TROMBOCITOZEI REACTIVE POSTSPLENECTOMIE LA PACIENTUL PEDIATRIC

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Revista Romana de PEDIATRIE | Volumul LXV, Nr. 2, An 2016
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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EVALUAREA TROMBOCITOZEI REACTIVE POSTSPLENECTOMIE LA PACIENTUL PEDIATRIC

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REZUMAT

Trombocitoza reprezintă creşterea numărului de trombocite peste 500.000/mm³.
Obiectiv. Obiectivul acestui studiu este de a evalua frecvenţa şi severitatea trombocitozei reactive la pacienţii pediatrici splenectomizaţi.
Material şi metodă. Am realizat un studiu retrospectiv în care au fost incluşi 20 de pacienţi (4-16 ani) care au suferit o intervenţie de splenectomie în intervalul 2006-2015. Criteriile de includere în studiu au fost: pacienţi cu vârsta sub 18 ani, care au fost splenectomizaţi şi care au dezvoltat trombocitoză ulterior intervenţiei.
Rezultate. În lotul studiat, 80% dintre pacienţii splenectomizaţi (16) au dezvoltat o formă de trombocitoză; în 4 cazuri formă severă (trombocite > 1milion/mm3), iar în 7 cazuri formă uşoară. Nu s-au observat diferenţe semnificative în repartiţia pe sexe a pacienţilor (9 de sex feminin şi 11 de sex masculin). La 13 dintre pacienţi trombocitoza s-a remis după 30 de zile şi doar în 3 dintre cazuri episodul a durat >360 de zile. Fenomene trombotice s-au observat la un singur pacient din lotul studiat. Toţi pacienţii au beneficiat de măsuri de tromboprofilaxie şi hidratare, iar 2 cazuri au necesitat asociere terapeutică de Hidoxiuree.
Concluzii. Studiul nostru relevă o frecvenţă crescută a trombocitozei după splenectomie (80%), cu un vârf maxim de incidenţă la 2-10 zile postchirurgical, trombocitoza fiind în general benignă şi cu remisie spontană; evenimente trombotice s-au semnalat într-un singur caz, iar trombocitoza severă a fost mai frecventă după splenectomia de cauză traumatică.

Cuvinte cheie: trombocitoză, splenectomie, copil

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TROMBOCYTOSIS FOLLOWING SPLENECTOMY IN PEDIATRIC PATIENTS

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Revista Romana de PEDIATRIE | Volumul LXV, Nr. 2, An 2016
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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National Awards “Science and Research”

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ICMJE- Recommendations

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Promoting Global Health

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TROMBOCYTOSIS FOLLOWING SPLENECTOMY IN PEDIATRIC PATIENTS

, , , , , , , and

ABSTRACT

Thrombocytosis represents a platelet count over 500.000/mm³.
Objective. The aim of this study is to evaluate the frequency and gravity of reactive thrombocytosis in pediatric patients who underwent splenectomy.
Material and method. We performed a retrospective study including 20 patients (4-16 years old) who underwent splenectomy between 2006-2015. The inclusion criteria in the study were: patients with the age under 18 years, who underwent splenectomy independently by the cause, and who developed afterwards thrombocytosis.
Results. In the studied group 64% of the splenectomised patients (16) developed a form of thrombocytosis. In 4 cases – severe form (Platelets > 1 million/mm3) and in 7 cases a mild form. There were not noticed any significant differences regarding the gender repartition of the patients (9 were females, and 11 were males). In 13 patients, thrombocytosis disappeared after 30 days, and only in 3 cases, the episode lasted more than 360 days. Thrombotic phenomena were noticed only in one patient from our study group. All the patients benefited from thromboprophylaxis and hydration measures, and 2 cases needed associated treatment with Hydroxyurea.
Conclusions. Our study reveals an increased frequency of thrombocytosis after splenectomy (80%), with a maximum peak of incidence in 2-10 days following the intervention, thrombocytosis being generally benign and self-limited; still one of the cases experienced thrombotic complications and severe thrombocytosis was more frequent after post-traumatic splenectomy.

Keywords: thrombocytosis, splenectomy, child

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Recent acquisitions in imaging diagnosis of digestive disorders in children

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 1, An 2012
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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National Awards “Science and Research”

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ICMJE- Recommendations

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Promoting Global Health

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Recent acquisitions in imaging diagnosis of digestive disorders in children

, , , and

REZUMAT

Elastography is a new imaging method based on ultrasounds, which allows the assessment of the tissues structure in terms of their stiffness, being useful in the exploration of different organs and systems, having more and more clinical applications. The development of the contrast agents of second generation led to the amplification of the ultrasound signals using the microbubbles, which can not cross the vascular wall and are eliminated through exhalation within 15 minutes.

Material and methods. We present the results of a prospective study conducted in our Clinic, assessing the performance of the ARFI method (”Acustic Radiation Force Imaging”) in the assessment of the liver elasticity in children and we present some pediatric cases in which the ultrasound with contrast has brought real benefits, making it easier to diagnose and facilitate optimal therapeutic decisions.

Key words: imagistic diagnosis, elastography, contrast, digestive, child

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ACHIZITII RECENTE IN DIAGNOSTICUL IMAGISTIC AL BOLILOR DIGESTIVE LA COPIL

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 1, An 2012
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

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Promoting Global Health

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ACHIZITII RECENTE IN DIAGNOSTICUL IMAGISTIC AL BOLILOR DIGESTIVE LA COPIL

, , , and

REZUMAT

Elastografia este o nouă metodă imagistică bazată pe ultrasunete, care permite evaluarea structurii ţesuturilor în ceea ce priveşte rigiditatea lor, fiind utilă în explorarea diferitelor organe şi sisteme şi cu tot mai multe aplicaţii clinice. Dezvoltarea substanţelor de contrast de generaţia a doua a dus la amplificarea semnalului ecografic cu ajutorul microbulelor, care nu pot străbate peretele vascular şi care se elimină prin exhalare în 15 minute.

Material şi metode. Prezentăm rezultatele unui studiu prospectiv derulat în clinica noastră, evaluând performanţele metodei ARFI (impulsul de difuzie a forţei acustice) în evaluarea elasticităţii ficatului la copii; prezentăm şi câteva cazuri pediatrice în care ecografia cu contrast a adus reale beneficii, uşurând diagnosticul şi facilitând luarea deciziilor terapeutice optime.

Cuvinte cheie: diagnostic imagistic, elastografie, contrast, digestiv, copil

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A case of Stevens Johnson syndrome in child

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 2, An 2012
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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National Awards “Science and Research”

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Promoting Global Health

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A case of Stevens Johnson syndrome in child

, , , and

ABSTRACT

We present a 9-year-old boy with epilepsy refractory to previous treatment diagnosed with Stevens Johnson syndrome appeared after the introduction of Lamictal in treatment. The boy had fever, polymorphous exanthema, papulopustular erythematous, bullous generalized vesiculobullous elements and skin denudation, conjunctivitis, mouth lesions. We have interpreted the associated pneumonia as a damage of a lower respiratory tract mucous membranes within Stevens Johnson syndrome. The evolution of the disease was favourable after high doses of Ig IV (intravenous immunoglobulin). In conclusion, even if the Steven Johnson syndrome incidence is low in children, pediatricians should be aware of the possibility of its reggresion (even after antiepileptics - Lamictal), and even if the use of Ig IV is controversial, it leads to healing when is given in high doses.

Key words: Stevens Johnson syndrome, child, epilepsy, Lamotrigine (Lamictal)

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UN CAZ DE SINDROM STEVENS JOHNSON LA COPIL

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 2, An 2012
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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National Awards “Science and Research”

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UN CAZ DE SINDROM STEVENS JOHNSON LA COPIL

, , , and

REZUMAT

Prezentăm cazul unui băiat de 9 ani cu epilepsie refractară la tratamentul anterior, diagnosticat cu sindrom Stevens Johnson apărut după introducerea în tratament a Lamictalului. Băiatul a prezentat febră, exantem polimorf maculo-papulo-eritematos, cu elemente veziculo buloase generalizate şi denudare tegumentară, conjunctivită, leziuni bucale. Pneumonia asociata am interpretat-o ca afectare a mucoasei tractului respirator inferior din cadrul sindromului Stevens Johnson. Evoluţia bolii a fost favorabilă după doze mari de imunoglobuline intravenos. În concluzie, deşi incidenţa sindromului Steven Johnson este mică la copil, pediatrii trebuie să fie conştienţi de posibilitatea apariţiei ei (chiar după antiepileptice – Lamictal), iar utilizarea imunoglobulinelor IV, deşi controversată, administrată în doze mari pare că duce la vindecarea bolii.

Cuvinte cheie: Sindrom Stevens Johnson, copil, epilepsie, Lamotrigin (Lamictal)

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Maple urine syrup disease – two cases presentations

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 4, An 2012
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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Promoting Global Health

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Maple urine syrup disease – two cases presentations

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ABSTRACT

Maple urine syrup disease (MSUD) is part of a heterogenous group of inborn errors of metabolism.

The aim of the paper was to present 2 cases of MSUD diagnosed in our clinic, their evolution and response to treatment.

Patients and method. The diagnosis was documented by determining serum and urinary aminoacids. Each case was examined and evaluated in dynamics in terms of clinical, laboratory, treatment and evolution.

Results. The MSUD onset-age in the first case was in the 5th-6h days and 3rd week for the second case (both were breastfed). The onset of clinical manifestations: lethargy, apathy, adinamy(first case), drowsiness, capping the eyes, hypotonia(second case); capricious appetite/eating disorders in both cases, intercurrent symptoms (cough, rhynorrhea in the second case, probably urosepsis in the first case).

Evolution: the first case who had a severe type: associated drowsiness, generalized weakness, sometimes alternating with bouts of tonic contractions/rigidity, tendency to opistotonus, changes in reflexes, trismus, needing mechanical ventilation and ultimately death; the second case (a milder type) had a favorable evolution dependent on hygienic-dietary and drug-treatment.

Conclusions. Since postnatal infants are apparently clinically healthy, there are no genotype-phenotype correlation, in many countries it has been added in the neonatal screening of metabolic diseases. Early diagnosis, along with specific treatment can prevent complications allowing a normal intellectual development of children with such defects.

Key words: maple urine syrup disease (MSUD), metabolic disease, child

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BOALA URINILOR CU MIROS DE SIROP DE ARTAR – DOUA PREZENTARI DE CAZ

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 4, An 2012
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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National Awards “Science and Research”

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BOALA URINILOR CU MIROS DE SIROP DE ARTAR – DOUA PREZENTARI DE CAZ

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REZUMAT

Boala urinilor cu miros de sirop de arţar face parte dintr-un grup heterogen de afecţiuni, respectiv erorile înnăscute de metabolism. Scopul lucrării. Ne propunem să prezentăm 2 cazuri diagnosticate în clinica noastră, urmărirea evoluţiei şi a răspunsului la tratament.

Material şi metodă. Diagnosticul s-a documentat prin determinarea amino-acizilor serici şi urinari. Fiecare caz a fost analizat, urmărindu-se în dinamică datele anamnestice, examenul clinic, examinări paraclinice şi de laborator, scheme terapeutice, evoluţie.

Rezultate. Vârsta la debutul tipic în primul caz, adică în zilele 5-6 de viaţă, şi la 3 săptămâni de viaţă la al doilea caz (deşi în ambele cazuri alimentaţia era naturală).

Manifestările clinice la debut. Tabloul neurologic: letargie, apatie, adinamie (primul caz), somnolenţă, plafonarea privirii, hipotonie (cazul 2); apetit capricios/ tulburări de alimentaţie (acumularea AA şi a metaboliţilor acestora), în ambele cazuri; simptomatologia intercurenţei (tuse, rinoree la cazul 2; probabil ITU/ urosepsis în primul caz).

Evoluţie. Primul caz, prezentând o formă severă asociază somnolenţă, hipotonie generalizată, uneori alternând cu crize de contractură tonică/rigiditate, trismus, cu necesitatea ventilaţiei mecanice şi în final deces; al doilea caz, cu o formă mai uşoară, a avut evoluţie favorabilă dependentă de tratament igienodietetic şi medicamentos.

Concluzii. Deoarece postnatal nou-născuţii sunt aparent sănătoşi din punct de vedere clinic, neexistând o corelaţie fenotip-genotip, în multe ţări a fost adăugată în screening-ul neonatal al afecţiunilor metabolice. Diagnosticul precoce, alături de regimul specific, poate preveni complicaţiile, permiţând astfel o dezvoltare intelectuală normală a copiilor purtători ai acestor defecte.

Cuvinte cheie: boala urinilor cu miros de sirop de arţar, leucinoză, boală metabolică, copil

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