Background: Pneumothorax (PTX) is a potential complication of respiratory support in preterm newborns. Less invasive approach to respiratory care likely decreases PTX incidence.
Methods: This retrospective study aimed to investigate the association between non-invasive respiratory support and PTX incidence. We also aimed for evaluating mortality rate and main morbidities linked to PTX, including bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (IVH), severe retinopathy (ROP). We included 459 premature infants delivered before 30 weeks gestation over the period of January 1, 2012 to December 31, 2017 and admitted to the Neonatal Intensive Care Unit of Clinical Centre, University of Debrecen.
Results: 27 infants were identified with diagnosis of symptomatic pneumothorax over the study period. Between 2015-2017, more preterm infants were stabilized on non-invasive respiratory support compared to the period of 2012-2014 (63.6% versus 20.6%, p<0.001). PTX became less frequent (2.6% versus 9.2 %, p=0.0027) with more extensive use of non-invasive respiratory support (2015-2017) as a primary approach to respiratory care. Mortality rate was higher (37% verus 10,2%, p<0,001) and severe IVH (32% versus 14,0%, p=0,037), severe ROP (29% versus 10,1%, P=0,028) were also more common among premature infants with PTX.
Conclusion: Primary use of non-invasive respiratory support in combination with early rescue surfactant administration in preterm infants with good respiratory effort reduces PTX rate and associated adverse outcome.

The diagnosis of acute bronchiolitis should be based on anamnesis and physical examination. The primary task of a primary care pediatrician is to judge the severity of the disease. Majority of cases do not require hospital admission.
Treatment is to ensure proper oxygenation and hydration status. Medicines used to treat older wheezing children are not effective in young infants and do not affect the course of the disease. The most critical tasks of home care are to ensure proper fluid intake, to continue breastfeeding, frequent physiological saline spray, regular, gentle nasal discharge, lifting of the head, providing adequate temperature, comfortable, smoke-free environment, frequent air-ventilation.

The RSV bronchiolitis is a leading cause of lower respiratory tract infection in early life. There is an acute neutrophilic inflammation of the airways and necrosis of epithelial cells which lead to increasing bronchial reactivity. A number of studies have investigated the long-term respiratory morbidity after viral bronchiolitis in early infancy. Nowadays there is a well-established conclusion that RSV infection in infancy is a risk factor for recurrent wheeze and probably for asthma in the first decade of life.

Introduction:Autoimmune polyendocrinopathy type 1 and intestinal lymphangiectasia are rarely combined, there are only a few published cases in the literature.
Case descriptions: A 5 months old boy presented with intractable diarrhoea and suspected primary immunodeficiency, the etiology of his diseases was explored with clinical exome sequencing by new generation technology showing AIRE mutation and at the same time we verified his intestinal lymphangiectasy with gastro-duodeno-jejunoscopy. His initial
symtomps were hypoproteinemia, hypogammaglobulinemia and lymphopenia, he also developed a CMV colitis and until his lymphagniectasy resolved he often needed parenteral nutrition and immunoglobulin support. His gastrointestinal symptoms resolved only by aminoacid based formula feeding. Because of the early age or the mild clinical phenotype his classical APECED symptoms has not been manifested yet at the moment.
Conclusions: Cases of atypical manifestations or late onset primary immunodeficiencies benefit most from clinical exome sequencing as they can be missed by other targeted NGS investigations, and this has a fundamental role in early adequate treatment of primary immunodeficiencies.

Introduction: Priapism is an involuntary penile erection lasting more than 4 hours. Urgent and adequate therapy is not always enough to prevent erectile dysfunction.
Case report: A 15 year old male patient affected by Crohn’s disease presented with stuttering priapism. After detailed testing we did not find any other diseases as etiologic factor. We treated the acute crisises with suprapubic local anesthesia. We initiated biological therapy, psychotherapy, and flavonoids. While receiving biological therapy, the patients Crohn’s disease improved. 3 months after starting the combined therapy the priapism subsided. No erectile dysfunction developed.
Conclusion: The stuttering priapism was caused by the underlying disease and its complications (psychological stress and pelvic inflammation), all of which required effective treatment to prevent complications.

Lamotrigine is a widely used antiepileptic drug, that can be associated with unexpected, severe reactions. The authors presented three cases of severe drug allergy associated with lamotrigine, such as lamotrigine induced anaemia, DRESS (drug rash with eosinophilia and systemic symptoms) syndrome, and Lyell syndrome. Suspending lamotrigine, the symptoms showed improvement. Transfusion helped in the first case, high-dose steroid therapy was effective in the other cases. A few months later, leukocyte transformation test was carried out with positive results.

Introduction: Spinal epidural abscess is an uncommon condition which can occur by hematogenous spread or by direct extension. Predisposing factors are invasive spinal or near spinal procedures and any condition that results in bacteremia or immunodeficiency.
Case: A sixteen year old adolescent attended to our emergency department because of backpain. MR imaging of the spinal column confirmed the diagnosis of spinal epidural abscess. Right after establishing the diagnosis the surgical and medical therapy was commenced without any delays. After therapy the patient was discharged to home without any neurological deficit.
Conclusion: We would like to emphasize the knowledge of the red flags, the specific alarming symptoms of each group of illnesses. In case of acute backpain these are fever, neurological deficit, immunosuppression, spinal or near spinal invasive procedures.

It is extremely important to start the antishock therapy and the multidisciplinary provision of severe burn injured children as soon as possible. Our case reports a 2,5 year-old girl who was injured under criminal circumstances. Due to the late antishock therapy, besides the symptoms of the already life threatening severe burn illness, as a result of the
delayed hypovolemic shock, an acute kidney failure had developed. Consequently, a chronic renal insufficiency evolved gradually. The symptoms were hyperkalemia, metabolic acidosis, anuria-oliguria, microalbuminuria, anemia, hypertension and hypercalciuria. In addition, it contributed on a large scale to the manifestation of the cardiopulmonary arrest, sepsis, and multiorgan failure. It extended the hospital care and the time of recovery too. With the review of these impressive adverse reactions we would like to call my colleagues attention to what kind of shortand long-term adverse reactions we have to face in similar cases.

Idiopathic pulmonary hemosiderosis is a rare chronic illness with alveolar haemorrhage and accumulation of hemosiderin-laden macrophages in the lungs. The prompt etiology of the disease is unknown, but most of the hypotheses expect the autoimmune theory. The idiopathic pulmonary hemosiderosis often associates with other autoimmune conditiones, for example celiac disease. In our case report, a sixteen-year old girl history is presented,
who had haemoptoe, gravis anaemia and somatic disorders, and her diagnosises are idiopathic pulmonary hemosiderosis and celiac disease.