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Alexandru Lacatus

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Articole semnate de acelasi autor in Revista Romana de Pediatrie:

Chronical constipation multifactorial etiopathogeny in childhood

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Revista Romana de PEDIATRIE | Volumul LXII, Nr. 2, An 2013
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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National Awards “Science and Research”

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Chronical constipation multifactorial etiopathogeny in childhood

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ABSTRACT

Constipation is an apparently common condition in children, but it has important consequences in pediatric age. Its prevalence varies between 0.7 and 29.6% (with an average of 8%), with no important difference between sexes. The etiology still remains unclear, and although many mechanisms involved in this disease were discovered, it is still very heterogenous. Constipation may be functional, related with an inadequate diet or with psychical circumstances which influences the normal act of defecation, organic, in which gastrointestinal diseases and not only, play a big role, or it may be talked about a genetic determinism. Specific associated gene mutations haven’t been related yet. There are plenty of genetic syndromes in which constipation is a frequent symptom. Trying to objectify the diagnosis, many types of classifications were suggested, based on the main types of the symptoms. Despite of this, diagnosing constipation in children still remains an important challenge.

Key words: child, constipation, delayed bowel movements

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ETIOPATOGENIA MULTIFACTORIALA A CONSTIPATIEI CRONICE LA VARSTA PEDIATRICA

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Revista Romana de PEDIATRIE | Volumul LXII, Nr. 2, An 2013
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.

ETIOPATOGENIA MULTIFACTORIALA A CONSTIPATIEI CRONICE LA VARSTA PEDIATRICA

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REZUMAT

Constipaţia este o patologie aparent banală, dar cu implicaţii importante la vârsta pediatrică. Prevalenţa acesteia variază de la 0,7% la 29,6% (în medie 8%), fără o diferenţă semnificativă între sexe. Etiologia constipaţiei rămâne încă neclară, fiind extrem de heterogenă în ciuda identificării a numeroase mecanisme ce stau la baza acestei afecţiuni. Constipaţia poate fi de natură funcţională, corelată cu o dietă neadecvată sau cu circumstante de natură psihică ce influenţează desfăşurarea normală a defecaţiei, organică, având la bază diferite boli ale tractului gastrointestinal şi nu numai, sau poate avea determinism genetic. Cu toate acestea, încă nu s-au găsit mutaţii genice asociate în mod specific. Numeroase sindroame genetice asociază ca mainifestare clinică constipaţia. În încercarea concretizării diagnosticului au fost propuse diferite clasificări bazate pe simptomatologie. Cu toate acestea, diagnosticul constipaţiei la populaţia pediatrică poate fi dificil de stabilit.

Cuvinte cheie: copil, constipaţie, tranzit intestinal încetinit

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Diagnosis and management in chronic constipation in children age (Part II)

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Revista Romana de PEDIATRIE | Volumul LXII, Nr. 3, An 2013
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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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

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Promoting Global Health

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Diagnosis and management in chronic constipation in children age (Part II)

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ABSTRACT

Constipation is a common health problem that affects children of all ages. The etiology is often functional, being the result of voluntary retention of the stool. A complete case history and a detailed physical examination are essential for an appropriate diagnosis. In most cases laboratory investigations are not required; they are indicated when a suspicion of an organic cause occurs (Hirschsprung disease, pseudoobstruction, hypothyroidism, diabetes insipidus, cystic fibrosis, congenital anorectal malformations) or in treatment-resistant cases. Early diagnosis is extremely important being associated with a better response to therapy. This includes performing DRE, colonoscopy, scintigraphy, colon videocapsule and anorectal manometry. The first stage of functional constipation treatment consists in desimpactation. Polyethylene glycol is effective and well tolerated. After desimpactation, a long-term maintenance program is necessary, due to increased frequency of relapses. Maintenance drugs include mineral oil, lactulose, polyethylene glycol and sorbitol. A diet rich in dietary fiber associated with family support and, when possible, child education are essential. The delay in diagnosis and treatment can lead to the progression into a chronic health problem with physical, psychological and social implications.

Key words: constipation, colonoscopy, anorectal manometry, child

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DIAGNOSTIC SI MANAGEMENT IN CONSTIPATIA CRONICA LA COPIL (Partea a II-a)

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Revista Romana de PEDIATRIE | Volumul LXII, Nr. 3, An 2013
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.

DIAGNOSTIC SI MANAGEMENT IN CONSTIPATIA CRONICA LA COPIL (Partea a II-a)

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REZUMAT

Constipaţia este o problemă comună care afectează copiii de toate vârstele. De cele mai multe ori etiologia este de natură funcţională, fiind rezultatul retenţiei voluntare a scaunului. Un rol important în stabilirea diagnosticului îl au obţinerea unei anamneze complete şi efectuarea unui examen fizic detaliat. În majoritatea cazurilor investigaţiile paraclinice nu sunt necesare pentru diagnostic, ele fiind indicate atunci când există suspiciunea unei cauze organice de constipaţie (boala Hirschsprung, pseudoobstrucţie, hipotiroidism, diabet insipid, fibroză chistică, malformaţii anorectale congenitale) sau în cazurile cu rezistenţă la tratament. Diagnosticul precoce este extrem de important, fiind asociat cu un răspuns mai bun la terapie. Acesta include efectuarea tuşeului rectal, colonoscopia, scintigrafia colonică, videocapsulă şi manometria anorectală. Prima etapă a tratamentului constipaţiei funcţionale constă în dezimpactare. Polietilen glicolul este eficace şi bine tolerat. După dezimpactare este iniţiat un program de întreţinere pe termen lung, din cauza frecvenţei crescute a recidivelor, cu medicamente ca uleiul mineral, lactuloza, polietilenglicolul şi sorbitolul. Regimul alimentar bogat în fibre alimentare asociat cu educaţia familiei şi, atunci când este posibil, a copilului este esenţial. Întârzierea diagnosticului şi implicit a tratamentului poate duce la progresia spre o problemă cronică semnificativă de sănătate cu implicaţii fizice, psihologice şi sociale.

Cuvinte cheie: constipaţie, colonoscopie, manometrie anorectală, copil

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CONSIDERATII CLINICO-EPIDEMIOLOGICE IN LEGATURA CU ULCERUL PRIMAR LA COPIL – STUDIU RETROSPECTIV PE 5 ANI

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 3, 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.

CONSIDERATII CLINICO-EPIDEMIOLOGICE IN LEGATURA CU ULCERUL PRIMAR LA COPIL – STUDIU RETROSPECTIV PE 5 ANI

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REZUMAT

Ulcerul peptic primar se menţine frecvent la copiii din ţările în curs de dezvoltare cu o incidenţă crescută a infecţiei cu H.pylori. Autorii au efectuat un studiu retrospectiv pe 84 de copii internaţi în Clinica V-a Pediatrie Gastroenterologie cu diagnosticul de boală ulceroasă între anii 2007-2023. Criteriile de includere în studiu au fost simptomatologia clinică sugestivă şi endoscopia pozitivă. În lotul studiat au existat 79 de copii cu ulcer primar şi 5 copii cu ulcer secundar. Raportând datele la o populaţie pediatrică de 1.400.000 de copii în nordestul României, incidenţa afecţiunii a fost de 5.64/100.000 iar frecvenţa a fost de 2,58% faţă de totalul de 3.052 de endoscopii digestive superioare efectuate în perioada menţionată. Raportul băieţi: fete a fost de 1.46:1 iar 77,41% dintre pacienţi proveneau din mediul urban. Ulcerele au debutat prin sindrom funcţional digestiv în 70,89% dintre cazuri sau printr-o complicaţie în 29,11% dintre cazuri. Prin endoscopie digestivă superioară au fost identifi cate 62 de ulcere duodenale (UD) şi 10 ulcere gastrice (UG). La 7 copii debutul prin perforaţie a permis identifi carea intraoperatorie a leziunilor. În 70,89% dintre cazuri a fost demonstrată prezenţa cu infecţie cu H. pylori. Factorii favorizanţi pentru această boală au fost: dieta necorespunzătoare (63,16%), fumatul (57,89%), consumul de alcool (15,78%), stresul psihologic (27,27%). Am obţinut o corelaţie semnifi cativă între numărul mare de membri ai unei familii (r = 0,63%; p = 0,002), statusul socioeconomic scăzut (r = 0,87, p = 0,0003) şi infecţia cu H.pylori. Tratamentul antibacterian a utilizat tripla terapie standard la 73,33% pacienţi, cvadrupla terapie bazată pe bismut la 16,66% copii şi terapia secvenţială în 10% dintre cazuri. Rata globală de eradicare moderată obţinută (66,66%) poate fi considerată o dovadă indirectă a rezistenţei mari la claritromicină la copiii din România.

Cuvinte cheie: boală ulceroasă primară, copil, H.pylori

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CLINICAL-EPIDEMIOLOGICAL CONSIDERATIONS REGARDING PRIMARY PEPTIC ULCER IN CHILDREN – 5 YEARS RETROSPECTIVE STUDY

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 3, 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.

CLINICAL-EPIDEMIOLOGICAL CONSIDERATIONS REGARDING PRIMARY PEPTIC ULCER IN CHILDREN – 5 YEARS RETROSPECTIVE STUDY

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ABSTRACT

Primary peptic ulcer still remains highly quoted in children from developing countries, the infection with H. pylori having a high incidence among this cases. Between 2007 and 2012 a retrospective study was performed, involving 84 children who were hospitalized in our clinic, ulcer disease being the main diagnosis.The study’s inclusion criteria were suggestive clinical symptoms and positive endoscopy. The studied group consisted by 79 children with primary ulcer and 5 with secondary ulcer. Reporting data for 1,400,000 children population in North – Eastern Romania an incidence of 5.64/100.000 of primitive ulcer disease has been found, the frequency being 2.58% compared with the overall 3052 upper digestive endoscopies done in the years mentioned above. Male to female ratio was 1.46:1. 77.41% of the patients originated in urban areas. The onset was by functional digestive syndrome in 70,89% of the cases or by complications in 29.11% of the cases. By upper digestive endoscopy 62 duodenal ulcers (DU) and 10 gastric ulcers (GU) were identifi ed. Perforation allowed intraoperative diagnosis of ulcerative lesions in 7 children. 70.89% were H. pylori infection – related ulcers. The contributing factors for developing this condition were unproper diet (63.16%), smoking (57.89), alcohol consumption (15.78), psychological stress (27.27%). We obtained a signifi cant correlation between the high number of a family members, (r = 0.63%; p = 0.002), the low socio-economical status (r = 0.87, p = 0.0003) and H.pylori infection. We used the standard triple therapy on 73.33% of the patients, the qvadruple therapy, based on bismuth on 16.66% of the children, and the sequential therapy in 10% of the cases. The global eradication rate was 66.66% therefore we considered this as being an indirect proof for the high claritromycine resistance in children from our region.

Keywords: primary ulcer disease, child, H.pylori

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