INTRODUCTION: This article reflects on the plight of patients with short bowel syndrome (SBS) in developing countries. SBS is life threatening, rare, complex and often not considered a priority by healthcare planners in the developing countries because of the high cost of treatment. Data was collected and analyzed from 3 different hospitals in two different countries (Romania and Austria) from November 2013 to February 2016 CASE PRESENTATION: The patient had an emergency surgery for volvulus as a result of an extensive ischemic necrosis, with just 80 cm of the bowel left and no ileocecal valve after enterectomy. Despite intensive care and surgeries for anastomotic joint ischemic necrosis and intestinal adhesion with just 70 cm of the intestine left after primary anastomosis, the patient remained in a catabolic state (metabolic acidosis, severe malabsorption and loss of nutrients, water and electrolytes through diarrhea) and was transferred overseas where two more surgeries (intestinal stomas) and good intensive care helped to achieve enteral autonomy at the optimal time. DISCUSSION: This immune-deficient patient was exposed to various types of bacteria ( Klebsiella pneumoniae , Pseudomonas aeruginosa ). Two years after surgery an acute enterocolitis with salmonella infection and resultant intestinal failure treated in patient’s country of origin failed to achieve enteral nutrition warranting a second overseas transfer. CONCLUSION: The lack of sufficient mucosal surface followed by long time intestinal adaptation process is crucial in determining bowel functional capacity. Long time hospital stay and cost was reduced through a parental home healthcare management training scheme. Highlights:

This paper highlights a clinical case of sepsis caused by soft tissue infection. Peripheral blood smear, plasma value of inflammatory biomarkers and the white blood cells count were performed. Significant morphological changes were revealed through peripheral blood smear test two days after patient admission. Patient developed septic shock after the third day in intensive care unit (ICU). Laboratory results showed major morphological changes (erythrocytes deformity, abnormal neutrophils); these were correlated with elevated plasma value of interleukin-6 and procalcitonin.

Sarcomatoid renal cell carcinoma (SRCC) is an aggressive form of de- differentiated renal cell carcinoma. We report a case of a 79-year-old male who presented himself to the Department of Emergency complaining of macroscopic hematuria for the last two days and a back pain located in the lumbar region persisting for around a month; there were no major changes in the initial laboratory tests. Abdominal ultrasonography identified a renal mass located in the lower pole of the left kidney. The computed tomography (CT) scan with iodine-based contrast revealed the left kidney had a complete deletion of corticomedullary differentiation and a large renal mass located in the lower pole with inhomogeneous iodophilia, which measured around about 15 cm in transversal diameter and 13.6 cm in craniocaudal diameter. Nephrectomy of the left kidney was performed. Histopathological and immunochemistry tests diagnosed a SRCC with clear cells and eosinophilia. We present these findings along with a short review of the literature.

Background and Objectives: Adequate levels of vitamin D are vital for both growth and immunomodulation in children. To evaluate the levels of vitamin D in children from Western Romania and to identify significant age, seasonal, and geographical disparities. Materials and Methods: This study evaluates the level of 25-hydroxyvitamin D levels assessed on Cobas 6000’s module e601 in 1698 children aged 1–18 years between 1 January 2018 and 31 December 2021 from Western Romania. Results: Children aged 1–6 years predominantly present sufficient levels (>30 ng/mL), while older age groups showed a marked decline. Adolescents aged 13–18 years were most affected, with over half displaying insufficient levels (20–30 ng/mL). Rural children were more likely to achieve sufficiency compared to urban peers. Males demonstrated significantly higher vitamin D levels when compared to females. Seasonal variations showed the highest vitamin D levels during late summer and early autumn (September: aOR = 5.47; 95% CI: 3.17–9.42, p < 0.001). Multivariate analysis revealed a significant improvement in vitamin D levels during 2019–2020. Conclusions: Our findings suggest the need for targeted screening programs and health policies to address vitamin D deficiency, particularly among older children, urban residents and during winter months.