(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.

Acute otitis media (AOM) in children is one of the leading causes of health care visits and antibiotic prescriptions worldwide. The overall aim of the current study is twofold: 1. to analyze and discuss the antibiotic prescription patterns in AOM in children without complications or risk factors and 2. to assess to what extent the watchful-waiting approach is a real practice or a mere desideratum. We performed an electronic search in the PubMed and Embase databases from 2013 to 2023 to capture original research studies investigating antibiotic prescribing patterns for AOM in children. Among the 12 papers included in the analysis, the antibiotic prescription rate ranged from 44.8% to 98%. Our study reveals similarities regarding the use of amoxicillin as a first-line antibiotic in pediatric AOM, but also discrepancies in the watchful-waiting approach attitude and in the choice of second or third-line antimicrobial agents. The proportion of cases managed with the watchful-waiting approach ranged from 7.5% (Australia) to 55.2% (Finland). Denmark was the only country reporting penicillin V as a first-choice regimen for children with AOM, which fulfils the guidelines’ recommendations. The most unsatisfying rate of amoxicillin use was recorded in Japan, contrary to the recommendations of local guidelines. The use of quinolones was reported in two out of twelve studies, with the highest proportion in Japan, where tosufloxacin was used in 21.4% of the total number of cases. The duration of the antibiotic regimens was analyzed in three out of twelve papers. Since global antibiotic overuse contributes to the emergence of antibiotic resistant bacteria, new strategies are needed to increase the rate of watchful waiting and to promote the judicious use of antibiotics.

Immune thrombocytopenic purpura (ITP) is the most frequent form of autoimmune disease in childhood, characterized by thrombocytopenia (platelet count <150·10⁹/L) with otherwise normal cell lineages. One of the main mechanisms is the platelet destruction by phagocytic cells, covered by human Fc receptors (FCGR). The FCR family involves 3 classes of receptors: FCGR1A, 1B, and 1C; FCGR2A, 2B, and 2C; FCGR3A and 3B, all present on chromosome 1q23-24. The response to ITP treatment may be influenced by the polymorphism of the FCGR3A gene, which contributes to different levels of destruction of antibody - bound platelets. Material and methods: We report the results of FCGR2/3 polymorphic genotypes in 16 children with ITP admitted at the “Sf. Maria” Emergency Children’s Hospital, Iasi, Romania, treated with corticosteroids, intravenous immunoglobulin (IVIg) or both, or conservative treatment, with a minimum of one year follow up. Results: We identified 9/16 patients with FCGR2C ORF haplotypes, 8 in heterozygous state and one in homozygous state, and 15/16 patients with FCGR2A-His166 variant. While it was previously reported that classical FCGR2C-ORF and 2B.4 variants correlate with the transient form of ITP and a good response to IVIg, in our sample it was present only in 3 patients, who had limited course of disease and a good response to IVIg. 5 patients were heterozygotes for FCGR2C-p.Gln62Trp, all of them developing an acute form, a good response to IVIg and no relapses. Furthermore, it has been demonstrated an association between FCGR genotypes characterized by increased immunoglobulin binding activity (FCGR3A allele V158 and FGCGR3B allele NA1) and chronic children ITP. In our study, only 2/16 patients express NA1 in homozygous state, one of them developing persistent ITP, while the other responded well to the treatment and did not relapse. Conclusions: Genetic influences contribute to the pathogenesis of ITP in children and response to IVIg. We evaluated the genetic risk factors in the FCGR2/3 locus that are associated with predisposition to limited course and a favorable response to IVIg in ITP in children. However, confirmation in a larger prospectively recruited cohort of children with ITP is needed.