Helicobacter pylori prevalence and risk factors among children with celiac disease.

BACKGROUND/AIMS: The relationship between Helicobacter pylori and celiac disease (CD) remains controversial. The aim of this study was to assess the prevalence and risk factors for H. pylori infection among children diagnosed with CD. MATERIALS AND METHODS: This study included 70 patients diagnosed with CD at a tertiary referral center in Romania. Age, gender, and indicators of environmental conditions were evaluated via interviews with the children's caretakers. A multivariable logistic regression analysis was performed to identify the independent predictors for H. pylori infection. RESULTS: Of the 70 patients, 37 (52.9%) were females, and the mean age was 4.04±3.26 years. H. pylori infection was diagnosed in 23 (32.8%) patients, of whom 12 (52.1%) were females, and the mean age was 6.2±4.5 years. Of the total number of children with CD and H. pylori infection, 18 (78.2%) had milder forms of enteropathy (Marsh I-II), whereas the remaining 5 (21.7%) had villous atrophy compared to the other 47 (67.2%) patients who were negative for H. pylori-infection and showed more severe intestinal damage. The development of H. pylori infection was independently related to children with one parent only [odd ratio (OR), 9.04; 95% confidence interval (CI), 1.29-62.89; p<0.001], living in houses without sanitary facilities (OR, 3.88; 95% CI, 1.27-14.22; p=0.016), belonging to low-income families (OR, 8.52; 95% CI, 2.52-71.39; p=0.002), and of parents with a prior history of gastritis (OR, 2.68; 95% CI, 1.49-14.50; p=0.004). CONCLUSION: Children with CD and H. pylori infection had milder forms of enteropathy compared to children who are negative for H. pylori, suggesting that H. pylori infection may confer some protection against the development of severe degrees of villous atrophy.

ATOPIC DERMATITIS--CLINICAL EPIDEMIOLOGY AND IMMUNOLOGICAL CORRELATIONS.

AIM: Medical records from 2010-2014 were retrospectively reviewed and analyzed in view of determining the correlations between the clinical severity of atopic dermatitis (AD) and total IgE level, eosinophilia, place of residence, family history of atopy, type of birth, and natural or artificial feeding. MATERIAL AND METHODS: Following medical record review, 296 cases diagnosed with AD were included in the study. Statistical analysis was performed using SPSS v20 for determining the frequency and testing the hypotheses, for p < 0.05, by t tests and One-Way ANOVA. RESULTS: Of the 296 cases, 53% were male children and 47% female children aged 1 month to 16 years. According to total serum IgE level, 49.3% of patients had elevated IgE levels, 20.6% normal levels and in 30.03% of cases it was not determined. According to the SCORAD, children had mild AD in 20% of cases, moderate in 70%, and severe in 10%. The independent samples t tests showed a statistically significant difference between the means demonstrating correlations between IgE level and place of residence (p < 0.01), family history of atopy (p < 0.01), baby feeding (p < 0.01), and by one-way ANOVA for SCORAD (p < 0.05). CONCLUSIONS: Atopy in AD can be influenced by complex factors, both internal and environmental, but this remains a controversial topic. External factors acting on a background genetically predisposed to atopy trigger the manifestation of AD.

Coexistence of celiac disease and systemic lupus erythematosus in a 6-year-old girl-case report.

Systemic lupus erythematosus (SLE) is a serious and potentially fatal syndrome characterized by an autoimmune assault on various organs and systems that may include the skin, joints, central nervous system, heart and kidneys. Recent research shows that gluten sensitivity causes more than just celiac disease and gluten has been linked to numerous autoimmune conditions. We report here a 6-year-old girl presenting with malaise, abdominal pain, loss of appetite, abdominal distension. After three weeks she developed other symptoms such as arthralgias, malar rash, being finally diagnosed with SLE and possible autoimmune hepatitis. The suspicion of celiac disease was based on a combination of symptoms (poor growth, iron deficiency anemia, chronic abdominal pain, abdominal distension, constipation, "sad child"), IgA deficiency, in the presence of SLE diagnosis. Positive diagnosis of celiac disease was confirmed by the presence of an anti IgG anti-transglutaminase antibodies titer of 120 EU/ml (normally less than 20 EU/ml). Small bowel biopsy showed a IIIB1 stage according to the Marsh classification. Three methylprednisolone pulses were promptly administered, followed by oral prednisone (2 mg/kg bw/day) with a good outcome.

Gut-liver axis and fibrosis in nonalcoholic fatty liver disease: an input for novel therapies.

Non-alcoholic fatty liver disease is a multifactorial condition, ranging from simple steatosis to non-alcoholic steatohepatitis with or without fibrosis. In non-alcoholic fatty liver disease, alteration of gut microbiota and increased intestinal permeability increase exposure of the liver to gut-derived bacterial products: lipopolysaccharides and unmethylated CpG DNA. These products stimulate innate immune receptors, namely Toll-like receptors, which activate signalling pathways involved in liver inflammation and fibrogenesis. Currently, there are several studies on the involvement of lipopolysaccharide-activated Toll-like receptor 4 signalling in non-alcoholic fatty liver disease pathogenesis. There has been widespread interest in the study of the involvement of resident hepatic stellate cells and Kupffer cells activation in liver fibrogenesis upon TLR4 stimulation. Although the best evidence to support a role for gut microbiota in non-alcoholic fatty liver disease-induced fibrosis comes largely from animal models, data from human studies are accumulating and could lead to new therapeutic approaches. Therapeutic modulation of gut microflora may be an alternative strategy to develop an anti-fibrotic therapy. In this review, we discuss the relevant role of gut-liver axis in non-alcoholic liver disease-associated liver fibrosis and discuss the evidence on novel anti-fibrotic therapeutic approaches.

[Variability of nutritional status and of the parameters of lipid metabolism in gluten-free diet]. / Variatiile statusului ponderal si parametrii metabolismului lipidic în timpul dietei de excludere a glutenului.

UNLABELLED: Celiac disease is one of the most common forms of food intolerance in children, being an autoimmune enteropathy occurring in genetically susceptible individuals. The only treatment of celiac disease consists in a lifelong strict gluten-free diet. After gluten free diet patients with normal weight or growth failure risk become obese on the one hand because of recovery intestinal absorption and, on the other hand, nutritionally unbalanced diet, high in fat and protein. AIM: The aim of this study was to assess the nutritional status and the presence and prevalence of various changes dyslipidemia in gluten free diet. MATERIAL AND METHODS: The trial was formed by 92 patients (mean age at diagnosis 88,5 months) diagnosed with CD between January 2008 - December 2010 in 2nd and 3rd Pediatric Clinics of "Sf. Maria" Hospital Iasi. Patients were divided into two groups: group I included 36 patients younger than 2 years and group II included 52 patients aged over 2 years at time of diagnosis of celiac disease. All patients received gluten free diet. Were evaluated periodically anthropometric indices (weight, height, body mass index and Z scores in children over 2 years and weight and nutritional index in children under 2 years) and lipid profile (total lipids, total cholesterol, HDL cholesterol, triglycerides). Assessing food intake was achieved by interviewing parents and children on dietary habits and daily food ration. RESULTS: Assessment of nutritional status: group I:--after 24 months of gluten free diet 5 cases presented overweight; group II: after 24 months of gluten free diet obesity (BMI > 30) was found in 16.07% of cases (9 patients) and overweight (BMI > 25) was found in 28.57% of cases (16 patients). Food intake: in all cases was observed increased calorie intake by an excess of lipids and carbohydrates in the diet. Investigation of lipid metabolism: in group II high values of cholesterol were found in 12 cases (21,42 of cases). In conclusions, in celiac disease gluten free diet should be balanced caloric, fat and protein to ensure an optimal nutritional status and prevent long-term complications.

Risk factors and their implications in the epidemiology of pediatric obesity.

UNLABELLED: Obesity is the most common food disorder in children from developed countries, its frequency alarmingly increasing in Romania. AIM: To evaluate the epidemiological dynamics of obesity and associated risk factors. MATERIAL AND METHODS: Retrospective and prospective study of 146 obese children admitted to the 2nd Iasi Pediatric Clinic between 2008-2012 aimed at evaluating the epidemiological dynamics of obesity and associated risk factors. Most subjects were teenagers (33%), followed by school age children (21%). RESULTS: A growing tendency towards obesity in the study children was noticed during the 5-year follow up. Genetic factors, short breastfeeding, early onset of obesity, and eating disorders were the main obesity-associated risk factors, along with obesity in 1st degree relatives. CONCLUSIONS: Early infantile and juvenile obesity remains a medical and social problem in our geographic area, and unfortunately a neglected reality. Genetic factors, absence of breastfeeding, inappropriate food habits in the early years of life lead to permanent disorders, with serious consequences in adult life.

Some implications of Scale Relativity theory in avascular stages of growth of solid tumors in the presence of an immune system response.

We present a traveling-wave analysis of a reduced mathematical model describing the growth of a solid tumor in the presence of an immune system response in the framework of Scale Relativity theory. Attention is focused upon the attack of tumor cells by tumor-infiltrating cytotoxic lymphocytes (TICLs), in a small multicellular tumor, without necrosis and at some stage prior to (tumor-induced) angiogenesis. For a particular choice of parameters, the underlying system of partial differential equations is able to simulate the well-documented phenomenon of cancer dormancy and propagation of a perturbation in the tumor cell concentration by cnoidal modes, by depicting spatially heterogeneous tumor cell distributions that are characterized by a relatively small total number of tumor cells. This behavior is consistent with several immunomorphological investigations. Moreover, the alteration of certain parameters of the model is enough to induce soliton like modes and soliton packets into the system, which in turn result in tumor invasion in the form of a standard traveling wave. In the same framework of Scale Relativity theory, a very important feature of malignant tumors also results, that even in avascular stages they might propagate and invade healthy tissues, by means of a diffusion on a Newtonian fluid.

[Liver involvement in celiac disease in children]. / Afectarea hepatica în boala celiaca la copil.

UNLABELLED: Celiac disease (CD) is an autoimmune systemic enteropathy triggered by gluten intake in patients with genetic susceptibility, characterized by clinic polymorphism: classic forms, mainly with digestive features, and atypical forms, liver involvement being a part of them. In present, any unknown cytolysis requires screening serologic determinations for CD. AIMS: to assess the presence of liver manifestations in children diagnosed with CD, the outcome of liver function with gluten-free diet (GFD) and also to emphasize the importance of the immunological screening for CD in patients with unknown etiology liver dysfunctions. MATERIAL AND METHODS: The trial was formed by 120 patients diagnosed with CD between January 2007 - December 2010 in 2nd and 3rd Pediatric Clinics of "Sf. Maria" Hospital Iasi; liver function was assessed; viral hepatitis and autoimmune hepatitis markers were determined; all patients were given GFD, hepatoprotective agents and antivirals specific to each form of hepatitis; the transaminases level variation was followed in time. RESULTS: 12 of the CD diagnosed patients (10, 14%) had altered liver function at the onset of disease; the only abnormality was the increased transaminases level in 57, 14% of cases; HBsAg was found positive in 33, 33% (4 cases); liver biopsy in one patient evidenced steatosis. The study has shown that 4% of the patients with cryptogenetic hepatitis have a silent form of CD, the serologic screening for AGA, AEA, ATGA being essential for diagnosis. CONCLUSIONS: we have to rule out CD in patients with liver disease of unknown etiology, before we consider it as "cryptogenetic"; occurrence of cytolysis in the absence of positive viral markers requires the assessment of screening tests for CD.

[Hepato-pulmonary syndrome]. / Sindromul hepato-pulmonar (shp).

The hepato-pulmonary syndrome (HPS) is a rare complication of liver cirrhosis, with poor outcome; the term includes liver disease, increased alveolo-arterial gradient and intrapulmonary vascular dilations, described by Fluckiger, Kennedy and Knudson. HPS impairs survival in cirrhotic patients and the posttransplant outcome is altered in correlation with severity of HPS. Combined determination of SaO2 in clino- and orthostatic position by a pulsoximeter is a simple test for HPS identification in patients with chronic liver disease or non-cirrhotic portal hypertension.

[Nutrition in cholestasis and long-term impact on trasnplant]. / Nutritia în colestaza si impactul pe termen lung dupa transplant.

AIM: Plurietiological hepatic cholestasis involves an increased risk of protein-caloric malnutrition and specifical nutritional deficiencies. Biological investigations to determine deficiencies in fat-soluble vitamins are essential for specific nutritional therapy . Although malnutrition is not an absolute contraindication for liver transplantation, its gravity has complex consequences in relation to this intervention. MATERIAL AND METHOD: The authors present a study conducted over a period of 5 years following the analysis of 293 children diagnosed with intra- or extrahepatic abnormalities that caused varying degrees of cholestasis. RESULTS: In the study group, the percentage of infants with cholestasis was 45.39% (133 cases) and among them 62.12% had malnutrition (82 children). Clinical evaluation of fat-soluble vitamins deficiency, in particular, but also of the soluble and minerals was performed in all patients. Liver transplantation was successfully performed in three cases. CONCLUSIONS: Most important factors affecting growth after transplantation were age at the time of the liver transplant and primary diagnosis that required transplant. The role of nutritional support prior to liver transplantation is of great importance. Quality nutritional support change impact that malnutrition has on survival after liver transplantation.

[Chronic hepatitis B--still a problem in children]. / Hepatita cronica virala B--o problema încâ în actualitate la copil.

Vaccination of the newborns and adolescents had impact on the incidence of acute and chronic infection with hepatitis B virus (HBV) in children. After a decade of this national program application, authors proposed to study the epidemiologic dynamics of chronic infection with HBV in this interval, compared with the previous period, prior to vaccination.

[Trends in epidemiological evolution of viral hepatitis B and C , in children , Romania and Iasi county between 1990-2009]. / Tendinte ale evolutiei epidemiologice a hepatitelor acute virale B si C la copil, in România si judetul Iasi, in perioada 1990-2009.

UNLABELLED: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the frequent causes of acute and chronic hepatitis worldwide and the leading causes for hepatic cirrhosis and liver cancer. There is a distinct geographical variation in VHB and VHC incidence in adult and child. AIM: To assess the evolution trend of VHB and VHC incidence in child, in Romania and Iasi County, during the last two decades. MATERIAL AND METHODS: Data were obtained using information from the Reporting National System for acute viral hepatitis A, B, and C, from various geographical areas of Romania. Some systematical errors of information were identified, without significant influence of results and conclusions. RESULTS: Results highlighted an incidence peak of VHB in Romania, in 1989, and in Iasi county, in 1991 (43.1, respectively 41.2 per thousand inhabitants). The VHB incidence trend decreased after the implementation of vaccination programme, especially in children < 4 years old. CONCLUSIONS: The study remarked the necessity of viral hepatitis surveillance programme continuity in Romania and the importance of prevention measures including, for VHB, an optimal vaccination.

[Chronic hepatitis C in children: are extrahepatic manifestations an argument for standard therapy?]. / Hepatita C la copil: manifestarile extrahepatice argumenteaza terapia standard si la copil?

UNLABELLED: Chronic hepatitis C is still an important health problem in children. Adequate management of those patients should be focused on two directions: disappearance or reduction of the viral load (conventional antiviral therapy) and treatment of autoimmune manifestations (corticoids, plasmapheresis, cytotoxic agents). AIM: To associate extrahepatic manifestations with other disorders and to evaluate the evolution under specific (antiviral) and non-specific therapy. MATERIALS AND METHODS: 43 children diagnosed with chronic hepatitis C and followed in the 2nd Pediatric Clinic Iasi between January 2005 and June 2010. RESULTS AND DISCUSSIONS: most children were diagnosed accidentally or for etiological investigations for elevated liver enzymes. Extrahepatic manifestations were found in 41.86% of patients, most of them with articular, skin and hematologic disorders, but also depression (2 cases) in those receiving interferon. CONCLUSIONS: In children, extrahepatic manifestations in chronic hepatitis C infection are more rare than in adults, especially with articular involvement. In certain cases, interferon therapy can trigger those manifestations with an immune mechanism. It is essential to evaluate the autoimmunity markers before proceeding with antiviral therapy.

[X-linked Bruton congenital agammaglobulinemia. Case report]. / Agamaglobulinemie congenitala legata de x Bruton. Prezentare de caz.

Congenital agamaglobulinemia is a B-cell deficiency caused by tirosin-kinase gene mutations. This article presents the case of a 2 years and 6 months old boy with a history of multiple respiratory infections, which also associates a malabsorbtion syndrome. The patient presented for symptoms of arthritis. After performing protein electrophoresis, the extremely low gamma fraction pointed out a hidden immunodeficiency. Gene analysis was performed in the Department of Pediatric Immunology of Debrecen University, Hungary and thus the final diagnosis was determined. Arthritis and respiratory symptoms improved after immunoglobulin treatment.

[Evaluation of quality of life in children with chronic hepatitis]. / Studiu de evaluare a calitatii vietii la copilul cu hepatita cronica.

UNLABELLED: The evolution of chronic viral and non-viral hepatitis in children, and the response to therapy influence the quality of life and the outcome of these patients and tehir family. MATERIAL AND METHOD: This study analyzes the quality of life in children with chronic liver disease, using the records of 45 patients hospitalised in the Hepatology Department of "Sf. Maria" Hospital of Children in Iasi. Data were customised using Kindle questionnaire, measuring the scores for quality of life in children and adolescents with chronic disease. Patients with chronic viral and autoimmune hepatitis hospitalised in the clinic were interrogated during three months (May-July 2008). All ethical aspects of clinical research were aproved and no child was harmed during the study. The questionnaire for children with chronic viral hepatitis, mostly with B virus, had a good aplicability, being simple and easy to respond. RESULTS: The results showed a positive perception of the disease, probably because of the young age (under 17) and the fact that the liver disfunction was at low rates. The study of quality of life in children with chronic disease can be an efficient method for treatment efficiency evaluation.

[Osteopenia in children with juvenile idiopathic arthritis]. / Osteopenia la copiii cu artrita juvenila idiopatica.

UNLABELLED: The aim of the study was to evaluate the presence and etiopathogenesis of osteopenia in 41 children with Juvenile Idiopathic Arthritis (JIA). METHODS: Bone status was evaluated by quantitative ultrasound using a Sunlight Omnisense 7000s Ultrasound Bone Sonometer. Measurements were performed at the distal radius and midshaft tibia. Results were obtained as Speed of sound (SOS) and Z-score. We used standardised clinical evaluation (modified Giannini's criteria, CHAQ). ESR, Fibrinogen, serum calcium, magnesium, alkaline phosphatase, protein electrophoresis, 25-OH vitamin D (RIA) and urinary Hydroxyproline were obtained in all patients. Osteopenia was present in 15 (36.5%) patients. Statistical analysis was performed with SPSS 13.0. RESULTS: Age, sex, age at onset, disease duration, life standards and duration of corticotherapy and methotrexate treatment were not related to osteopenia in our study. The disease activity, evaluated by clinical criteria, ESR and Fibrinogen, was strongly associated with osteopenia (p<0.001). Nutritional status was an independent risk factor for osteopenia (p<0.001). Low serum calcium (p=0.034), magnesium (p=0.010), 25-OH vitamin D (p=0.091) and alkaline phosphatase (p=0.31) were more frequent in patients with osteopenia. Hydroxyproline was increased in all patients with osteopenia (p<0.001). CONCLUSIONS: Osteopenia was a frequent (36.5%) complication of JIA in our study. The disease activity and nutritional status were the most important risk factors for osteopenia. The increase of bone reabsorption was the main pathogenic mechanism of osteopenia in our study. Calcium and magnesium deficits were related to osteopenia. Decrease of bone synthesis was not associated with osteopenia in the present study.

[Structure and replication of viral hepatitis C virus, the key of the future therapeutic goals]. / Structura si replicarea virusului hepatitic c, cheia viitoarelor tinte terapeutice.

This paper reviews literature data on the hepatitis C virus. Hepatitis C virus is a positive-sense, single-stranded RNA virus. It is a genetically variable virus and it is estimated that the dominant viral sequence changes every few weeks. At least 6 genotypes are now recognized. All of this genotypes appear to have a similar effect on the liver but, the duration and response to therapy is strongly influenced by them. A complete understanding of this virus will greatly facilitate new antiviral agents.

Glycogen storage disease type I--between chronic ambulatory follow-up and pediatric emergency.

BACKGROUND AND AIMS: To describe the characteristics of patients with type I glycogenosis, the presentation types, the main clinical signs, the diagnostic criteria and also the disease outcomes on long term follow-up. METHODS: The study group consisted of 6 patients (medium age 3 years 6 months) admitted in hospital between 2001 and 2005 and followed-up for 1 to 5 years. The sex ratio was 1:1. RESULTS: The referral reasons varied from hepatomegaly incidentally discovered (3 of 6 patients) to abdominal pain (4 of 6 patients), growth failure (3 of 6 patients), symptoms of hypoglycemia (3 of 6 patients), recurrent epistaxis (1 patient). Hepatomegaly was present in all cases. Biological profile: hypoglycemia, increased transaminase values, hypertriglyceridemia, lactic acidosis, normal uric acid levels. Two patients had neutropenia and other two had increased glomerular filtration rate. Liver biopsy showed glycogen-laden hepatocytes and markedly increased fat. Four patients had type Ia and 2 patients type Ib glycogenosis. The therapy consisted of: diet, ursodeoxycholic acid, granulocyte colony-stimulating factor, broad spectrum antibiotics for those with type Ib glycogenosis. The follow-up parameters were clinical, biological, imaging. Metabolic interventions and antiinfectious therapy were necessary. All patients are alive, two of them on the waiting list for liver transplantation. CONCLUSIONS: Glycogen storage disease type I is a rare condition, but with possible life-threatening consequences. It has to be kept in mind whenever important hepatomegaly and/or hypoglycemia are present.

[Obesity in children: new controversies and present prevention measures]. / Obezitatea copilului--noi paradigme si masuri preventive actuale.

The authors realise a synthesis on classical data and recent pathogenic explanations in childhood obesity. The obesity is a nutritional disorder of great interest nowadays and surpasses the incidence of the major problem of pediatrics until now--the malnutrition. There is documented data concerning the global incidence of obesity which is continuously growing when it comes to children. That is why the prophylaxis must become a priority by using measures in the first period of life (natural feeding, the need of late diversification, the avoidance of hyperproteic diets). The recent pathogenic data and the long term populational studies change the old conceptions regarding the risk of some categories of children. Thus mother's malnutrition, the low birth weight, children that followed hyperproteic diets paradoxically represent categories of risk for obesity. A recent recorded phenomenon, which amplifies the risk for obesity is the early adiposity rebound which is recorded nowadays even for ages lower than five years. There are described the hormonal mechanisms involved in appetite and satiety up to the receptor level: leptin, ghrelin, adiponectin, endocannabinoid receptors. There are pointed out all the long term risk elements (high birth weight, low birth weight, the pregnant woman's nutrition) and the modern medical treatments for obesity.

[Metabolic abnormalities with hematologic manifestation]. / Anomalii metabolice cu expresie hematologica.

These are unusual diseases in pediatric pathology. We present the morphologic aspects of peripheral blood smear and bone marrow smear of nine storage disease cases.