New insights regarding Helicobacter pylori infection in children

Helicobacter pylori (H. pylori) are one of the most common infections during childhood, and if left untreated it might persist lifelong resulting in severe complications such as gastric malignancies. The epidemiology of this infection has wide variations along the continents, countries and sub-regions being related mainly to the socio-economic status, hygiene and sanitary conditions. Nevertheless, a descending trend of H. pylori prevalence was noticed worldwide during the last decades, fact that might decrease in time the incidence of gastric cancer in adults. The diagnosis of this infection remains tricky in children and the selection of the most effective diagnostic tool is essential in order to early diagnose H. pylori associated gastropathies and extraintestinal manifestations. In spite of the lack of symptoms which occurs especially in pediatric subjects, H. pylori infection might result in severe damage to the gastric mucosa and further complications requiring close monitoring after the eradication regimen. Therefore, multiple non-invasive and invasive methods were designed to identify properly the presence of this bacterium within the individual’s stomach and for enabling the clinician to use to most adequate method based on its sensitivity and specificity, but also based on the specific clinical situations. Aside from the well-known standard triple therapy used for the eradication of this infection, multiple other regimens were lately proposed in order to prevent failure of eradication. Moreover, probiotics were recently proved to improve the eradication rate, and at the same time to decrease the side effects of the antibiotics therapy. The proper eradication of H. pylori infection during childhood remains the cornerstone in preventing gastric cancer during adulthood

THE THERAPEUTIC APPROACH OF ACUTE DIARRHEIC DISEASE IN PEDIATRIC PATIENT

Objectives. Approaching acute diarrheal disease (ADD) in pediatric patient, we have set as a primary objective a throughout evaluation of etiology and risk factors and, on the other hand the risk/benefit assessment regarding the justification of antibiotic therapy in the treatment of ADD in pediatric patient. Material and method. We performed an analytic, descriptive study, in which we included 125 patients admitted in the 1st Pediatrics Clinic of Tg. Mureș during 2016 (January to December), diagnosed with ADD. Results. The study group comprised 125 patients, out of which a bacterial etiology was noticed in 23 cases (18.4%). On the other hand, it was observed that 84 patients received antibiotics (67.2%), 110 patients (88%) received symptomatic treatment, and in 60% of the cases (75 patients), a probiotic was associated. The medium hospitalization length was of 5 days, depending on the presence/absence of risk factors such as fever, inflammatory syndrome, hydro-electrolytical imbalances or acute dehydration syndrome, risk factors that increased the medium hospitalization length with up to 2 days (p < 0.05). Conclusions. Antibiotics must be used rationally and justified in the treatment of ADD, analyzing carefully the risk/benefit ratio. Taking into account the self-limiting character and the favorable prognosis of this disorder, we conclude that we face an abuse of antibiotics in case of pediatric patients diagnosed with ADD

TROMBOCYTOSIS FOLLOWING SPLENECTOMY IN PEDIATRIC PATIENTS

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