Tag Archives: children

Maternal Knowledge, Attitudes and Practices Regarding Dietary Fats

Nădășan Valentin*, Sîmpetrean Andreea, Tarcea Monica, Abram Zoltan

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0043

Objective: The purpose of the study was to assess the knowledge, attitudes, and behavior regarding dietary fats among mothers in Romania.
Material and methods: A sample of 305 mothers from Romania were included in a cross-sectional observational study. The online questionnaire addressed their knowledge, attitudes, and practices regarding the dietary fats used in their children’s diet. The frequencies and proportions of the collected variables were calculated based on respondents’ answers.
Results: While almost all the respondents (94.8%) believed that mothers are supposed to know the difference between saturated and unsaturated fats, only less than half of them (39.7%) stated that they know the difference. As far as the types of margarine, although more than half of the respondents (64.7%) believed that mothers should be able to discriminate between the hydrogenated and interesterified margarine, only 11.5% claimed that they are able to discern between them. The actual ability to identify foods rich in saturated fats varied in a great degree from item to item. More common dietary fats such as sunflower oil, corn oil, and lard, were more frequently identified than less common dietary fats such as coconut oil and palm oil. Only 16.4% of the mothers were able to correctly differentiate hydrogenated from interesterified margarine. The most frequently used spreadable fat used in the children’s diet was butter and the most frequently used cooking fats were sunflower oil, olive oil, and butter.
Conclusion: The results of this study might be informative in the development of maternal nutrition education programs.

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Ambulatory Blood Pressure and Arterial Stiffness in Obese Children and Adolescents

Duicu Carmen1*, Mărginean Cristina Oana1, Pitea Ana Maria1, Melit Lorena Elena2

1 University of Medicine and Pharmacy Tirgu Mureș, Romania, 1st Department of Pediatrics
2 Emergency Clinical County Hospital of Tirgu Mureș, Romania, Pediatrics Clinic 1

DOI: 10.1515/amma-2015-0090

The aim of the present study was to investigate differences regarding 24-hour blood pressure and arterial stiffness in a cohort of office normotensive obese and non-obese children and adolescents, and to evaluate correlations of these parameters with some anthropometric indices.
We retrospectively evaluated ABPM records in 71 children (42 boys); 31 obese compared with 40 normal-weight children.
Results: Mean 24-hour, day-time and night-time SBP was significantly higher in the obese group than in the control group (p <0.01 during the entire period). Significantly higher AASI values were found in obese children compared to controls (0.45 vs. 0.41, p <0.05), the difference being more obvious for day-time AASI (p <0.001). Conclusions: This research confirms that SBP and AASI are increased in obese children. AASI is a useful index of arterial stiffness that can be easily measured under ambulatory circumstances in children.

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Gastroesophageal Reflux Disease and Helicobacter pylori in Children

Grama Alina1, Duicu Carmen1, Sigmirean Marcela1, Chinceșan Mihaela2, Voidăzan S3, Grama O4

1 Pediatric Department II, Faculty of Medicine, University of Medicine and Pharmacy Târgu Mureș
2 Pediatric Department I, Faculty of Medicine, University of Medicine and Pharmacy Târgu Mureș
3 Epidemiology – Preventive Medicine Department, Faculty of Medicine, University of Medicine and Pharmacy Târgu Mureş
4 Ginecology Department II , Faculty of Medicine, University of Medicine and Pharmacy Târgu Mureș

Introduction: The role of Helicobacter pylori in gastroesophageal reflux disease remains controversial, particularly in children, since there are limited published data. More than half of the world’s population carries this infection. Infection rates vary among the developed and developing countries of the world.
The aim of our study was to determine the role of Helicobacter pylori infection in the development of gastroesophageal reflux disease in a pediatric population.
Material and method: We retrospectively reviewed medical records of patients hospitalized in the Two Pediatric Clinic Târgu-Mureș, Gastroenterology Department, from 2009 to 2010. We included in the study 376 children between 1 and 18 years with clinical symptoms (epigastric pain, vomiting, nausea, anorexia, loss weight) and the outcome of endoscopy confirmed the Helicobacter pylori gastritis and gastroesophageal reflux disease.
Results: Among the 376 patients, 55.05% were positive for Helicobacter pylori and 12.5% were found to have gastroesophageal reflux disease. The prevalence of gastroesophageal reflux disease in the Helicobacter pylori positive population was 11.6 % compared to 13.61 % in the Helicobacter pylori negative population (p > 0.05). The biggest prevalence of this infection was in the 10–14 yrs age group (63.05%).
Conclusions: We found no significant difference in gastroesophageal reflux disease between children with and without Helicobacter pylori infection. Antral predominant nonatrophic gastritis is common in children.

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Management of Pediatric Supraventricular Arrhythmias

Borka-Balás Réka1, Gozar Liliana2, Blesneac Cristina2, Baghiu Maria Despina3, Togănel Rodica2

1 Clinical Center Pharmaquest, Tîrgu-Mureş, Romania
2 University of Medicine and Pharmacy, Faculty of Medicine, Cardiology Clinic III – Children, Tîrgu-Mureş, Romania
3 University of Medicine and Pharmacy, Faculty of Medicine, Pediatric Clinic I, Tîrgu-Mureş, Romania

Background: Supraventricular tachycardia is the most common symptomatic arrhythmia in children.
Objective: To evaluate the incidence of supraventricular tachycardia in children, to identify the etiology and the predisposing factors and to propose an effective treatment strategy.
Method: Between January 2004 and December 2009, children with supraventricular arrhythmias treated in Pediatric Cardiology Clinic Tirgu-Mures, were included in this retrospective study. The arrhythmia was diagnosed with clinical examination, 12-leads ECG and/or 24 hours Holter monitoring, echocardiography for identification of associated cardiac malformations. In all cases the followed parameters were: age of onset, predisposing factors, underlying mechanism of arrhythmia, efficacy of treatment.
Results: 87 children with supraventricular arrhythmias with a median age of 9 years were included. Supraventricular tachycardias were the most frequent in children at school age and adolescents (70.1%); the incidence decreased in younger children and infants. Predisposing factors were cardiac malformations, cardiac surgery, dilatative cardiomyopathy, myocarditis. Trigger factors were physical exercises, infections, fever and emotions. The commonest underlying mechanism was atrioventricular nodal reentrant tachycardia (85.71%). The emergency treatment: vagal stimulation successful in 12 patients, medical treatment in 72 patients, electric cardioversion 3 patients. 90% of patients benefits of long-term treatment; the most used were betablockers and class III antiarrhythmics. Only 12% of patients present breakthrough episodes.
Conclusions: The incidence of supraventricular tachycardias in children is high, they are occurring frequently on structurally normal heart, but they have also many predisposing factors. The underlying mechanism is important in selection of effective medication. Class III antiarrhythmics were effective in cases refractory to other medications.

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Helicobacter pylori Gastritis in Children – Assessment of Resistance to Treatment on the Casuistry of the Ist Pediatric Clinic Tîrgu Mureș

Mărginean Oana, Pitea Ana-Maria, Brînzaniuc Klara

University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: It is generally recognized the role of Helicobacter pylori in the pathogenesis of peptic ulcer disease in adults and children. Some cases raise serious concern regarding the therapeutic approach because they do not heal with normal treatment schemes or have frequent relapses due to the fact that the microorganism has virulence factors that determine resistance to therapy.
The purpose of this work was to analyze the cases of gastritis due to H. pylori in children from our casuistry, which have not healed despite a properly conducted treatment to eradicate the bacteria.
Material and methods: This was a prospective study carried out on 1,041 children aged between 2 and 18 years, diagnosed with different types of gastritis in Ist Pediatric Clinic from Tîrgu Mureș, admitted between January 2001 and March 2010. We have had 539 cases of gastritis due to H. pylori; for these patients a specific treatment was prescribed in order to eradicate the infection and to cure gastritis (accor-ding to the current internationally accepted recommendations).
Results: The average age of patients in the study group was 12.9 years, with a higher incidence in the 7–12 (33.02%) and 13-18 years (62.89%) age group, predominantly among female patients (63.45%) and those from rural areas (55.84%). From the patients diagnosed with Helicobacter pylori gastritis, 478 cases presented for review; after proper treatment with anti-infectives in combination with proton pump inhibitors, clinical-histological healing of the disease after a month was found in 426 cases (89.12%); a number of 52 patients remained positive (10.87%). Two months after treatment the endoscopical and histopatological modifications persisted in 26 cases (5.43%); a total of six cases (1.25%) remained positive for Helicobacter pylori infection after therapy.
Conclusions: The resistance of Helicobacter pylori infection to therapy is caused by the continued action of favoring factors, the virulence of the microorganisms in association with a genetic predisposition present in some individuals.

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The Role of Acanthosis Nigricans in Identifying Clinical and Metabolic Features of the Metabolic Syndrome in Obese Children

Duncescu Corina1, Mărăzan Monica1,2, Chirita-Emandi Adela1, Craioveanu Teodora2, Dăescu Camelia1,2, Sabău I2, Micle Ioana1,2

1 “Louis Ţurcanu” Emergency Hospital for Children, Timişoara, Romania
2 1st Pediatric Clinic, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania

Background: Acanthosis nigricans (AN) is a dermatologic marker of hyperinsulinemia and has been linked with metabolic syndrome in adults. In children, the relationship between AN and different components of the metabolic syndrome has received mixed research results. We investigated whether the clinical and metabolic profile of obese children with AN was different from those without AN.
Material and methods: We studied retrospectively the observation charts of children who were evaluated in our clinic for obesity and/or anomalies of glucose metabolism from January 1st 2005 to December 31st 2009. The study population consisted of 52 children. The analyzed data included: age, sex, body mass index (BMI), the presence or absence of AN, systolic and diastolic blood pressure, the results of the oral glucose tolerance test, triglycerides and high-density lipoprotein (HDL) cholesterol levels, baseline insulin, the homeostatic model assessment: insulin resistance (HOMA-IR), glicated hemoglobin. We divided our study population into two groups according to the presence or absence of AN. We used One-Way ANOVA to evaluate the clinical and metabolic differences between the two study groups.
Results: We found significant differences between the two groups for BMI, systolic and diastolic blood pressure, triglycerides, HDL cholesterol, baseline insulin and HOMA-IR.
Conclusions: Our study shows that AN seems to be linked with most of the features of the metabolic syndrome in children. The relationship of AN and anomalies of glucose metabolism need further testing.

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The Elastographic Aspect of Liver in Pediatric Patients with Hepatopathies and Malignities Versus Healthy Children

Mărginean Oana1, Baghiu Maria Despina1, Brînzaniuc Klara2, Mărginean Claudiu3, Chinceșan Mihaela1, Pitea Ana Maria1

1 Clinic of Pediatrics, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Anatomy and Embriology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: Liver injury in context of chronical diseases, including malignacies, obesity, viral hepatitis, drug-related hepatotoxicity is an important concern for practicing pediatricians. The usual (biochemical) parameters for liver assessment prove to be now insufficient. Nowadays there is a high interest for finding non-invasive methods of hepatic evaluation, as an alternative to liver biopsy. Elastography fills a gap, provi-ding information on the degree of hepatic fibrosis.
Objective: Real-time elastographic assessment of liver tissue in correlation with biochemical parameters in children with hepatopathies and malignancies versus healthy children.
Material and method: Between September 15, 2010 and March 15, 2011 we conducted a prospective study in the Ist Pediatric Clinic Tîrgu Mureș, Romania, including a group of children with various malignancies under/after chemotherapy, a group of children with liver diseases (drug-related hepatotoxicity, obesity, hepatitis) and a control group composed of children with normal biochemical parameters. We assessed the liver tissue elasticity, expressed as SWV (shear wave velocity) on elastography, biochemical parameters, then statistical correlations were performed.
Results: Comparing SWV-values between the three groups, higher speeds were found in groups with liver damage after chemotherapy and those with hepatopathies (p=0.04). Aspartate transaminase (AST, IU) and alanine transaminase (ALT, IU) levels were different in a statistically significant manner between the three groups (p=0.0006 and 0.0002 respectively). In the after-chemiotherapy group significant correlations were obtained between elasticity and AST (p=0.0001).
Conclusions: In children with liver damage, SWV (which is correlated with the degree of liver fibrosis) increase in parallel with transaminases.

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Association Between Angiotensin Converting Enzyme Gene Insertion (I)/Deletion (D) Polymorphism and Secondary Arterial Hypertension in a Romanian Children Population

Duicu Carmen1, Bănescu Claudia2, Gáll Zsuzsanna1, Grama Alina1, Gozar Horea3

1 Department of Pediatrics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Genetics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Pediatric Surgery, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Arterial hypertension is defined as systolic or diastolic blood pressure measurements higher than 95 age-gender-height percentile of the adopted reference values. Angiotensin-converting enzyme (ACE) is a component of renin-angiotensin system. ACE insertion/deletion (I/D) gene polymorphisms have been associated with the risk of various cardiovascular anomalies.
Aim: The purpose of our study was to assess the possible association of ACE I/D polymorphism gene and secondary hypertension in children.
Material and method: We genotyped 40 healthy and 38 hypertensive children and adolescents. The ACE I//D gene polymorphism was determined by polymerase chain reaction (PCR) and restriction fragment length polymorphism technique utilizing specific primers. We compared the distribution of ACE I/D genotypes in the two study groups.
Results: The results of the study showed that the frequency of I/D ACE genotype distribution in patients with hypertension (DD = 18.42%,
ID = 68.42%, II = 13.16%) did differ significantly from genotype distribution in controls (DD = 47.5%, ID = 42.5%, II = 10%), and the DD genotype was not associated with secondary hypertension.
Conclusion: In conclusion we demonstrate that ACE gene polymorphisms are genetic markers for secondary arterial hypertension in children.

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Clinical, Paraclinical and Histological Considerations for Coeliac Disease in Children

Eşianu Andrea Gertrud1, Baghiu Despina Maria1, Mărginean Oana1, Mocan Simona2, Chinceşan Mihaela1, Pitea Ana Maria1

1 Pediatric Clinic I, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pathology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

Introduction: Coeliac disease is an autoimmune enteropathy caused by gluten intolerance in genetically susceptible people. Gluten is a protein found in food containing wheat, oat, barley, rye. It can start with typical (classical) gastro-intestinal symptoms, atypical symptoms or may be silent (asymptomatic).
bjectives: Evaluation of the anthropometric, clinical, paraclinical and histopatological data of children with coeliac disease hospitalised at the Pediatric Clinic I in Târgu Mureş.
Material and method: The work is based on a study conducted retrospectively during 2006-2010. From the total number of 10982 patients, 25 were admitted for malabsorption syndrome and 12 out of these, with coeliac disease. The diagnosis has been set according to anamnesis, clinical examination, serology tests, histopathological and immunohistochemical test.
Results: Eight children with coeliac disease were older than 2 years of age and 4 children younger than 2 years of age. Two-thirds of the patients showed classical symptoms and one-third an asymptomatic form. The IgA type endomysial antibodies (IgA EMA) were positive in all children. Histopathologic and immunohistochemical tests were carried out in 58.3% of the cases.
Conclusions: The classical symptoms were prevalent. Anemia, weight loss, diarrhoea and growth failure were the most frequent signs and symptoms. Type 3c according to histopathological modified Marsh-Oberhuber classification was present in the majority of the cases. Serological screening (IgA EMA) is recommended in children presenting with weight loss, ferriprive anemia that does not respond to oral iron therapy, and growth failure.

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Anthropometric Assessment of Children with Malignant Disease

Chinceșan Mihaela¹, Baghiu Despina¹, Grama Alina¹, Urtila Patricia², Răduț Ioana³

1 Pediatric Clinic No. I, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
² Louis Țurcanu Pediatric Clinic No. III, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
³ Student, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: The nutritional evaluation of the children with cancer includes medical history, physical examination, anthropometric measurement and laboratory data.
Objective: To assess the anthropometric parameters in children with malignant disease compared to children with a non-oncologic disease.
Material and method: A prospective study was performed on 73 children hospitalized in the Pediatric Clinic I Tg. Mures, between November 2009 – January 2011. The children were divided into two groups: group 1, children with malignant disease (27 children) and group 2-control group, children with different pediatric disease (46 children). Anthropometric measurements: weight, height, body mass index, middle upper arm circumference, tricipital skin fold thickness were performed. The values of parameters were converted in Z score for age and sex using Switzerland Growth Chart 1989. We studied the anthropometric parameters compared to the two groups and performed statistical correlations.
Results: We observed a low weight at group I (-0.86 SD), but not in group II (0.2 SD), with a statistically significant difference p=0.002. The height of children in group I was much lower (-0.74 SD) from group II (0.4 SD) with p=0.0019. We also found a statistically significant difference among the anthropometric parameters of the arm: middle upper arm circumference (-1.5 SD versus -0.55 SD) with p=0.0311 and tricipital skin fold thickness (-1.22 SD versus -0.32 SD) with p=0.0093.
Conclusions: Weight, height, MUAC and TSF are significantly lower at children with cancer compared to children with nononcological diseases. The arms anthropometry better identify malnutrition in children with cancer than simply assessing weight or height measurements.

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