The bezoar is a conglomerate of indigestible or partially digestible foreign material that stagnates in the digestive tract. Cases of primary intestinal trichobezoar, without associated gastric trichobezoar, are rare. Trichobezoar occurs most frequently in patients with mental disorders. We present the case of a patient aged 12 years and 5 months, who was referred to our hospital with the suspicion of intestinal obstruction, the clinical symptomatology consisting of uncontrollable vomiting, cramping abdominal pain and the absence of intestinal transit. Imaging investigations were inconclusive as to the cause of the bowel obstruction. Surgery was performed for mechanical intestinal obstruction and during the exploratory laparotomy an intraluminal formation was revealed in the ileum which after enterotomy was identified as a trichobezoar and other formations in the colon which were manually manipulated towards the distal colon and later evacuated manually by digital rectal palpation. Postoperative pediatric psychiatric evaluation revealed symptoms suggestive of Asperger Syndrome. Our paper, explores the association between tricophagy and pervasive developmental disorders. Although many cases of autistic children ingesting inedible items are described in the literature, there are very rare situations in which pica causes obstruction of the small intestine, requiring surgical intervention.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

INTRODUCTION:The epidemiological and clinical characteristics of acute poisoning with liquid laundry detergent capsules have been comprehensively reported. However, studies of laboratory test results in these exposures are uncommon. This study analyzed the impact of the ingestion of liquid laundry detergent capsules on admission laboratory tests in paediatric patients. METHODS:This retrospective study was conducted in the clinical toxicology unit of a paediatric poison centre between 2015 and 2021. Paediatric patients (less than 18 years of age) who ingested liquid laundry detergent capsules were included. The relationship between the European Association of Poisons Centers and Clinical Toxicologists/European Commission/International Programme on Chemical Safety Poisoning Severity Score and admission laboratory test results was assessed using Fisher's exact test or analysis of variance. RESULTS:A total of 156 patients were included in the study. A considerable proportion of patients presented with leucocytosis, acidosis, hyperlactataemia or base deficit. The median values of white blood cell count (P = 0.042), pH (P = 0.022), and base excess (P = 0.013) were significantly different among the Poisoning Severity Score groups. Hyperlactataemia was strongly associated with the Poisoning Severity Score (P = 0.003). DISCUSSION:Leucocytosis is a non-specific marker of severity following ingestion of liquid laundry detergent capsules. The incidence of metabolic acidosis and hyperlactataemia was higher in this study than in previous reports, but these metabolic features were not related to the severity of exposure. The exact mechanisms of toxicity are not yet known, but the high concentration of non-ionic and anionic surfactants, as well as propylene glycol and ethanol, in the capsule are likely contributing factors. CONCLUSIONS:Pediatric patients who ingest liquid laundry detergent capsules may develop leucocytosis, metabolic acidosis, hyperlactataemia, and a base deficit.

One-fourth of the global population suffer from anemia, with iron deficiency being the main reason; it affects both sexes almost equally, with a slight preponderance of women being afflicted. Anemia can be caused by a wide range of conditions and circumstances, and it can present both orally and systemically. Reduced red blood cell count and/or hemoglobin concentration, or disruption in their function, which finally results in reduced oxygen delivery to tissues, are all defining characteristics of anemia. Anemia is linked to decreased well-being, poor cognitive function, and persistent fatigue. The orofacial signs and symptoms include magenta tongue, midfacial overgrowth, angular stomatitis, atrophic glossitis, paresthesia/anesthesia of the mental nerve, dysphagia, osteosclerosis, and conjunctiva and facial pallor. Common orofacial manifestations also include conjunctival hemorrhage, nose bleeding, spontaneous and posttraumatic gingival hemorrhage, and persistent post-extraction bleeding. Patients with anemia require multidisciplinary care. Consequently, the dentist must have a solid awareness of this disorder, with a focus on warning indicators, dental management, and appropriate communication with the patient’s physician.

The dental treatment can easily lead to strong reactions of fear and acute anxiety in adults and children alike. It is one of the most common reasons for avoiding the dental office and for neglecting orodental problems. Dental anxiety has been shown to increase the incidence of dental pathology (decayed and/or extracted teeth), increase the frequency and intensity of episodes of dental pain, and reduce the overall quality of oral health. Dental disorders can not only have significant physical consequences for the child, such as disturbed sleep, reduced food intake, digestive disorders, delayed growth and development, but can also affect their mental concentration, which leads to decreased school performance; social interactions can also be adversely affected. Pain, previous unpleasant experiences with dentists or less trained dentists can be serious reasons why the child is afraid, developing phobias that can follow him for a lifetime. To gain their trust and help them escape the fear of the dental office, children always need to be treated by a calm, warm, patient doctor who can understand their fears and explain, step by step, what is going on. Behavior management is widely accepted as a key factor in providing oral and dental care to children. It is imperative that any behavioral approach of the pediatric patient be based on empathy and concern for the physical and mental well-being of each child. A wide variety of behavioral management techniques (pharmacological and non-pharmacological) are available to pediatric dentists. It is important to choose the right one for the benefit of each child patient, depending on the individual’s physical and mental characteristics in each case.

Introduction. Gynecomastia is the benign development of glandular breast tissue in male patients. Neonatal breast en­largement is a common condition due to post­na­tal ma­ter­nal hormones depletion. Firstly, it should be dif­feren­tia­ted from mastitis and breast abscess. Recent studies in­di­cate that using progestogen-only contraceptives by breast­feeding women appears to be safe for the breastfed in­fant. Case report. We report the case of a 2-month-old boy who presented for endocrine evaluation for asymmetric gy­ne­comastia, which had been observed since birth, but left breast enlargement worsened in the last two weeks, over­lapping the beginning of mother’s treatment with the contraceptive desogestrel. Hormonal evaluation re­vealed a slight increase in prolactin values, with normal go­na­dal, adrenal and thyroid gland hormones. Breast ultra­sound showed bilateral glandular breast tissue, without signs of breast abscess. The patient was managed in a mul­ti­dis­ci­pli­na­ry team and had a good clinical evolution, with the resolution of gynecomastia without a particular treatment. Conclusions. We present herein the case of a male infant who was evaluated for bilateral breast enlargement, diag­nosed as neonatal gynecomastia, overlapping the mother’s treatment with progestogen-only contraceptive desogestrel, who was followed-up, without a particular treatment, with the resolution of breast enlargement.

Pain is a sensory experience that each of us has undergone throughout our lives, a warning sign, an indication of dys­func­tion. Usually, the pain signals a present or imminent tissue injury, allowing the prevention or aggravation of the in­jury and having a protective role. There are no objective mea­sure­ments of pain; the physiological response of the tis­sues to acute injury and pain is similar regardless of whe­ther the source is surgery, trauma, burns or visceral da­mage. Al­most the entire oral and maxillofacial pathology re­lates to the trigeminal nerve; the fight against pain and ob­tai­ning anesthesia cannot be conceived without knowing its anatomy. The approach to a child in the dental office is dif­ferent from that of an adult patient. All children requiring den­tal treatment should be assessed before operation to de­termine the most appropriate form of pain and anxiety ma­nage­ment. The psychological component of analgesia is undeniable in dentistry in general and in pedodontics par­ti­cularly. There are several analgesia techniques and the choice of one or the other must be a well-motivated and as­sumed decision of the doctor, based on the evaluation of the child’s attitude, but also on the appreciation of the com­ple­xity and particularities of the therapeutic work to be performed. It is essential for the physician to know and master the techniques of anesthesia, the anesthetics, but also the accidents and/or complications that may occur. Per­for­ming analgesia in children requires the practitioner a certain experience, totally different from that imposed by the adult patient, given that this act, essential, will con­di­tion, to a large extent, the development of the current ses­sion, but also the future ones. Behavioral guidance or be­ha­vioral guidance accompanied by inhalation are the basic methods in the arsenal of modern sedatives available to the pedodontics. If the sedation methods in the dental of­fice used usually for the dental treatment of children could not be used or did not work, the next step is the dental treat­ment for children under venous conscious sedation or under conditions of general anesthesia in the hospital. Com­pletely uncooperative children often end up being treated with different types of deep sedation – conscious drug sedation or general anesthesia. Choosing or not these methods of analgesia remains at the discretion of the pa­tient/parents of the little patient, under the guidance of the dentist, without losing sight of the fact that nothing re­places the communication between doctor, patient and the parent. However, a successful treatment depends on the choice of the appropriate anesthetic technique and, even then, many children can only be managed with sedation or ge­neral anesthesia.

Background and Objectives: the comorbidity of personality disorders in patients who use psychoactive substances is common in psychiatric practice. The epidemiology of disharmonious personality traits in patients with ADHD and addictions in adulthood is still insufficiently researched. The study investigated the typology of personality traits in a group of adult patients consuming psychoactive substances, in whom symptoms of ADHD were identified. Materials and Methods: the study evaluates a group of 104 patients with chronic psychoactive substances abuse, in whom symptoms of ADHD were identified in early adulthood, in terms of comorbid personality traits. Results: statistically significant data have been obtained regarding the presence of clinical traits characteristic for cluster B personality disorders, the patients presenting lower levels of self-control, self-image instability, difficulties in the areas of social relationships and own identity integration. Conclusions: ADHD symptomatology precedes the clinical traits of personality disorders in patients with addictions, negatively influencing chronic evolution and quality of life.

In recent state of the art, some authors use the term "autism epidemic" which can be explained by the increase in "aware­ness" for this disorder both among parents who ad­dress the doctor early, but also due to the change in diag­nos­tic criteria. With the increase in the number of child­ren diagnosed with autism spectrum disorder, all other pe­dia­tric specialties have faced difficulties in the medical eva­lua­tion of these children, due to the difficulties of ver­ba­li­za­tion and collaboration in various investigations. Even more challenging is the evaluation of these children in dental services. Children with autism are more prone than neurotypical children to various dental pathologies, es­pe­cially caries, due to difficulties of personal autonomy, dif­fi­cul­ties of sensory integration, misunderstanding of healthy oral routines, self-aggressive behaviors that often make them victims of traumas of the oral cavity, or poor ac­ces­si­bi­li­ty/compliance to dental treatments. This pa­per aims to summarize the main oral pathologies faced by pediatric patients with autism, the main risk factors un­der­lying these pathologies, as well as the challenges that the dental services face in the evaluation and treatment of den­tal problems in these children.

Objectives. To establish the radiographic prescriptions in dental implant assessment amongst dentists in Roma­nia. Materials and method. Fifty-four dentists were in­ter­viewed during a dental meeting, using a 15-questions ques­tion­naire, regarding the imaging modality options for both preoperative implant site assessment and for follow-up. We took into consideration particularly the cost, the patient’s radiation dose for each imaging prescriptions, and the broad coverage of facial bones and teeth. Results. The majority of dentists (34) prescribed only panoramic radiographs for dental implant assessment, and 10 dentists (18.5%) ordered panoramic radiographs plus periapical radiographs and/or conventional tomography and/or cone beam computed to­mography (CBCT). Only three (5.55%) of the interviewed dentists prescribed conventional tomography or CBCT as a single examination, and seven of those interviewed preferred the combination of cone beam computed tomography or of conventional tomography with other imaging methods. In the frequency order, the main reason given for prescribing panoramic radiographs were broad coverage, cost, ac­ces­sibi­lity, and radiation dose. Conclusions. This study revealed that most of the Romanian dentists prescribe for dental implant assessment only panoramic radiographs. Thus, they are not following or ignore the recommendations of the international societies of dentomaxillofacial imaging regarding the use, in oral implantology, of the cross-sectional imaging techniques.

Patients with different types of labio-maxillo-palatine clefts go through a lifelong series of multidisciplinary therapeutic procedures; this “journey” sometimes begins prenatally and extends into adulthood. Presurgical orthopedic treat­ment (PSO) is one of the first stages of this therapeutic plan. The nasoalveolar molding technique (NAM) is a new method of approach, from the field of pre-surgical or­tho­pe­dics, in­sti­tu­ted at a very young age (infant), and aims to reduce the initial severity, the level of alveolar cleft and/or the degree of nasal deformity. This approach enables the primary surgical restore of the nostril and lip to heal beneath minimum ten­sion, thereby reducing scar for­ma­tion and enhancing the esthetic result. The NAM tech­nique is the non-surgical, pas­sive method of bringing the gum and lip together by re­di­rec­ting natural growth forces. NAM has been shown to be an effective adjunctive the­ra­py for reducing pain, de­for­mity and the level of soft tissue tearing before surgery. This paper reviews the basic principles of NAM therapy, the different types of devices used in this therapy, the protocol followed and a critical eva­lua­tion of the advantages and disadvantages of this tech­nique. As an example, finally, we present the case of an infant with a unilateral labio-maxil­lary cleft, to which a NAM-type orthopedic device was applied with the aim of reducing tensions at the level of the tissues with the de­fect, to minimize the extent of the sur­gi­cal intervention and to minimize the risk of postsurgical re­trac­tile scars. World­wide, the authors of various studies agree on the positive out­come of NAM for better aesthetics after surgical repair of cleft lip and palate (DLP). However, what still remains, at this moment, unfounded equivocal is whether the pre-sur­gi­cal reduction of the cleft sizes and the modeling ma­ni­pu­la­tion of the nasal complex benefit our patients in the long term. Despite a relatively small amount of high-level evi­dence, NAM appears to be a promising technique that de­serves further research.

Orofacial clefts are congenital defects resulting from a lack of fusion between facial buds; they are the most common con­ge­ni­tal malformations of the cephalic region and involve a variety of abnormalities in the upper lip and upper jaw, sometimes in the nose and hearing aid, involving a lack of uni- or bilateral substance in the affected area. Labio-maxillo-palatine clefts appear in different forms and complexities; in 10-30% of cases only the division of the lip occurs, in about 25% only the division of the pa­late occurs and 40-50% of cases have complete division, labio-maxillo-palatine uni- or bilateral. The diagnosis can be established from the antenatal period, from the first 13-16 weeks of gestation, with the help of ultrasound of the pregnant uterus or fetal MRI. However, most cracks are diag­nosed, unfortunately, at birth; over time, these children may frequently develop repeated respiratory infections, ade­no­i­di­tis, medium otitis, even hearing loss, will present pho­na­tion disorders, requiring speech therapy, and dental ab­nor­ma­li­ties which require prosthesis, dental treatments and oro-maxillo-facial surgery. The modern treatment of labio-maxillo-palatal divisions is complex and must be per­formed in specialized centers; it must start from birth and can last until adolescence or adulthood, involving the presence of a whole team of specialists, who will con­tri­bute to the treatment of various pathological aspects. Or­tho­don­tic treatment, if necessary, should be started at the age of 3 months old and speech therapy at the age of 9 months old. All medical and surgical interventions aim to re­store an aesthetic and morphological aspect as close as pos­si­ble to the normal one, as well as to ensure the normal psy­cho­so­ma­tic and emotional development. This paper is based on the experiences of specialists working in different sections of the “Grigore Alexandrescu” Emergency Clinical Hospital for Chil­dren Bucharest, on our current work protocols, and we have tried to illustrate how they represent current best prac­tices. Concluding, the multidisciplinary treatment should be considered in cleft lip and palate children in order to be able to fully ensure speech and hearing, continuation of occlusion and maxillofacial growth in the normal course and the improvement of physical appearance and psy­cho­lo­gi­cal state. A rational, multidisciplinary approach makes it possible to obtain optimal results in these patients.