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Adela Chirita-Emandi

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Articole semnate de acelasi autor in Revista Romana de Pediatrie:

Early sexual development

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Revista Romana de PEDIATRIE | Volumul LX, Nr. 3, An 2011
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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Early sexual development

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ABSTRACT

Puberty is a biological process that involves major physical and psychological changes at the end of which the child becomes an adult. Clinically, the onset of puberty is announced by the appearance of secondary sexual character that develops specific females, respectively to form the adult male, going through the five stages described by Tanner. The onset of puberty varies by race, ethnicity, geographic location, environmental and nutritional conditions, in the Caucasian population ranging from 8 to 12 years. Early sexual development is arbitrarily defined as the occurrence of secondary sexual characteristics before age 8 in girls and before age 9 in boys, respectively. Precocious puberty is classified into three broad categories: (1) gonadotropin dependent precocious puberty (central), (2) gonadotropin independent precocious puberty (peripheral), (3) partial precocious puberty. This paper aims to present the particular appearance of secondary sexual characteristics, the hormonal changes and the therapeutic possibilities of each category. Close follow-up of children, detailed medical history, chronological record of pubertal signs, repeated anthropometric and hormonal measurement are the key to a correct diagnosis and an early and effective treatment.

Key words: precocious puberty, gonadotropin, thelarche, adrenarche

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DEZVOLTAREA SEXUALA PRECOCE

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Revista Romana de PEDIATRIE | Volumul LX, Nr. 3, An 2011
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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DOAJ
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HIGHLIGHTS

National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

The published medical research literature is a global public good. Medical journal editors have a social responsibility to promote global health by publishing, whenever possible, research that furthers health worldwide.

DEZVOLTAREA SEXUALA PRECOCE

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REZUMAT

Pubertatea este un proces biologic ce presupune modificări fizice şi psihologice majore, la finele căruia copilul devine adult. Clinic, debutul pubertăţii este anunţat de apariţia caracterelor sexuale secundare ce evoluează specific pentru sexul feminin, respectiv masculin până la forma adultă, trecând prin cele 5 stadii descrise de Tanner. Debutul pubertăţii variază în funcţie de rasă, etnie, localizarea geografică, condiţii de mediu şi nutriţionale, la populaţia caucaziană situându-se între 8 şi 12 ani. Dezvoltarea sexuală precoce este definită arbitrar ca apariţia caracterelor sexuale secundare înainte de vârsta de 8 ani la fete, respectiv înainte de 9 ani la băieţi. Pubertatea precoce se clasifică în 3 categorii mari: (1) pubertatea precoce gonadodropin dependentă (centrală), (2) pubertatea precoce gonadotropin independentă (periferică), (3) pubertatea precoce parţială. Lucrarea de faţă îşi propune să prezinte sintetic, pentru fiecare categorie în parte, modul specific de apariţie a caracterelor sexuale secundare, modificările hormonale şi posibilităţile terapeutice. Urmărirea copiilor longitudinal, anamneza amănunţită, înregistrarea cronologică a semnelor pubertare, măsurătorile somatometrice şi investigaţiile hormonale repetate reprezintă cheia unui diagnostic corect şi premisa unui tratament precoce şi eficient.

Cuvinte cheie: pubertate precoce, gonadotropine, telarha, adrenarha

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Persistent severe hypoglycemia due to growth hormone deficiency

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 1, An 2012
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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HIGHLIGHTS

National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

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Persistent severe hypoglycemia due to growth hormone deficiency

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ABSTRACT

Introduction. In children, persistent hypoglycemia has a major negative impact on structural and functional brain development. In infants, hypoglycemia may be the presenting feature of growth hormone (GH) deficiency.

Aim. We present the outcome of GH substitution in a girl with persistent severe hypoglycemia since infancy.

Material and methods. The child was admitted in our clinic at age three in order to establish the etiology and proper treatment of the hypoglycemia. We assessed growth, as well as the biological and hormonal profile, until the presentation in our clinic. In addition to anthropometric measurements, we obtained repeated metabolic and hormonal serum tests, a GH stimulation test with arginine, bone age X-ray. Interpreting the results was difficult considering the long time treatment with prednisone (2 years and 6 months), started at the onset of the hypoglycemia.

Results. We established that the persistent severe hypoglycemia was due to GH deficiency and started recombinant human growth hormone (rhGH) substitution. The outcome was spectacular in terms of symptoms, anthropometric, biological and hormonal profile.

Conclusions. The etiologic diagnosis of persistent severe hypoglycemia is difficult and requires an extensive approach. In this case, the certainty of the diagnosis was established by the spectacular outcome on rhGH substitution.

Key words: persistent hypoglycemia, GH defi ciency, rhGH

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HIPOGLICEMIA SEVERA PERSISTENTA PRIN DEFICIT DE HORMON DE CRESTERE

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 1, An 2012
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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HIGHLIGHTS

National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

The published medical research literature is a global public good. Medical journal editors have a social responsibility to promote global health by publishing, whenever possible, research that furthers health worldwide.

HIPOGLICEMIA SEVERA PERSISTENTA PRIN DEFICIT DE HORMON DE CRESTERE

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REZUMAT

Introducere. În copilărie, hipoglicemia persistentă are un impact negativ major asupra dezvoltării structurale şi funcţionale a creierului. În perioada de sugar, hipoglicemia poate fi forma de prezentare a deficitului de hormon de creştere (GH).

Scop. Prezentarea evoluţiei sub tratament substitutiv cu GH în cazul unei fetiţe cu hipoglicemie severă persistentă din perioada de sugar.

Material şi metodă. Copilul se internează în clinica noastră la 3 ani în vederea stabilirii etiologiei şi tratamentului hipoglicemiilor. Am realizat profilul somatometric, biologic şi hormonal până în momentul prezentării în clinica noastră. Pe lângă somatometrie, am obţinut determinări sanguine metabolice şi hormonale repetate, testul de stimulare a secreţiei de GH cu arginină, radiografie de vârstă osoasă. Interpretarea rezultatelor a fost îngreunată de tratamentul cu Prednison „a la longue“ (2 ani şi 6 luni), instituit la debutul hipoglicemiilor.

Rezultate. Am stabilit diagnosticul de hipoglicemie severă persistentă prin deficit de GH şi am instituit tratamentul substitutiv. Evoluţia a fost spectaculoasă atât din punct de vedere al simptomatologiei, cât şi somatometric, biologic şi hormonal.

Concluzii. Managementul unui copil cu hipoglicemie severă persistentă este dificil şi impune o abordare complexă. În cazul de faţă, certitudinea diagnostică a venit odată cu evoluţia spectaculoasă sub tratament substitutiv cu hormon de creştere uman recombinat.

Cuvinte cheie: hipoglicemie persistentă, deficit GH, tratament substitutiv

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EVALUAREA INSULINO-REZISTENTEI LA COPIL: O APRECIERE CRITICA A MODELELOR MINIMALE

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 1, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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HIGHLIGHTS

National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

The published medical research literature is a global public good. Medical journal editors have a social responsibility to promote global health by publishing, whenever possible, research that furthers health worldwide.

EVALUAREA INSULINO-REZISTENTEI LA COPIL: O APRECIERE CRITICA A MODELELOR MINIMALE

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REZUMAT

Obezitatea infantilă a urmat, în ultimele două decenii, un trend ascendent. Rezistenţa la insulină (IR) este esen- ţială pentru fiziopatologia obezităţii. Până în prezent, au fost propuse mai multe metode de evaluare a IR. Ne-am propus evaluarea critică a unora dintre cele mai simple metode folosite pentru determinarea IR la copii şi adolescenţi. Am realizat un studiu retrospectiv al copiilor evaluaţi pentru obezitate în Spitalul Clinic de Urgenţă pentru Copii „Louis Ţurcanu“ Timişoara, pe o perioadă de 10 ani. Populaţia de studiu a fost alcătuită din 342 de copii. Au fost analizate variabilele antropometrice şi metabolice şi au fost evaluaţi următorii indici ai IR: scăderea toleranţei la glucoză (STG), Homeostatic Model of Assessment - IR (HOMA-IR), Homeostatic Model of Assessment- β (HOMA-β), Index cantitativ de verificare a sensibilităţii la insulina (QUICKI), precum şi raportul TG/HDLc. Datele au fost exprimate ca frecvenţă, medie ± deviaţia standard sau media ± intervalul intercuartilic pentru un interval de încredere de 95%. S-a folosit testul t pentru grupuri independente sau testul Mann-Whitney pentru a evalua diferenţele de indici IR, în funcţie de greutate, sex şi dezvoltare pubertară. HOMA-IR a diagnosticat cei mai mulţi copii cu IR, la polul opus am găsit QUICKI. STG a fost rar diagnosticat. Este necesar a se reconsidera modul în care se evaluează metabolismul carbohidraţilor la copii. Dintre posibilităţile existente, HOMA-IR este metoda optimă de evaluare a IR la copii.

Cuvinte cheie: Homeostatic Model of Assessment - IR, test de toleranţă la glucoza orală, Index cantitativ de verificare a sensibilităţii la insulină, rezistenţă la insulină, sensibilitatea la insulină, toleranţă scăzută la glucoză, copii

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EVALUATING INSULIN RESISTANCE IN CHILDREN: A CRITICAL APPRAISAL OF MINIMAL MODELS

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 1, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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HIGHLIGHTS

National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

The published medical research literature is a global public good. Medical journal editors have a social responsibility to promote global health by publishing, whenever possible, research that furthers health worldwide.

EVALUATING INSULIN RESISTANCE IN CHILDREN: A CRITICAL APPRAISAL OF MINIMAL MODELS

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ABSTRACT

Childhood obesity has followed, during the last two decades, an ascending trend. Insulin resistance (IR) is central to the pathophysiology of obesity. So far, several methods of assessing IR have been proposed. We aimed to evaluate critically some of the simplest methods used to assess IR in the pediatric population. We studied retrospectively the records of children evaluated for obesity in the “Louis Ţurcanu” Emergency Hospital for Children Timişoara, over a period of 10 years. The study population consisted of 342 children. Anthropometric and metabolic variables were analyzed, and the following indices of IR were assessed: impaired glucose tolerance (IGT), Homeostatic Model of Assesment-IR (HOMA-IR), Homeostatic Model of Assesment- b (HOMA- β), Quantitative Insulin Sensitivity Check Index (QUICKI) as well as the TG/HDLc ratio. Data was expresed as frequencies, means ± standard deviations or median ± interquartile interval for or a 95% confidence interval. The t-test for independent groups or the Mann-Whitney test to assess differences of IR indices across weight, gender and pubertal categories. HOMA-IR diagnosed the most children with IR, at the opposite pole we found QUICKI. IGT was a rare finding. It is necessary to reconsider how we assess the carbohydrate metabolism in children. Of the methods we evaluated, HOMA-IR is the optimal method for assessing IR children.

Keywords: Homeostatic Model, oral glucose tolerance test, Quantitative Insulin Sensitivity Check Index, insulin resistance, insulin sensitivity, impaired glucose tolerance, children.

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