PEDIATRIC EMERGENCY OF UNEXPECTED CAUSE: INFANTILE FIBROMATOSIS-CASE REPORT

Introduction:Infantile fibromatosis (IF) is a rare benign mesenchymal tumor of early childhood, located solitarily or multicentrically in the skin, soft tissues, muscles, bones, or visceral organs. The cause is unknown, and some cases are linked to mutations in two different genes. Rapid growth is typical, and while there are reports of spontaneous regression, relapses have also been recorded. Treatment depends on the location of the lesions, with surgery being the main treatment option. Case report: This paper presents an unusual emergency presentation of infantile fibromatosis in a 16-month-old girl, initially manifested as acute laryngitis. The rapid development of respiratory failure necessitated immediate life-saving treatment. Emergency diagnostics revealed a large mass deep within the neck structures, causing significant compression and endangering the airways. The child’s condition was critical, and the multidisciplinary team thoroughly discussed available treatment options. Eventually, after careful preparations, the tumormass was surgically removed on the sixth day. The postoperative course was challenging, but the outcome was positive. Pathohistological diagnosis confirmed infantile fibromatosis, and the treatment was successfully completed. Conclusion: Despite its rarity, infantile fibromatosis must be considered a potential cause of urgent, life-threatening conditions in children. Treatment requires individual adaptation and collaboration with a multidisciplinary team

Frequency of Urinary Tract Infection When Diagnosing Vesico Uretheral Reflux in Children in Tuzla Canton

Background: Vesicoureteral reflux (VUR) represents the return of urine from the bladder into the ureter and the renal canal system. Reflux can occur only on one or both kidneys. VUR most often occurs due to an incompetent ureterovesical junction, which consequently leads to hydronephrosis and dysfunction of the lower parts of the urinary system. Objective: The aim of the study was to determine the frequency of urinary infection when diagnosing vesicouretheral reflux in children in the Tuzla Canton, in the five-year period from 01.01.2016 to 01.01.2021. Methods: Through a retrospective study, we analyzed data from 256 children with vesiocouretheral reflux (VUR), examined in the Nephrology Outpatient Clinic, Clinic for Children’s Diseases, University Clinical Center Tuzla, in the period from 01.01.2016 to 01.01.2021, from early neonatal to 15 years of age. The age and gender of children, the most common symptoms of urinary tract infections during the detection of VUR, and the degree of VUR were analyzed. Results: From 256 children with VUR, 54% were male and 46% female. The highest prevalence of VUR was in the age group 0–2 years, and the lowest in the age of children &gt; 15 years. There was no statistically significant difference between the groups of our respondents in relation to age groups, nor in relation to the gender of the children. Statistically significantly more children were without nonspecific symptoms and with asymptomatic bacteriuria in the group without UTI symptoms in children with VUR compared to the group with UTI symptoms in children with VUR. Pathological urine culture between the groups was without a statistically significant difference. Conclusion: Although urinary tract infection in children is common, the possibility of permanent consequences should always be kept in mind if VUR is not diagnosed and treated in time.</jats:p

Early signs of diabetic nephropathy and ultrasound characteristics of kidneys in children and youth with diabetes mellitus type 1

Introduction: Diabetic nephropathy is a chronic complication in patients with diabetes mellitus typ 1, which leads to kidney disfunction. Aim: The aim of this study was to compare the metabolic control and albuminuria with ultrasound findings of morphometric measurements and registration Doppler signals of kidneys between children and youth with diabetes mellitus type 1 according to the duration of illness. Material and Methods: The retrospective-prospective study included 69 patients of both genders, that got diabetes mellitus type 1 when they were in the age from 2. to 25. years. Patients were divided into two groups according to the length of diabetes mellitus type 1: the first group was those whose illness had lasted for more than 10 years, and second group with duration of diabetes mellitus typ 1 less than 10 years. Results: No significant difference was registered between the groups regarding frequency of albuminuria, but the chance of it occurring are greater in patients with longer duration of diabetes mellitus type 1. Patients with albuminuria and diabetes mellitus type 1 duration over 10 years had higher glycated hemoglobin A1C, blood pressure, body mass index followed by enlarged volume of both kidneys. Patients with albuminuria and diabetes mellitus type 1 for less than 10 years had a higher creatinine clearance. Conclusion: Ultrasound dimensions and volume of the kidneys in patients with metabolic control parameters are useful for monitoring especially in the early stages of diabetic nephropathy

INTRAARTICULAR STEROIDS IN TREATMENT OF JUVENILE IDIOPATHIC ARTHRITIS: A SINGLE CENTER EXPERIENCE

Aim: To evaluate the therapeutic response to triamcinolone acetonide (TA) and triamcinolone hexacetonide (TH) injections in the knee of children with JIA. Material and methods: 46 joints of 42 children undergoing intra-articular injections were randomly treated with either TH or TA depending on the availability of the drug. A good response was defined as the decrease in articular score of 60% from the baseline and the ultrasound absence of synovitis. Clinical, laboratory variables were noted to examine possible predictive factors of the result. Results: Of 42 children with JIA, the most common was the oligoarticular persistent form in 24 (57.1%) children. Six-month remission was observed in 21.4 % of children, TA vs. TH: 36.8% vs. 8.7% (p=0.02). The absence of signs of knee inflammation within 12 months was found in 23.8% of children, after the application of TA vs. TH: 31.6% vs. 17.4% (p=0.28). However, long-term, a twenty-four-month remission was achieved in 52.4% of children – in twice as many children after TH (69.9%) than after TA application (31.6%) (p=0.03). A statistically significant correlation was observed between articular score values and duration of remission after TH application, (r=0.56, p=0.006; 95%CI: 0.145-0.80). Two children developed side effects in the form of subcutaneous atrophy at the site of injection, one girl developed transient crystal synovitis after TH applications. Conclusion:This study has shown that intraarticular steroid injections are safe for the treatment of joint inflammation in JIA,and TA is effective in short-term follow-up where TH is an optimum choice in long-term follow-up