GASTRITIS MASKING LATE SYMPTOMS OF MUSHROOM POISONING IN A TEENAGER. A CASE REPORT

Aim of the study. Mushroom poisoning in children is an infrequent but challenging problem for parents and pediatricians. In Romanian rural areas, picking mushrooms and eating them is a common practice that may lead to severe or even fatal events. Case report. We report the case of a 14 years old teenager with late symptoms caused by the ingestion of a small amount of mushrooms, initially admitted into the gastroenterology unit for gastritis. A 14 years old female teenager presented with vomiting and gastric pain that started two days prior to admission. Clinical examination showed generally impaired status, bilious vomits and colicative gastric pain. History revealed that 72 hours before all family members (both parents and four brothers) had eaten home-cooked mushrooms picked by the father. Laboratory data showed fulminant hepatic failure (ASAT=5141 U/L, ALAT=6520 U/l, LDH=2520U/l), hyperammonemia, mixed hyperbilirubinemia and normal renal function; the prothrombin time and activated partial thromboplastin time were prolonged. All family members were symptom-free and their laboratory tests were within normal ranges. The patient was transferred to the toxicology unit, where supportive therapy was started with large amounts of IV fluids, IV benzyl penicillin, proton pump inhibitors, arginine infusion and N–acetylcysteine. The evolution was both clinically and biologically favorable, with normalization of hepatic enzymes within two weeks. Conclusions. In our case, the ingestion of mushrooms produced late gastrointestinal symptoms and fulminant liver failure. In Romania, conducting public information campaigns regarding the poisonous nature of wild mushrooms could be an effective prevention method

ABDOMINAL HOLLOW VISCUS TRAUMA IN CHILDREN, INJURY MECHANISMS AND TREATMENT PRINCIPLES

Abdominal hollow viscus trauma represents an important cause of pediatric morbidity, following head, vertebral column, spinal cord and thoracic injuries, whose main mechanisms of production are road traffic accidents, falls with abdominal impact, sports injuries, physical aggression and explosions. If there is a penetrating abdominal trauma, most frequently it associates hollow organ injuries, while abdominal blunt trauma is associated more often with parenchymal injuries, with effects on the hemodynamic status. Imaging and paraclinical investigations used to evaluate an abdominal trauma consist of thoraco-abdominal radiography in orthostatic position, abdominal ultrasonography, diagnostic peritoneal lavage, abdominal computed tomography and exploratory laparoscopy. Unlike penetrating injuries, when surgical exploration is obvious, in the case of young children with abdominal contusions, the injuries involving hollow viscus can be overlooked at time of the initial assessment, because of a poor communication between doctor and patient, difficult interpretation of symptoms when there are other injuries associated, but also because of the intial lack of ultrasound signs of perforation. Delayed diagnosis and adequate treatment lead to extended duration of hospitalisation, to elevated costs and rates of morbidity. The incidence of mortality caused by abdominal trauma associated with hollow viscus penetration is approximately 10%, being more elevated as the digestive injuries are multiple or associated with other lesions

Predictor Factors for Chronicity in Immune Thrombocytopenic Purpura in Children

(1) Background: Immune thrombocytopenia (ITP) is an acute autoimmune blood disorder that is the main cause of thrombocytopenia in children. It is characterized by a decrease in platelets below 100 × 109/L, and limited evolution with severe complications such as intracranial hemorrhage. The chronic form is defined by the persistence of thrombocytopenia more than 12 months after diagnosis. (2) Methods: We performed a retrospective study over a period of 10 years (1 January 2011–31 December 2020) at the Emergency Clinical Hospital for Children “Sf. Maria”, Iasi. The aim of the study was to describe the clinical characteristics and to determine the prognostic factors in immune thrombocytopenia in children. (3) Results: In this study we included 271 children with ITP, comprising 123 females (45.4%) and 148 males (54.6%). The remission rate was higher in males, being 68.9% compared to 56.1% in females. Children with ITP under 9 years of age had a higher remission rate. Children with a platelet count > 10 × 109/L at diagnosis had a higher likelihood-of-remission rate compared to patients who presented initial platelet count below this value. (4) Conclusions: The risk factors highly suggestive for chronicity are: age at diagnosis, female sex, and the number of platelets at the onset of the disease

Pediatric Emergency Department Management in Acute Poisoning—A 2-Year Retrospective Study

(1) Background: Poisonings in children are common reasons for addressing ED and can potentially have serious complications. Our research aims to review risk factors leading to poisoning in children. (2) Methods: A retrospective review of all pediatric poisoning cases addressing the Children’s emergency department of St Mary Hospital over a two-year period was performed. (3) Results: We collected data on 797 children admitted for acute poisoning. The highest incidence identified was in the 12–18 and 1–3-year-old age groups. The distribution of voluntary versus unintentional poisonings was relatively balanced: 50.19% versus 47.43% (for some cases the type of intoxication remained unknown). Exposure to the toxic substance by ingestion was significant compared to the other routes, with an incidence of 87.1%. Acute poisoning happened at home in 70.4% of cases. A known risk factor before reaching the ED was present in 13.04%. (4) Conclusions: Our study showed a greater risk for acute poisoning in children between 1–3 years of age, and adolescents over 12 years. Identifying and documenting epidemiological aspects and other variables is important for establishing preventive measures and for therapeutic conduct. Adequate risk stratification and preventive measures involving closer supervision of minors or cognitive-behavioral programs can prevent voluntary intoxication