Cilj: Prikazati dva novorođenčeta s klinički sličnom, ali etiološki različitom prezentacijom generalizirane hipotonije, s naglaskom na diferencijalno razlikovanje perifernih i središnjih uzroka uz primjenu suvremenih dijagnostičkih postupaka.Metode: Prikazana su dva slučaja novorođenčadi hospitalizirane u tercijarnom centru. Evaluacija je obuhvatila perinatalne podatke, klinički pregled, laboratorijske i metaboličke pretrage, neuroradiološke metode (ultrazvuk i magnetska rezonanca mozga), elektroencefalografiju (EEG) te proširenu genetičku analizu cjelokupnog egzoma (WES – Whole Exome Sequencing).Prikaz bolesnika: U prvom slučaju, muško, terminsko novorođenče, od rođenja je imalo tešku hipotoniju, bulbarnu disfunkciju i progresivnu respiratornu insuficijenciju uz uredne neuroradiološke i elektrofiziološke nalaze. WES je potvrdio patogenu de novo varijantu ACTA1 c.547C>T (p.Arg183Cys), u skladu s klinički teškim oblikom nemalinske miopatije. U drugom slučaju kasno prematurno novorođenče prezentiralo se hipotonijom, respiratornim distresom, apnejama i kasnijim razvojem toničko-kloničkih konvulzija. Neuroradiološki nalaz pokazao je periventrikularnu leukomalaciju, talamične hemoragije i uvećanu cisternu magnu, dok je EEG ukazao na multifokalnu epileptičku aktivnost, što je bilo u skladu s hipoksično-ishemijskim oštećenjem mozga nakon perinatalne asfiksije.Zaključak: Iako je inicijalna prezentacija bila gotovo identična kod oba novorođenčeta, etiologija hipotonije bila je različita. Sustavna i višeslojna dijagnostička evaluacija ključna je za razlikovanje perifernih i središnjih uzroka. Rana primjena genetičkog testiranja može ubrzati dijagnozu neuromišićnih poremećaja, dok pravodobno prepoznavanje perinatalne asfiksije omogućuje proaktivnu neuroprotektivnu terapiju. Ovi slučajevi naglašavaju važnost integracije kliničkih, neuroradioloških i genetičkih podataka u procjeni hipotone novorođenčadi.

Postavlja se pitanje što je to zapravo inteligencija? Ima mnogo definicija inteligencije ali najmanje ćemo pogriješiti ako se priklonimo onoj koja kaže da je inteligencija sposobnost dolaska do točnog odgovora na postavljeno pitanje. Time je definirana i gradacija inteligencije koja ovisi o težini postavljenog pitanja i točnosti odgovora. Ovdje namjerno nismo spominjali uz pojam inteligencije čovjeka jer je tzv. inteligencija svojstvena i životinjskom svijetu. Što leži u temelju inteligencije? Živčani sustav odnosno njegova paradigma mozak. Međutim, izgradili smo računala i u njih ugradili mogućnost da mogu davati točne odgovore na postavljena pitanja. Ovisno o tome „s koje strane dominantno” dobivamo točne odgovore na postavljena pitanja, od mozga ili računala, inteligenciju smo podijelili na prirodnu i umjetnu. Kad smo na planu pitanja i odgovora, preko kojeg definiramo inteligenciju onda smo zapravo, na planu informacija, podataka. Što je podatak kod prirodne inteligencije a što kod umjetne inteligencije? Kod prirodne je prolaz električnog impulsa u živčanom sustavu kroz „ansambl” neurona odnosno njihovih spojnica, sinapsa. Kod računala je to isto električni impuls koji vrši promjene na stanovitim česticama a koje se mogu mijenjati i dobiti nove oblike. Koja od ove dvije osnove pruža „veće mogućnosti” inteligenciji? Odgovor je nedvojben: prirodna inteligencija i njena paradigma mozak. Ne samo na sadašnjoj razini razumijevanja inteligencije nego i u dalekoj predvidivoj budućnosti koja će uključiti i tzv. nanotehnologiju u računalima ili „iluziju” o tzv. kvantnoj tehnologiji u računalima. Na čemu se gradi takva konstatacija: sinapsa kao temelj prolaza elektriciteta kroz stanice živčanog sustava sa svojom sposobnostima uključivanja minimalnog do nevjerojatno velikog broja jedinica, sa svojim pobočnim utjecajem koji pokazuje nemjerljive količine tih mogućnosti, sa svojom sposobnosti nastajanja i nestajanja tih prolaza je neusporedivo bolji pratilac zahtjeva za stvaranjem, nestajanjem i manipulacijom informacijama nego bilo koji stroj.

Adrenal insufficiency is a frequently underestimated disorder that, if unrecognized, increases the risk of adverse outcomes during acute illnesses and diagnostic or therapeutic interventions. The rising incidence of chronic diseases commonly treated with glucocorticoids has made iatrogenic adrenal insufficiency a significant concern even within the pediatric population.The aim of this paper is to emphasize the importance of acknowledging and promptly recognizing signs of adrenal insufficiency in children, both in those receiving chronic hydrocortisone replacement therapy for previously diagnosed adrenal insufficiency and in those on long-term glucocorticoid therapy in whom adrenal insufficiency may remain undetected. Through a systematic review and analysis of relevant scientific literature, clinical guidelines, and textbooks, we provide an overview of the pathophysiology underlying adrenal insufficiency, its recognition, and management, with special emphasis on adrenal insufficiency induced by chronic glucocorticoid therapy. By synthesizing available recommendations and guidelines, we outline strategies for identifying risk factors for adrenal insufficiency, offer management recommendations for acute illness and stress, and propose guidance for the safe tapering and discontinuation of chronic glucocorticoid therapy.Raising awareness of iatrogenic adrenal insufficiency in children treated with long-term glucocorticoids, recognizing that these patients are unable to mount an adequate stress response, and educating physicians and caregivers on timely action in emergencies are fundamental steps toward reducing the risk of severe complications.

Differentiating benign viral illnesses from serious bacterial infections (SBIs) is still challenging when treating pediatric patients. Young febrile infants, particularly those ≤90 days of age, carry a disproportionately high risk of invasive bacterial infections (IBIs) due to immunologic immaturity and subtle clinical presentations. Given increasing antimicrobial resistance, there is a critical need for reliable biomarkers capable of supporting early and accurate diagnostic decision-making. Procalcitonin (PCT), an acute-phase biomarker with rapid induction during bacterial infection, has emerged as one of the most promising tools. Compared with C-reactive protein (CRP), PCT demonstrates faster kinetics, stronger correlation with disease severity, and superior diagnostic accuracy in multiple pediatric settings, including neonatal sepsis, febrile infants, neutropenia, meningitis, bronchiolitis, and lower respiratory tract infections. Age-specific reference ranges improve interpretability in neonates, and serial PCT measurements have been successfully incorporated into antibiotic stewardship protocols. Numerous multicenter studies and randomized trials show that PCT-guided management reduces unnecessary antibiotic exposure without compromising clinical safety or increasing treatment failure. Despite its advantages, PCT is not without limitations, as transient elevations may occur in noninfectious conditions and levels can remain low in the earliest phases of infection. Nevertheless, accumulating evidence demonstrates that low PCT values reliably indicate a low probability of bacterial infection, enabling safer reduction in antibiotic use. Overall, PCT represents a valuable biomarker for improving diagnostic accuracy and promoting rational antibiotic therapy in pediatric practice.

Uvod: Tumori središnjeg živčanog sustava predstavljaju najčešće solidne tumore u dječjoj dobi, pri čemu su glijalni i embrionalni tumori najzastupljeniji. Klinička slika često je nespecifična te ovisi o dobi djeteta i lokalizaciji tumora. Dijagnoza se temelji na neuroradiološkoj obradi (magnetska rezonancija i kompjutorizirana tomografija) te patohistološkoj i molekularnoj analizi tumora. Rano prepoznavanje simptoma ključno je za pravodobno planiranje liječenja, poboljšanje ishoda terapije i kvalitete života bolesnika. Prikaz slučaja: Prvi prikazani slučaj odnosi se na sedmogodišnju djevojčicu koja se klinički prezentirala ataksijom, glavoboljom i smetnjama vida. Neuroradiološkom obradom verificiran je tumor u području IV. moždane komore sa znakovima hipertenzivnog hidrocefalusa, a metilacijskim profiliranjem potvrđeno je da se radi o meduloblastomu (grupa 4, subklasa 6). Drugi slučaj uključuje dvanaestogodišnjeg dječaka s frontalnim glavoboljama i jutarnjim povraćanjem. Magnetskom rezonancijom mozga i kralježnične moždine verificiran je tumor u području IV. moždane komore s metastazama, dok je molekularnom analizom tumorskog tkiva potvrđen meduloblastom (grupa 4, podtip V). Treći slučaj je sedamnaestogodišnja djevojka koja se prezentirala umorom, gubitkom tjelesne mase i sekundarnom amenorejom. Slikovnom obradom uočen je tumor supraselarne i pinealne regije uz jednu solitarnu intrakranijsku metastazu, čime je postavljena dijagnoza metastatskog bifokalnog germinoma uz negativne tumorske markere. Zaključak: Procjena djeteta sa sumnjom na tumor središnjeg živčanog sustava mora biti sustavna te uključivati detaljan neurološki pregled, praćenje rasta i opsega glave u dojenčadi i mlađe djece, kao i procjenu pubertetskog statusa. Kombinacija navedenih simptoma zahtijeva pravodobnu neuroradiološku obradu radi ranog otkrivanja bolesti i započinjanja odgovarajućeg onkološkog liječenja.

Uvod: Wilsonova bolest je autosomno recesivni poremećaj metabolizma bakra uzrokovan mutacijama gena ATP7B koji dovodi do smanjenog izlučivanja bakra iz hepatocita u žuč i njegova nakupljanja, prvenstveno u jetri i središnjem živčanom sustavu. Klinička slika uključuje jetrene, neurološke i psihijatrijske manifestacije. U dječjoj dobi je najčešća jetrena prezentacija, često u obliku asimptomatskog povišenja aminotransferaza. Prikaz bolesnika: Djevojčica u dobi od šest godina, urednog rasta i razvoja, bez tegoba, dolazi na obradu povišenih aminotransferaza. Povišene vrijednosti jetrenih enzima prvi su put zabilježene u tijeku respiratorne infekcije, a u kontrolnim nalazima tijekom 7 mjeseci se prati porast alanin aminotransferaze (ALT) (maksimalno 12 puta iznad gornje granice referentnog intervala) i blaže povišene aspartat aminotransferaza (AST) i gama-glutamil transferaza (GGT) uz uredne parametre sintetske funkcije jetre i bilirubin. Diferencijalno-dijagnostičkom obradom isključeni su infektivni i autoimuni uzroci, a vrijednosti lipidograma, alfa-1 antitripsinai i hormona štitnjače bili su uredni. Ceruloplazmin je bio uredan, ali je izlučivanje bakra u 24-satnom urinu bilo povišeno, a zatim je i nalaz penicilaminskog testa bio patološki pa je učinjena biopsija jetre čiji nalaz je utvrdio makrovezikularnu steatozu i blagu fibrozu uz značajno povišenu koncentraciju bakra u suhoj tvari jetrenog tkiva (399 µg/g). Zaključno je postavljena dijagnoza Wilsonove bolesti i liječenje je započeto penicilaminom u postupno rastućim dozama, uz vitamin B6 i smanjeni unos bakra. Prati se povoljan biokemijski odgovor. Molekularno-genetskom analizom utvrđene su 2 heterozigotne mutacije gena ATP7B te je potvrđena dijagnoza. Zaključak: Ovaj prikaz naglašava važnost sustavne obrade perzistentno povišenih aminotransferaza čak i u djece bez simptoma kako bi se na vrijeme dijagnosticirale lječive bolesti kao što je Wilsonova bolest.

Serious allergic reactions develop within minutes or several hours after exposure to an allergen. In children, the majority of serious allergic reactions are caused by food allergens. Anaphylaxis is a serious allergic reaction that occurs rapidly and can cause death. Intramuscularly applied adrenaline is the first-line therapy for the treatment of anaphylaxis. Adrenaline autoinjectors should be prescribed to all patients who have had an anaphylactic reaction or are at high risk of developing one. Adrenaline autoinjectors should be used by parents, teachers, or older children in all anaphylactic reactions, including those less severe. Parents, children, and teachers should be regularly educated on how to use adrenaline autoinjectors. Children with severe food allergies and their parents face a high risk of severe allergic reactions during everyday life. The collaboration of children, parents, teachers, primary care specialists and allergologists, as well as the healthcare system and food industry is important to minimize the burden of severe food allergy.

Childhood obesity is a global public health problem of the 21st century. Today, childhood obesity is considered a complex chronic, relapsing disease that negatively affects the quality of life, not only by causing unnecessary accumulation of adipose tissue, excessive body weight, but also by triggering severe health complications that have traditionally been described in adults. These complications include type 2 diabetes, hyperlipidemia, and cardiovascular disease, as well as many other negative health consequences. The etiology of obesity is multifactorial and includes genetic predisposition, environmental factors, socio-economic and behavioral factors. Obesity that begins in early childhood often continues into adolescence. It has been observed that obese adolescents have a higher risk of remaining obese in adulthood. Treatment of obesity in children requires a comprehensive approach, including changes in health behavior and lifestyle, pharmacological, psychological, motivational, metabolic and surgical interventions. The first step in treating childhood obesity is considered to be changing unhealthy behavior and lifestyle. This intervention is considered safe in almost all age groups of children and includes nutritional interventions aimed at changing unhealthy eating habits and establishing long-term healthy eating habits and can be combined with motivational and psychological support. If necessary, this intervention may be combined with other treatment modalities including pharmacotherapy and surgery. It is also considered that this intervention should be individually tailored personalized. Such an approach also requires a comprehensive understanding of the polygenic factors that contribute to obesity and their interactions with genetic factors, pathogenic environmental factors, and the impact on the outcomes of different treatment strategies. Also, a personalized approach to the treatment of obesity in children aims to increase the effectiveness of interventions and reduce side effects. Interventions that include changes in health behavior and lifestyle, however, require further research. The addition of anti-obesity medication to an intervention that changes health behavior and lifestyle is considered a step that should be taken immediately after the diagnosis of obesity in children. This combination shows promise for the effective management of obesity in children (1-4). The use of anti-obesity medications in children must be rational because it is still unknown whether and what the negative effects of these medications on the child's growth and development may be. Data on the efficacy and safety of anti-obesity medications in children mainly come from not so many clinical trials, and long-term effects on weight loss, adherence to treatment, and side effects require long-term evaluation. Poor reimbursement for anti-obesity medications, a lack of prevention programs, and a widespread belief that obesity is not a chronic disease are also issues that limit the practice of initiating treatment for obesity in childhood. Effective treatment of childhood obesity requires a comprehensive, multidisciplinary approach that addresses not only the physical aspects of obesity, but also social, socioeconomic, and other factors. Overcoming the barriers to treating childhood obesity will require firm efforts by health care providers, researchers, policymakers, and families.

Introduction: Acute onset of chest pain and dyspnea in adolescents is an emergency and often a diagnostic challenge. In the differential diagnosis, one of the possible causes of a sudden onset of chest pain and dyspnea is spontaneous pneumomediastinum (SPM). The most common causes of SPM are asthma exacerbation and lower respiratory tract infections. Other predisposing causes are trauma, vomiting, cough, Valsalva maneuver, helium inhalation from a balloon, use of e-cigarettes and vape devices, and drug inhalation. We will present a case of sudden onset of chest pain in an adolescent caused by SPM, which we believe was caused by the consumption of an e-cigarette or vape device. Case report: A 17-year-old male was examined in the pediatric emergency department due to the sudden onset of stabbing chest pain lasting one day, with shortness of breath and a dry cough. From the anamnestic data, we learn that the pain first occurred during physical exertion (stacking wood) and that he smokes an e-cigarette. He denies allergies and asthma. He had not been recently ill. Upon examination, the young man was in good general condition, with cardiopulmonary compensation and normal oxygen saturations on room air, and was afebrile. The chest was sensitive to palpation in the sternum area, with no signs of subcutaneous emphysema. Auscultation revealed normal breath sounds and normal lung sounds on percussion. Radiological work-up (heart and lung X-ray, MSCT of the chest) revealed pneumomediastinum, from the soft tissues of the neck almost to the diaphragm. Laboratory work-up revealed a slightly elevated CRP with a normal complete blood count, acid-base status, normal immunoglobulin, and alpha-antitrypsin values. Skin prick test for inhaled allergens was negative for all tested allergens. He was hospitalized for further observation. Symptomatic therapy and rest were continued during the stay, and gradual recovery of symptoms was monitored. In conclusion, we believe that this is a spontaneous pneumomediastinum most likely caused by the consumption of an e-cigarette or vape device. He is discharged home with recommendations for rest, the use of analgesics as needed, and avoidance of e-cigarette and vape device consumption. Conclusion: SPM caused by the use of vape devices is rare, but with the increasing consumption of such devices, its incidence is increasing, especially in adolescents and young adults. It is known from the literature that the use of vape devices is also associated with more severe clinical conditions, such as spontaneous pneumothorax, pneumorrhagia, and diffuse alveolar hemorrhage, which shows that the use of vape devices in patients with sudden chest pain is an important anamnestic data point.