Sleep apnea syndrome associated with gonadal hormone imbalance (Review).

Patients with obstructive sleep apnea exhibit an increased risk of developing gonadal disorders. Because a notable number of people worldwide have sleep respiratory and reproductive disorders, it is essential to recognize the association between local upper airway dysfunction and its gonadal effects. Repeated breathing pauses cause sleep fragmentation, disorganization of sleep cycles and stages, sympathetic activation, intermittent hypoxemia and systemic inflammation. Nocturnal intermittent hypoxemia has a direct central effect on neurotransmitters, with disturbances in the normal production of hypothalamic-pituitary hormones. Awakenings and micro-awakenings at the end of apneic episodes produce a central stress responsible for hormonal changes and subsequent endocrine imbalances. The aim of the present study was to investigate the impact of obstructive sleep apnea syndrome (OSAS) on gonadal hormonal homeostasis and its consequences. Recognizing and understanding how local upper airway dysfunction causes gonadal imbalance may facilitate better care for patients with OSAS. Although there may be a direct relationship between sleep-disordered breathing and gonadal function mediated by hormones via the hypothalamic-pituitary-gonadal axis, to date, current therapies have not been effective.

The Impact of Chronic Suppurative Otitis Media with and without Cholesteatoma in Patients from Northeastern Romania.

Quality of life is a widely used concept that tends to become an important part of clinical management. The present study performs an analysis of the impact of suppurative chronic otitis media with and without cholesteatoma on quality of life, using the COMQ-12 questionnaire. It was applied to a group of 40 healthy people and to 40 patients before surgery, and the answers to the questions were analyzed and correlated with socioeconomic factors. After the confirmation of the diagnosis based on clinical and imaging information, the patients completed the COMQ-12 questionnaire. It was observed that the chronic ear problems had negative impacts of varying degrees on daily and long-term activities. The evaluation and analysis of information can be used in setting therapeutic targets.

[Chronic hepatitis B--still a problem in children]. / Hepatita cronica virala B--o problema încâ în actualitate la copil.

Vaccination of the newborns and adolescents had impact on the incidence of acute and chronic infection with hepatitis B virus (HBV) in children. After a decade of this national program application, authors proposed to study the epidemiologic dynamics of chronic infection with HBV in this interval, compared with the previous period, prior to vaccination.

Glycogen storage disease type I--between chronic ambulatory follow-up and pediatric emergency.

BACKGROUND AND AIMS: To describe the characteristics of patients with type I glycogenosis, the presentation types, the main clinical signs, the diagnostic criteria and also the disease outcomes on long term follow-up. METHODS: The study group consisted of 6 patients (medium age 3 years 6 months) admitted in hospital between 2001 and 2005 and followed-up for 1 to 5 years. The sex ratio was 1:1. RESULTS: The referral reasons varied from hepatomegaly incidentally discovered (3 of 6 patients) to abdominal pain (4 of 6 patients), growth failure (3 of 6 patients), symptoms of hypoglycemia (3 of 6 patients), recurrent epistaxis (1 patient). Hepatomegaly was present in all cases. Biological profile: hypoglycemia, increased transaminase values, hypertriglyceridemia, lactic acidosis, normal uric acid levels. Two patients had neutropenia and other two had increased glomerular filtration rate. Liver biopsy showed glycogen-laden hepatocytes and markedly increased fat. Four patients had type Ia and 2 patients type Ib glycogenosis. The therapy consisted of: diet, ursodeoxycholic acid, granulocyte colony-stimulating factor, broad spectrum antibiotics for those with type Ib glycogenosis. The follow-up parameters were clinical, biological, imaging. Metabolic interventions and antiinfectious therapy were necessary. All patients are alive, two of them on the waiting list for liver transplantation. CONCLUSIONS: Glycogen storage disease type I is a rare condition, but with possible life-threatening consequences. It has to be kept in mind whenever important hepatomegaly and/or hypoglycemia are present.

[Obesity in children: new controversies and present prevention measures]. / Obezitatea copilului--noi paradigme si masuri preventive actuale.

The authors realise a synthesis on classical data and recent pathogenic explanations in childhood obesity. The obesity is a nutritional disorder of great interest nowadays and surpasses the incidence of the major problem of pediatrics until now--the malnutrition. There is documented data concerning the global incidence of obesity which is continuously growing when it comes to children. That is why the prophylaxis must become a priority by using measures in the first period of life (natural feeding, the need of late diversification, the avoidance of hyperproteic diets). The recent pathogenic data and the long term populational studies change the old conceptions regarding the risk of some categories of children. Thus mother's malnutrition, the low birth weight, children that followed hyperproteic diets paradoxically represent categories of risk for obesity. A recent recorded phenomenon, which amplifies the risk for obesity is the early adiposity rebound which is recorded nowadays even for ages lower than five years. There are described the hormonal mechanisms involved in appetite and satiety up to the receptor level: leptin, ghrelin, adiponectin, endocannabinoid receptors. There are pointed out all the long term risk elements (high birth weight, low birth weight, the pregnant woman's nutrition) and the modern medical treatments for obesity.