Intestinal ischemia in neonates and children.

The article reviews the intestinal ischemia theme on newborn and children. The intestinal ischemia may be either acute - intestinal infarction (by vascular obstruction or by reduced mesenteric blood flow besides the occlusive mechanism), either chronic. In neonates, acute intestinal ischemia may be caused by aortic thrombosis, volvulus or hypoplastic left heart syndrome. In children, acute intestinal ischemia may be caused by fibromuscular dysplasia, volvulus, abdominal compartment syndrome, Burkitt lymphoma, dermatomyositis (by vascular obstruction) or familial dysautonomia, Addison's disease, situs inversus abdominus (intraoperative), burns, chemotherapy administration (by nonocclusive mesenteric ischemia). Chronic intestinal ischemia is a rare condition in pediatrics and can be seen in abdominal aortic coarctation or hypoplasia, idiopathic infantile arterial calcinosis.

Overweight and Underweight Prevalence Trends in Children from Romania - Pooled Analysis of Cross-Sectional Studies between 2006 and 2015.

AIM: High-quality national representative data on obesity in Romanian children are needed to shape public health policies. To provide a unified data landscape on national prevalence, trends and other factors associated with underweight, overweight, and obesity in Romanian children aged 6-19 years, across the last decade (2006-2015). METHODS: Using a common protocol, we selected published and unpublished studies that measured Romanian children in schools between 2006 and 2015. Children's BMI was classified using the current WHO, IOTF, and CDC references. RESULTS: 25,060 children from 8 Romanian counties were included in the analysis. The prevalence of underweight children was 5%/4.5%/8.5% (WHO/IOTF/CDC), while the prevalence of overweight (including obese) children was 28.3%/23%/23.2% (WHO/IOTF/CDC). The prevalence of overweight children did not change significantly over the last decade (chi-square test p = 0.6). Male gender (odds ratio (OR) 1.37; 95% CI 1.29-1.45, compared to female); prepubertal age (OR = 3.86; 95% CI 3.41-4.36,compared to postpubertal age), and urban environment (OR 1.12; 95% CI 1.01-1.26, compared to rural environment) had higher risk for overweight. CONCLUSION: While the prevalence of underweight children was low, almost one in four children in Romania was overweight or obese (according to WHO criteria) between 2006 and 2015. This prevalence remained relatively stable over the last decade. Male gender, prepubertal age, and urban environment, were the most relevant risk factors associated with overweight status in Romanian children.

The Value of Induced Sputum in the Diagnosis and Management of Children with Bronchial Asthma.

BACKGROUND: Induced sputum in children with bronchial asthma represents a non-invasive method of bronchial inflammation assessment. The main objective of our study was to analyze the cellularity of sputum in patients with bronchial asthma according to the level of disease control and the controlling therapy (with/without inhaled glucocorticoids). The second objective was to establish the correlation between sputum cellularity and other indirect parameters used to evidence bronchial inflammation (exhaled nitric oxide) and obstruction (forced expiratory volume in 1 second). METHODS: The study included children with bronchial asthma that were assessed clinically (physical exam, questionnaire on the control of bronchial asthma in children) and by medical tests (induced sputum, exhaled nitric oxide, spirometry). RESULTS: In patients with partially controlled asthma and those with uncontrolled asthma, the eosinophils percentage in the sputum was higher than in patients with controlled asthma (19.8±26.4% respectively 9.2±20.5% versus 4.5±14.6%, p<0.001). Higher percentage of neutrophils in the sputum was found in the partially controlled and uncontrolled asthma than in the controlled asthma (43.9±20.1% respectively 51.6±38.3% versus 35±19.7%, p=0.009). We also evidenced a direct and statistically significant correlation between the exhaled nitric oxide and the neutrophils percentage in the sputum (r=0.67, p=0.0003). Also, an indirect, moderate to good correlation (r=-0.56, p=0.005) was evidenced between the values of the forced expiratory volume in 1 second and the high eosinophils percentage in the sputum. CONCLUSIONS: In partially controlled and uncontrolled bronchial asthma the eosinophils and neutrophils count in the sputum is significantly higher than in patients with controlled asthma. There is an indirect correlation between the high eosinophils count in the sputum and the forced expiratory volume in 1 second, as well as a direct correlation between the neutrophils count and the exhaled nitric oxide, suggesting that induced sputum should be used in combination with other indirect parameters for the evidence of bronchial inflammation.

Clinical, imaging and cystometric findings of voiding dysfunction in children.

UNLABELLED: The AIM of the study was to validate some of the imaging criteria for voiding dysfunction in children. MATERIAL AND METHODS: The study included a number of 55 children with voiding dysfunction symptoms. They were investigated clinically as well as through imaging techniques: renourinary ultrasound, voiding cystourethrography and cystometry. RESULTS: The most common symptoms were urgency (87.3%), increased frequency (81.8%), and daytime urinary incontinence (76.3%). Ultrasound scans detected a reduced bladder capacity in 65.5% patients. The voiding cystourethrography detected bladder trabeculations (58.2%) and spinning top urethra (63.6%). Cystometric recordings indicated overactive bladder in 70.9% patients. Reduced bladder capacity detected by ultrasound associated with trabeculated bladder and spinning top urethra detected by voiding cystourethrography in a patient with specific symptoms may suggest an overactive bladder. In CONCLUSION, voiding dysfunction in child can be diagnosed by minimal or non-invasive methods.

Epidemiological survey 6 years apart: increased prevalence of asthma and other allergic diseases in schoolchildren aged 13-14 years in cluj-napoca, romania (based on isaac questionnaire).

BACKGROUND: The prevalence of asthma and allergy has increased during recent decades. OBJECTIVE: We investigate the prevalence of asthma and other allergic diseases in children aged 13-14 years and we evaluate the trend of prevalence after an interval of 6 years. MATERIAL AND METHODS: We used a core questionnaire designed by the International Study of Asthma and Allergy in Children. In 1991, the questionnaire was administered to 2,866 children from a Romanian city and during 2001 to 1,657 children from the same area. RESULTS: The prevalence of asthma increased from 3.3% in 1995 to 5.5% in 2001 (p<0.001). In 1995, 4.3% of children reported asthma-related symptoms, significantly fewer than the percentage 6 years later (13.6%; p<0.00001). Similar results were obtained with regard to allergic rhinitis (13.6% versus 20%; p<0.00001) and eczema (11.5% versus 16.2%; p=0.00015). As far as gender differences are concerned, in the first stage of study all three allergic disorders were found to occur more frequently in females. In the study undertaken in 2001, females proved to have a higher prevalence of asthma (p=0.226), but a lower prevalence for allergic rhinitis (p=0.121) and eczema (p=0.064). CONCLUSIONS: The prevalence of asthma and allergy increased significantly during the past 6 years.

[Relationship between asthma and obesity in school age students]. / Relatia dintre astm si obezitate la copiii de vârsta scolara.

BACKGROUND: Obesity and asthma are both public health problems with an increasing prevalence all over the world. The association between asthma and obesity was studied and proved in some papers, although the pathogenic pathway between them is not exactly known. The aim of this study was to examine the relationship between obesity and asthma by measuring the prevalence of obesity in asthmatic children compared with a control population. METHODS: Two groups of children aged between 7 and 18 years were studied: one group of asthmatic children and a control group, with the same age and sex with the first group. The differences between the two groups regarding the BMI were calculated, obesity being defined as a body mass index greater than the 95th percentile. RESULTS: A number of 200 children with asthma and 200 children in the control group were studied. The mean age was 10.49 years. 61.5% of children were boys. No significant difference was observed in the two groups regarding the percentage of overweight and obese children, except in the group of 7-10 years, where there is a greater percentage of children with overweight in the asthmatic group (23.3% vs 1% in the control group, p = 0.045). CONCLUSION: Obesity does not constitute, therefore, a risk factor for asthma and does not contribute to the severity of the disease.

[The effects on growth velocity of inhaled corticosteroids therapy in children with asthma]. / Efectele glucocorticosteroizilor inhalatori administrati de durata asupra velocitatii cresterii la copiii cu astm bronsic persistent.

INTRODUCTION: Studies have demonstrated growth suppressive effects in case of use of inhaled corticosteroids therapy. OBJECTIVE: To assess growth velocity during 12 months of inhaled corticosteroids therapy in children with persistent asthma. METHODS: Measurements of height were performed in the study group including 109 children with mild and moderately severe, persistent asthma, after 12 month with low or medium doses of either beclomethasone dipropionate or fluticasone propionate. The results were compared with a control group including 71 children with asthma treated with montelukast or cromones. RESULTS: There were statistically significant differences between study group and controls concerning the growth velocity after 3 months of inhaled glucocorticoid therapy (GSI). CONCLUSIONS: The velocity of growth was decreased in the study group compared to controls after 3 months of treatment, but the differences become unsignificant after 12 months of therapy.

[Evaluation of the effect of inhaled glucocorticosteroids by morning cortisolemia]. / Evaluarea efectului glucocorticoizilor administrati inhalator prin cortizolemia matinala.

The authors study the effect on adrenal function of a small dose of inhaled steroids in children with asthma. The study group consisting in 61 children treated with inhaled steroids (38 children treated with beclomethasone dipropionate and 23 treated with fluticasone propionate) who were compared with 17 controls (children with asthma treated with nonsteroidal therapy). In the study group, after 12 months of therapy morning cortisolemia was lower as compared with the values before the treatment. In children treated with beclomethasone the morning cortisol before therapy was 217.6 +/- 76.4 nmol/L and after therapy of 171.5 +/- 52 nmol/L (p < 0.077). In children treated with fluticasone initial cortisol was of 210.8 +/- 19.5 nmol/L and after treatment of 175.2 +/- 30.9 nmol/L (p < 0.027).

[Increase of the prevalence of bronchial asthma and related symptoms in students in Cluj-Napoca. Epidemiologic study with a five-years interval]. / Cresterea prevalentei astmului bronsic si simptomelor asociate la scolarul mare în Cluj-napoca. Studiu epidemiologic la 5 ani interval.

BACKGROUND: The prevalence of asthma is increasing in developed countries during the past decade. In Romania there are few studies on asthma epidemiology and no data on the trend of the prevalence. AIMS: The authors investigate the prevalence of asthma and associated symptoms in children and evaluate the trend of prevalence 5 years apart. METHODS: We used a core questionnaire designed by the International Study of Asthma and Allergy in Children (ISAAC). The questionnaire was applied during 1995 in 2,866 children aged 13-14 years from a Romanian city, and during 2001 in 1,657 children from the same area. RESULTS: The prevalence of previous diagnosed asthma increased significant, from 3.3% in 1995 to 5.5% in 2001 (p = 0.0005). A higher percentage of pupils presented probable asthma (4.3% in 1995 and 13.6% in 2001; p < 0. 00001). Similar results were obtained regarding symptoms related to asthma like wheezing, cough during exercise and night cough. Previous diagnosed asthma was more frequent in boys, but probable asthma and symptoms related to asthma were more prevalent in girls both in 1995 and in 2001. The prevalence of asthma is similar with that reported in other central and eastern European countries that used the same core questionnaire provided by ISAAC. CONCLUSION: The prevalence of asthma and associated symptoms increased significantly during the past 5 years.

[Prevalence of bronchial asthma in 7 years -old children in Cluj-Napoca, an ISAAC study]. / Prevalenta astmului bronsic la copiii de 7 ani din municipiul Cluj-Napoca. Studiu ISAAC.

The authors studied the prevalence of asthma in children of 7 years from Cluj Napoca and analyzed the possible risk factors. We used the questionnaire elaborated by International Study on Asthma and Allergic Diseases in Children (ISAAC) which allowed the comparison of our data with those from other countries. Anamnesis, functional tests and allergic skin tests were performed in children with positive answers for questionnaire. 1334 children completed the study, 52.5% being males. Prevalence of asthma diagnosed previous to the questionnaire was of 5.7%, and it was higher in males (6.1%). By anamnesis, functional and skin tests data the diagnosis of asthma was made in a total of 217 children, so that the real prevalence of asthma is of 16.3% in this age group. Maternal smoking during the first year of life was significantly higher in children with wheezing. The high number of respiratory tract infections in the first year of life could also play a role. In conclusion, prevalence of asthma diagnosed in children of 7 years of age from Cluj Napoca is of 5.7% with a real prevalence of disease that seems to be much higher, of 16.3%. Maternal smoking represents a risk factor correlated with wheezing.

[The effectiveness of montelukast in recurrent post-bronchiolitis wheezing]. / Eficienta Montelukastului în wheezingul recurent post bronsiolitic.

Some studies showed increased levels of leukotrienes in the nasopharyngeal secretions in children with wheezing secondary to viral infections, leading to therapeutical attempts with leukotriene receptor inhibitors in infants and small children with recurrent wheezing. This is a double blind randomized study for evaluating the efficacy of montelukast in infants and small children. In the study group (20 children) treated with montelukast, 5 mg/day for 3 months, the frequency of bronchial obstruction episodes in the 6 months following the start of therapy was significantly lower (p = 0.001) than the 6 months before treatment (1.25 +/- 1.41 versus 3.79 +/- 2.41). In the control group (18 children) treated with placebo, the frequency of the bronchial obstruction episodes decreased (from 3.04 +/- 1 to 2.41 +/- 1.5) in the two analyzed periods, but the differences were not statistically significant (p = 0.067). The differences between the two groups are present also after excluding the children with atopy. The results suggest the beneficial role of leukotriene receptor antagonists in improving the symptoms of patients with recurrent post-bronchiolitis wheezing.