Waist circumference a clinical criterion for prediction of cardio-vascular complications in children and adolescences with overweight and obesity.

Overweight and obesity in childhood are associated with early cardiovascular dysfunction and promote heightened risk of cardiovascular morbidity and mortality in adulthood. Waist circumference (WC) correlates with visceral obesity, which is why obese children with elevated WC need to be carefully monitored to prevent long-term cardio-metabolic complications. The purpose of our study was to establish if WC could be a predictor of cardiovascular complications in children.The authors conducted a retrospective study that included 160 overweight and obese children and adolescents, aged 6 to 18 years. Patients were evaluated completely anthropometrically, biologically, and imagistic. The anthropometric data tracked were height, weight, WC, and body mass index. Echocardiography evaluated the following parameters: the interventricular septum, left ventricular mass, the relative thickness of the ventricular wall, the pathological epicardial fat.Our results confirm that the presence of visceral obesity was significantly associated (χ = 11.72, P = .0006) with pathological epicardial fat. In children, visceral obesity is not a risk factor for vascular or cardiac impairment, but in adolescents, the results showed that visceral obesity is an important predictive factor for the occurrence of vascular (AUC = 0.669, P = .021) and cardiac (AUC = 0.697, P = .037) impairment. Concentric left ventricular (LV) hypertrophy is significantly influenced by the presence of visceral obesity (AUC = 0.664, P = .013 children; AUC = 0.716, P = .026 adolescents).WC above the 90th percentile is a predictive factor for increased LVM index and concentric hypertrophy in both children and adolescents.

[Psychogenic pain in children]. / Durerea psihogena la copil.

Children present many relations between psychic and somatic processes. The most important clinical aspect is the pain that cannot be attributed to any medical condition and occurs in at least one organ. Psychogenic pain is frequent in the pediatric population and its incidence is increasing. The authors present some of the most debated theories on the mechanisms of psychosomatic pain and some types of such pain, underlining the importance of full investigations. The pain is diagnosed as psychogenic after the exclusion of a potentially lethal disease.

[Pulmonary manifestations in childhood obesity]. / Manifestari pulmonare in obezitatea copilului.

Obesity has an increasing incidence throughout the world, inducing a complex and multisystemic pathology. The respiratory manifestations are: restrictive respiratory physiology, reduced respiratory compliance, altered ventilation/perfusion index, bronchial hyperresponsiveness. Increases in body mass index (BMI) are associated with increases in prevalence, incidence and severity of bronchial asthma. The mechanic effects of obesity remain important, but the adipocites have many influences by the hormones, leptines, cytokines and other proinflammatory agents.

[Clinical and developmental aspects of cardiac involvement in infant of diabetic mother]. / Aspecte clinice si evolutive ale afectarii cardiace la noul nascut din mama diabetica.

The authors evaluated the main clinical and evolutive aspects of heart involvement in the newborn of diabetic mother (IDM). We studied the files of 35 IDM in a 4 years period; they were investigated the first week of life and at 6-12 months (18 cases). Most of the patients were asymptomatic/signs of extracardiac suffering; 15 had a systolic murmur. ECG: left ventricle (LV) hypertrophy (8) and LV repolarization disturbances (19 cases). Chest X-ray: cardiomegaly (9 cases). Echocardiography: hypertrophic cardiomyopathy (HCM), especially septal (25 cases, 71%); LV diastolic dysfunction (19-35) and normal systolic function; pulmonary hypertension (3), other congenital heart diseases (8 cases). The control revealed the alleviation of the LV walls size and LV diastolic function. The high incidence of the cardiac manifestations in IDM and the risk of occurrence of some severe problems, require a complete cardiological exam from the first few days of life and a follow-up schedule until the normalization of the cardiac parameters.

[Aspects of left ventricular function in children with chronic renal failure]. / Particularitati ale functiei ventriculului stâng la copiii cu insuficienta renala cronica.

OBJECTIVE: To present the main morphological and functional cardiac modifications in children with chronic renal failure (CRF) and the effect of hemodialysis on systolic function of the left ventricle (LV). METHODS: 22 patients (5-19 years) with CRF of different degrees of severity. 16 of them were included in a hemodialysis (HD) program and they were followed-up for at least 1 year. The systolic and diastolic function of the LV were investigated by echocardiography (echo) 2D and Doppler. RESULTS: Although the clinical signs of cardiac suffering were rare, echo detected concentric hypertrophy (9 cases), dilated cardiomyopathy (4 cases), mitral and tricuspidian regurgitation and pulmonary hypertension (3 cases) and pericardial effusion (10 cases). Systolic function was normal in most of the cases, but the diastolic function (evaluated by E/A ratio, isovolumic relaxation and deceleration time) was modified in 10 cases. The HD session induced the improvement of the LV systolic function parameters and the decrease of right ventricle dimensions. CONCLUSIONS: Echocardiography has a higher sensitivity compared to ECG and chest X-ray in evaluation of the LV function, mainly in the cases without cardiac symptoms. An efficient chronic HD program and also a complex antihypertensive treatment contribute to the alleviation of the LV function. For the HD session, echo is useful in monitoring the systolic LV function.

[The assessment of left ventricular function in cardiac and extracardiac disorders in children]. / Evaluarea functiei ventriculului stâng în afectiuni cardiace si extracardiace la copil.

The left ventricle (LV) suffers during various cardiac and extracardiac diseases. After the description of the cardiac performance during human development, the authors present the assessment of the left ventricle function in some cardiac and also extracardiac disorders of the child. There are listed the changes in myocardial structure, systolic and diastolic function in hypertrophy and dilation of the LV determined by systemic diseases that affect the pediatric patients and can lead to severe cardiac failure.