Ancuta Ignat

Helicobacter pylori infection and gastroesophageal reflux in children

Some studies suggest that Helicobacter pylori (H. pylori) infection would be a protective factor for the gastroesophageal reflux. The aim of this study was to explore this fact. A group of 72 children, admitted in a pediatric gastroenterology regional center in Northeast Romania, diagnosed with gastroesophageal reflux by 24-hour continuous esophageal pH monitoring (results were interpreted using the Boix-Ochoa score), underwent upper endoscopy with gastric biopsy to detect the presence of H. pylori by the rapid urease testing and for bacteriological and histologic examination. 19 children (26.39%) had H. pylori infection, while 53 (73.61%) did not. The grade of esophagitis was classified according to the Los Angeles classification system. Out of 47 children with esophagitis A, 16 (34.04%) had H. pylori infection, while out of the 25 children with esophagitis B, only 3 (12%) had H. pylori infection, with statistic significance (χ2 = 54.69, P << 0.05, 95% confidence interval [CI]). Regarding the value of the Boix-Ochoa score, it appears that the presence of the H. pylori determines lower pH-metry scores (F = 8.13, P = 0.0015, 95% CI). The presence of the H. pylori was not an important factor in the gastroesophageal reflux. On the other hand its relationship with esophagitis appears to be inverse ratio. The fact that the H. pylori presence is statistically greater in the grade A esophagitis could confirm the hypothesis that the bacteria would slow down the development of the esophagitis.

Neisseria meningitidis Serogroup C Causing Primary Arthritis in a Child: Case Report.

Abstract Introduction: Neisseria meningitidis (N. meningitidis) is associated with severe invasive infections such as meningitis and fulminant septicemia. Septic arthritis due to N. meningitidis is rare and bone infections have been reported exceptionally. We report the case of a 1-year old girl who presented with a painful, swollen right knee, accompanied by fever and agitation. Arthrocentesis of the right knee, while patient was under anesthesia, yielded grossly purulent fluid, so we made arthrotomy and drainage. The culture from synovial fluid revealed N. meningitidis, sensitive to Ceftriaxone. The patient received intravenous antibiotherapy with Ceftriaxone. The status of the patient improved after surgical drainage and intravenous antibiotic therapy. She recovered completely after 1 month. Conclusion: This observation illustrates an unusual presentation of invasive meningococcal infection and the early identification of the bacteria, combined with the correct treatment, prevent the complications and even death.

Acrodermatitis Enteropathica: A Case Report.

Abstract Acrodermatitis enteropathica is a rare genetic autosomal recessive disorder, characterized by periorificial dermatitis, alopecia, and diarrhea. It is caused by mutations in the gene that encodes a membrane protein that binds zinc. We report a 14-month-old boy, admitted for erythematous, scaly and pustular lesions, initially located in the inguinal and perianal regions and on thighs, and very few erythematous lesions on the face. Due to the numerous bacterial skin superinfections with Staphylococcus aureus, including abscesses that required surgical incision, the clinical picture was modified, leading to a delayed establishment of the diagnosis. Later, the symptoms became suggestive for this disease, the diagnostic having been confirmed by low plasma zinc values. Under zinc therapy, skin lesions improved significantly in a few days, with favorable outcome. Two months later, the skin lesions almost disappeared. Abscesses due to bacterial skin superinfections may lead to initially misdiagnosed acrodermatitis enteropathica.

Heterotopic Gastric Mucosa in the Distal Part of Esophagus in a Teenager: Case Report.

Abstract Heterotopic gastric mucosa (HGM) of the esophagus is a congenital anomaly consisting of ectopic gastric mucosa. It may be connected with disorders of the upper gastrointestinal tract, exacerbated by Helicobacter pylori. The diagnosis of HGM is confirmed via endoscopy with biopsy. Histopathology provides the definitive diagnosis by demonstrating gastric mucosa adjacent to normal esophageal mucosa. HGM located in the distal esophagus needs differentiation from Barretts esophagus. Barretts esophagus is a well-known premalignant injury for adenocarcinoma of the esophagus. Malignant progression of HGM occurs in a stepwise pattern, following the metaplasia–dysplasia–adenocarcinoma sequence. We present a rare case of a teenage girl with HGM located in the distal esophagus, associated with chronic gastritis and biliary duodenogastric reflux. Endoscopy combined with biopsies is a mandatory method in clinical evaluation of metaplastic and nonmetaplastic changes within HGM of the esophagus.

Silent presentation of multiple metastasis Burkitt lymphoma in a child: A case report and review of the literature

Rationale: The Burkitt lymphoma (BL) is a very aggressive B-cell non-Hodgkins lymphoma. It accounts for 34% of lymphoma cases in children. Patient concerns: We present the case of a 6-year-old boy diagnosed with BL, who presented multiple contrasting elements of the disease: silent symptomatology, without involvement of the bone marrow at first, but with multiorgan infiltration and a fast evolution, despite starting the treatment shortly after the symptoms appeared. Diagnoses: He was diagnosed with BL after immunophenotyping from the pleural fluid. Interventions: After a week from admission, chemotherapy was initiated according to protocol NH-BFM therapeutic group III—cytoreductive phase in the acute care ward and subsequently the AA 24 treatment. Outcomes: Following the treatment, the patient developed medullary aplasia and cutaneous toxicity. The patients general state remained severe during the hospitalization. Lessons: Even though the prognosis of BL has improved over time (up to 90% survival rate), in this case the evolution was unfavorable. In our patient, the symptoms appeared abruptly. They appeared late in the phase of multiple-organ dissemination, which generated the pessimistic prognosis.

Different evolution in the treatment of a severe persistent asthma in 2 twins: Case report and review of the literature

Rationale: Asthma is a multifactorial disease with complex genetic inheritance. In children under the age of 5 years, the diagnosis of asthma is a challenge. Patient concern: We present the case of twin sisters under the same treatment for persistent asthma, but with different evolution over the time. Diagnoses: One of the sister is diagnosed with severe persistent bronchial asthma associated with bronchiectasis and dyslipidemia and the other one only with mild persistent asthma. Interventions: At each admission the treatment for the exacerbations and the underlying respiratory infections was represented by antibiotics, short-acting &bgr;2 agonists, and, sometimes, oxygen and systemic corticosteroids. As chronic treatment, they received in the last period inhaled corticosteroids associated with long-acting &bgr;2 agonist. Outcomes: Until the age of 6.5 years, they had similar diagnoses and treatment; from this point one was asymptomatic, with normal pulmonary function tests. The other one had a more complicated evolution which led to a severe crisis by the age of 10 years old. Lessons: Although asthma is a multifactorial disease with complex genetic inheritance, the genetics has its limits. Our twins had a similar onset with the same genetic inheritance, with the same risk factors, with the same comorbidities and with the same treatment. In this context, different evolutions of severe persistent asthma require more extensive genetic investigations. Patient concern: We present the case of twin sisters under the same treatment for persistent asthma, but with different evolution over the time.

OC-56 Adjusting problems to extrauterine life in newborns delivered by caesarean section

The transition from intrauterine to extrauterine life is a complex physiological adaptation. The most common adjustment problems are present in preterm and in term infants delivered by caesarean section. Caesarean section performed at the request of the mother (in the absence of maternal or fetal indications) increase the risk of prolonged hospitalisation, can cause breathing problems in children and increases the risk of complications in a subsequent pregnancy. Also, breast feeding is delayed in children born by caesarean section. Birth by caesarean benefits are for short term: fewer surgical complications, low risk of bleeding, and absence of urinary incontinence. There are authors who claim that birth by caesarean section performed at the request of the mother, as well as emergency caesarean delivery is associated with a high morbidity risk to both mother and fetus.

P254 Children vaccination: civic obligation or personal choice?

One of the greatest achievements of medicine was the discovery and introduction of vaccination for all major contagious diseases. Romania was one of the countries that have contributed to the development of vaccinology. Currently, one of the most intensely debated issues is related to a person’s right to accept or not vaccination. The patient can be put in different situations, which is why the authors discuss these issues. Given that it is easier and cheaper to prevent than cure, through vaccination this goal can be achieved. The compulsory vaccins should meet the necessary criteria of mandatory and optional ones remain at the discretion of the patient or legal caregivers. Facing the major risks that an epidemic outbreak represents, general interest prevails, because ultimately, the freedom and security of any person ceases where it affects another person’s freedom and security.

OC-43 A family case of an adenomatous polyposis

Introduction The inherited gastrointestinal polyposis syndromes are divided into adenomatous and hamartomatous varieties. The adenomatous polyposis syndromes include familial adenomatous polyposis coli, Gardner’s syndrome and Turcot’s syndrome. Gardner’s syndrome is characterised by the presence of numerous intestinal polyps, with extra-intestinal manifestations of bone and soft-tissue such as desmoid fibromatosis, lipomas, osteomas and epidermal cysts. Cases report We report the cases of 2 brothers (17-year-old girl and 15-year-old boy) with typical symptoms of Gardner’s syndrome who were sent from the Genetics Clinic at the V-th Paediatrics Clinic of “St. Mary” Children’s Emergency Hospital to perform a colonoscopy (for highlighting the colonic mucosa damage). Their mother and their maternal grandfather had a suggestive history of a similar disease. The patients were diagnosed to have colonic polyps. Conclusion The patients with Gardner’s syndrome must be closely followed-up, since there is a constant threat to their lives at any age.

P253 Subocclusive intestinal syndrome secondary to cytomegalovirus infection in an infant

Background Subocclusive intestinal syndrome is caused by a heterogeneous group of enteric neuromuscular diseases that causes abnormalities of gut motility. Subocclusive syndrome can occur at any age, but in young children, most often, can be fatal. This may be due to intrinsic primary or secondary visceral disorders (drug toxicity, ischemia, inflammatory or autoimmune diseases, infection with Epstein-Barr virus or cytomegalovirus, myopathies). Case presentation We present the case of an infant male, 1 month and 2 week old, admitted in the Paediatric Gastroenterology Clinic, „St. Mary’ Children Emergency Hospital, Iasi, Romania for jaundice and the appearance of flatulence, with progressive intensification from the age of 3 week old, with loose stools. Laboratory analysis revealed a positive Cytomegalovirus IgG and IgM antibodies. Conclusion Cytomegalovirus infection should be considered in intestinal pseudo-obstruction in order to initiate appropriate treatment and avoid serious complications that may arise.