Tag Archives: children

Obesity and Insulin Resistance Status: The Impact of Using Different International Growth Standards in Romanian 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

Introduction: Worldwide, childhood obesity is on the rise. A lot of debate exists within the scientific community regarding the best way to define overweight and obesity in different populations. Currently, three sets of growth references are in use internationally: the 2007 World Health Organization (WHO) growth standards, the International Obesity Task Force (IOTF) reference, and the 2000 Center for Disease Control and Prevention (CDC) growth charts. We examined the impact of using these international growth references on diagnosing obesity in a group of overweight and obese Romanian children. Afterwards, we evaluated the relationship between diagnosed obesity and insulin resistance status.
Material and method: We studied retrospectively the observation charts of children who had their insulin levels tested in our hospital’s laboratory between January 1st 2008 and December 31st 2009. The study population consisted of 76 children. We analyzed: age, gender, body mass index (BMI), the homeostatic model assessment: insulin resistance (HOMA-IR). We divided the children into two categories according to their HOMA-IR values. We used each of the standards and grouped the study population into two BMI groups: overweight and obese. We used One-Way ANOVA to evaluate the differences between the three definitions.
Results: We found significant differences between the WHO and the IOTF and CDC references. The WHO standards identified the least overweight children with insulin resistance.
Conclusions: Our study shows that using WHO growth standards may be the proper method to diagnose obese children. A large populational study is needed to establish the proper growth references for our population.

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Parameters for the Assessment of Pulmonary Vasodilator Therapy in Pulmonary Arterial Hypertension in Children

Şuteu Carmen1, Făgărăşan Amalia2, Muntean Iolanda2, Gozar Liliana2, Paşc Sorina1, Blesneac Cristina1, Togănel Rodica2

1 Cardiology Clinic III – Children, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
2 Cardiology Clinic III – Children, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: Pulmonary arterial hypertension (PAH) is a rare pathology with different etiologies, representing a cause of morbidity and mortality in the pediatric age group. Most cases of PAH in children are secondary to congenital heart diseases (CHD), followed closely by idiopathic PAH and familial forms. Our objective was to evaluate children with pulmonary arterial hypertension in order to establish which parameter is more useful for the assessment of pulmonary arterial hypertension.
Method: Twenty pediatric patients diagnosed with pulmonary arterial hypertension undergoing pulmonary vasodilator therapy were evaluated between March 2008 and January 2012 in the Pediatric Cardiology Department from Tirgu Mures County Emergency Clinical Hospital. Patients were assessed clinically, the exercise capacity was assessed using the 6-minute walk test, and echocardiography was performed. The initial assessment was considered at the time of initiation of the pulmonary vasodilator therapy, further evaluations being performed at intervals of 3 months.
Results: This study demonstrates the improvement of the functional class and 6-minute walk test, without compromising peripheral oxygen saturation whereas echocardiographic evaluation of patients did not show any echocardiographic parameter to correlate with improved exercise capacity and functional class.
Conclusion: The 6-minute walk test and NYHA functional class represent useful parameters for evaluating the efficiency of pulmonary vasodilator therapy

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The Association of Month of Birth with Allergic Sensitization in Pediatric Patients with Asthma in Mureș County, Romania

Căpîlna Brîndușa¹, Baghiu Maria Despina¹, Căpîlna R

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

Objective: To demonstrate a link between the allergy disease and birth date, starting from the hypothesis that the season of birth may affect the future development of allergy.
Methods: Our prospective study included eighty-six asthmatic children, with ages between 1 and 18 years, who were admitted to the Clinic of Pediatrics I from Tîrgu Mureș, Romania, between October 2008 and June 2010. We analyzed the age, month of birth, sensitization to a given antigen (Dermatophagoides pteronyssinus, Dermatophagoides farinae, milk proteins, egg, mold, dog epithelium, cat epithelium, soya, carrot, potatoes, peanuts, tomato). Specific IgE serum levels to allergens were measured. RAST equal or higher than class 1 was considered as positive. This data was combined with the presence of different types of allergens during the year. The study was extended to the intrauterine period, when the fetus is also faced with different type of antigens, and maternal antibody.
Results: We observed the appearance of three “waves”, in February, April, September and early October the incidence of allergic sensitization was higher than in other months.
Conclusions: Our results support the hypothesis that the first few months of life represent a sensitive period, during which protection from exposure to pollen allergens may be associated with decreased sensitization to pollens.

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Household Environmental Tobacco Smoke and Risk of Allergic Sensitization Among Children with Asthma

Căpîlna Brîndușa, Baghiu Maria Despina

Pediatric Clinic 1, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.2478/amma-2013-0008

Background: Exposure to cigarette smoke is causing health problems, its components are known to possess carcinogenic, mutagenic, cytotoxic or irritant properties. Prevalence of smoking in pregnant women is between 17% and 35% worldwide. Passive smoking is identified as a factor with negative impact on health, and children are especially vulnerable. Children raised in families with smokers have a higher incidence of respiratory infections, recurrent wheezing, bronchitis, nocturnal cough and asthma. The aim of this study was determination of sensitization to various allergens in children exposed to cigarette smoke compared with children not exposed to cigarette smoke.
Material and method: One-hundred eighty children treated in Pediatric Clinic 1 of Tîrgu Mureș were included in the study between 2008–2011. The patients were divided into two groups: 50 children exposed to cigarette smoke and 130 children not exposed. Measurement of lung function was performed in children over 4 years using a spirometer. Serum specific IgE was analyzed to inhalatory and food allergens. Wheezing phenotype was determined in children younger than 4 years and exposure to cigarette smoke was evaluated based on parents’ responses to questionnaires.
Results: There was a significantly greater likelihood of developing sensitivity in children exposed to tobacco smoke than in those not exposed to dermatophagoides pteronissimus, dermatophagoides farinae, milk and grass pollen.
Conclusions: During early childhood both pre- and postnatal tobacco smoke exposure has an adjuvant effect on allergic sensitization inhalatory and food allergens.

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Particularities of Sleep Habits in School Children from Tîrgu Mureș

Sólyom Réka1, Baghiu Maria Despina2, Neagoș Adriana3

1 University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pediatrics 1, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 Oto-rhino-laryngology Clinic, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0033

Introduction: The international literature gives us very variable data regarding sleep disorders and the complaints related to this pathology. However, interpreting these data is difficult because of the ethnical and cultural differences and the numerous possibilities of the assessments. In this paper the authors examined and evaluated the main parameters which characterize the sleep habits of a group of children in Romania, as well as the complaints related to it, which could influence the quality of sleeping.
Material and method: Distributing questionnaires amongst children in Tîrgu Mureș. We used different questionnaires, based on the Epworth and Conner’s scores, for children between 11–14 and 15–18 years and for their parents.
Results: The gender ratio was approximately equal, the height and weight of the children was within the framework of Romanian standards. The most frequent nocturnal complaints were: problems with falling asleep, agitation, awakenings during the night. The most frequent daytime complaints: fatigue when in school, difficulty waking up in the morning and mood swings. The results showed significant differences between weekday sleeping hours and weekend sleep time (p = 0.0022).
Conclusion: Sleep habits change with age, which is a physiological effect. Other factors that modify sleeping habits in a negative way and reduce the time spent sleeping, play a crucial role in the occurrence of persistent fatigue, reduced quality school performance and even of a depraved life quality.

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Evaluation of Child Self-perception Regarding Their Oro-dental Status

Mártha I. Krisztina1, Roşu Sorana2, Gyergyay Réka3, Vikárius Katalin4

1 Department of Pediatric Dentistry and Orthodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 PhD student, ”Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania
3 PhD student, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Student, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.2478/amma-2013-0061

Aim: The aim of this study was to evaluate the state of oral health and the self-perception of children regarding their oro-dental status, their knowledge and attitude towards oral health.
Methods: A sample of 130 children (11–14 years) and one of their parents were asked to complete a Child Perception Questionnaire (CPQ11-14) in Sfântu Gheorghe, Romania. From these, 69 children were examined and data was recorded about Decayed-Missing-Filled Teeth (DMFT), oral hygiene, dental malposition and malocclusion, Aesthetic Component of Index of Treatment Need (AC-IOTN). Consent of the parents was obtained. Statistical analyses were performed.
Results: The optimal score of CPQ evaluation is 96 and the maximum score achieved was 93, the minimum was 43. 78.10 average score can be graded as medium. As the data points out, most of the children and their parents have a medium knowledge and self-perception. The clinical examination underline the main problems: dental caries (62%), occlusal coloration (23%), dental malposition (17%), rooftop deep bite (14%), dental rotation and crowding (12%), dental plaque and tartar (10%). As far as the AC-IOTN is concerned, 48 of 69 children have no need for treatment, 18 have a high need for treatment, and 3 have a moderate need for treatment.
Conclusions: Overall, the children and their parents have a poor oral health knowledge, which is reflected in the medium level of the achieved CPQ scores, in the clinical examination and can be associated with high levels of dental caries and malocclusion.

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Clinical Features and Echocardiographic Findings in Children with Hypertrophic Cardiomyopathy

Blesneac Cristina¹, Benedek Theodora², Togănel Rodica¹, Benedek I²

¹ Department M4, IIIrd Pediatric Discipline, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
² Clinic of Cardiology, Department M3, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.2478/amma-2013-0065

Background: Hypertrophic cardiomyopathy, one of the most common inherited cardiomyopathies, is a heterogeneous disease resulting from sarcomeric protein mutations, with an incidence in the adult population of 1:500. Current information on the epidemiology and outcomes of this disease in children is limited.
Methods: Thirty-four children diagnosed with hypertrophic cardiomyopathy in the Pediatric Cardiology Department from Tîrgu Mureș were evaluated concerning familial and personal history, clinical, paraclinical and therapeutic aspects. Hypertrophic cardiomyopathy was defined by the presence of a hypertrophied, non-dilated ventricle, in the absence of a cardiac or systemic disease that could produce ventricular hypertrophy.
Results: The youngest diagnosed child was a neonate, a total of 10 patients being diagnosed until 1 year of age. In 6 cases a positive familial history was found. Noonan syndrome was found in 2 cases. Only 21 patients were symptomatic, the predominant symptoms being shortness of breath on exertion with exercise limitations. Left ventricular outflow tract obstruction was present in 21 cases (61.7%). Twenty-four patients were on β-blocking therapy, while 4 patients underwent septal myectomy.
Conclusions: Hypertrophic cardiomyopathy is a heterogeneous disorder in terms of evolution, age of onset, type and extent of hypertrophy, and the risk of sudden death. It can affect children of any age. There is a need for a complex evaluation, including familial and personal anamnesis, clinical examination, electrocardiogram and echocardiography of all patients. It is highly important to develop screening strategies, including genetic testing, for an early diagnosis, especially in asymptomatic patients with a positive familial background.

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Epidemiological Survey of Dental Fear and Anxiety in Children Living in Transylvania

Gyergyay Réka1, Székely Melinda2, Mártha Krisztina1

1 Department of Pedodontics and Orthodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu-Mureş
2 Department of Morphology of Teeth and Dental Arches; Technology of Dental Prosthesis and Dental Materials, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu-Mureş

DOI: 10.2478/amma-2014-0033

Aims: The objectives of the present survey were: 1) a systematic epidemiological investigation of dental fear and anxiety among children living in the central part of Romania and 2) to identify the most fearful aspects of dental care perceived by these children.
Methods: In this cross-sectional study 406 schoolchildren, 170 males and 263 females, aged 11-18 yearsfrom two cities, Tîrgu Mureş and Sfîntu Gheorghe were assessed. The subjects’ dental fear was evaluated with the Romanian versions of Corah’s Dental Anxiety Scale (MDAS) and Kleinknecht’s Dental Fear Survey (DFS), the anxiety level with Spielberger`s State and Trait Anxiety Inventory (STAI-S, STAI-T) and their opinion about dentists with Getz’s Dental Beliefs Scale (DBS). Questionnaires were completed anonymously at school. The study was approved by theResearch Ethics Committeeof the University of Medicine and Pharmacy Tîrgu Mureş. For statistical analysis t-test, one-way ANOVA and Pearson’s correlation test were used by SPSS/PC statistics v. 17.0.
Results: The mean (±SD) scores of the surveyed subjects (mean age 15.69±2.06 years) were high: MDAS 10.65 (±4.5), DFS 38.68 (±15.1), DBS 36.93 (±11.9), STAI-S 37.90 (±10.9) and STAI-T 41.04 (±9.9), respectively. There was a strong positive Pearson-correlation between MDAS and DFS scores (r=0.73; p≤0.01) and a somewhat lower correlation between these scales and the general anxiety scores. Except for DBS, statistically significantly higher scores were found in females for every questionnaire (t-test, p≤0.05). The 11-year-old group presented the lowest scores in every case, while the peak was around 14 years. Age was a statistically significant factor only in case of DBS, STAI-S and STAI-T (one-way ANOVA, p<0.05). Drilling and injection were considered the most fearful moments of a dental treatment. Subjects claimed dental practitioners working under time pressure and communication deficiencies.
Conclusions: Having their special features, our findings were consistent with the local and international data. The subjects claim lack of time and communication deficiencies with the dentists. Identifying the reasons of dental fear and anxiety, might lead to solutions of avoidance or control.

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Predictive Factors in the Onset of Epilepsy in Children with Cerebral Palsy

Todoran Butilă Anamaria*, Sin Anca, Micheu Cristian, Csep Katalin, Voidăzan Septimiu, Racos Szabo Elisabeta

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 1515/amma-2015-0069

Objectives: the aim of the study was to identify predictive risk factors of the development of epilepsy in patients with cerebral palsy (CP).
Materials and methods: We performed a bidirectional study in wich 177 patients diagnosed with CP with and without epilepsy have been selected for characteristics and risk factor comparison. We analyzed the history related to pregnancy and birth, gestational age, birth weight, fetal distress, the presence of neonatal convulsion, age of onset for the epilepsy, associated types of seizures, the response to anticonvulsant therapy and brain changes identified by Computer tomography and Magnetic resonance imaging examination.
Results: epilepsy was found in 91 (51.4%) patients, most frequently in quadriplegic form (76.2% vs 23.8%), OR:3.04, 95% CI:1.42-6.52, p-0.005. In this group, the most common were partial seizures (34.4%), epileptic encephalopathy like Lennox Gastaut and West type (62.5%), and also neonatal seizures. Eighty percent of on-term infants with neonatal seizures later developed epilepsy. Factors like fetal distress, low birth weight, cytomegalovirus infection, history of pathological pregnancy were associated with an increased risk of developing epilepsy. Imaging change, especially cerebral atrophy had the highest frequency (37.5% vs 16%) in pacients with epilepsy. 28 (30.8%) patients had resistance epilepsy, 13 (46.4%) of them having quadriplegia. Early onset of epilepsy constitutes a sign of severity of epileptic forms (OR:3.09, 95% CI:1.187-8.061, p-0.01).
Conclusions: The data are consistent with those in literature but is necessary following this study to clarify and support the assumption on preddictive factors and prognosis of epilepsy in this population.

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Comparison Between Clinical and Echocardiographic Findings in Infants and Children Diagnosed with Hypertrophic Cardiomyopathy

Blesneac Cristina¹, Șuteu Carmen1, Togănel Rodica¹, Benedek Theodora², Benedek I²

¹ University of Medicine and Pharmacy Tîrgu Mureş, Department M4, IIIrd Pediatric Discipline
² University of Medicine and Pharmacy Tîrgu Mureş, Department M3, Clinic of Cardiology

DOI: 10.1515/amma-2015-0027

Background: Hypertrophic cardiomyopathy is a rather common hereditary disease with an autozomal dominant character, caused by mutations of genes that code for proteins of the cardiac sarcomere. The observed prevalence of this disease is much lower in pediatric patients compared to adults, because it’s late gene expression. Hypertrophic cardiomyopathy presenting in infancy has been shown to have a very high mortality.
Methods: Thirty-nine patients diagnosed with hypertrophic cardiomyopathy in the IIIrd Pediatric Cardiology Department from Tîrgu Mureș were included in this study. Patients were divided into two groups: group 1 – patients diagnosed during infancy, group 2 – patients diagnosed after 1 year of age. Data regarding familial and personal history, and echocardiographic findings were compared between these two groups.
Results: Group 1 included 17 patients and group 2 – 22 patients. Positive familial history was found in both groups (group 1 – 6 cases, group 2 – 3 cases), all of them in obstructive forms. Syncope was found in four cases, all of them in group 1 (p=0.02; odds ratio 15; 95% CI, 0.7473 to 301.1). While in group 1, asymmetric septal hypertrophy was predominant (64.7%), in group 2 – concentric left ventricular hypertrophy predominated (54.5%). Obstructive hypertrophic cardiomyopathy was found in 14 patients in group 1 (82.4%)compared to 13 patients in group 2 (59.1%). Diastolic function was impaired more predominantly in group 1 (p=0.0274; odds ratio 11.67; 95% CI, 1.526 to 89.17).
Conclusions: hypertrophic cardiomyopathy has an extensive clinical variability with regard to age of onset, severity and progression of disease.

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