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Daniela Pacurar

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Articole semnate de acelasi autor in Revista Romana de Pediatrie:

EVALUARE EPIDEMIOLOGICA SI PSIHO-SOCIALA A COPILULUI OBEZ – STUDIU PROSPECTIV

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 4, An 2015
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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EVALUARE EPIDEMIOLOGICA SI PSIHO-SOCIALA A COPILULUI OBEZ – STUDIU PROSPECTIV

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REZUMAT

Obiectiv. Studiul de faţă şi-a propus evaluarea unor parametri epidemiologici şi psiho-sociali într-un eşantion de copii supraponderali şi obezi spitalizaţi pentru diverse patologii. Durata studiului a fost de 12 luni.

Material şi metodă. S-a efectuat un studiu prospectiv, fiind incluşi 78 de copii (6-18 ani) supraponderali (IMC peste percentila 85) şi obezi (IMC peste percentila 95). Criteriul de excludere din studiu a constat în prezenţa unei patologii corelate cu obezitatea secundară. S-a aplicat un chestionar complex care a cuprins factorii de risc familiali şi personali, evaluarea psihologică şi evaluarea calităţii vieţii conform chestionarului PedsQL. Pentru fiecare pacient s-a efectuat evaluare clinică, a parametrilor de laborator şi imagistică (ecografie abdominală).

Rezultate. Dintre copiii incluşi în studiu, 55 au un părinte supraponderal şi 15 au ambii părinţi cu exces ponderal. Ancheta alimentară a dezvăluit greşeli alimentare în rândul a 65 de pacienţi (83,3%). Timpul mediu zilnic alocat televizorului şi calculatorului este crescut (5,7 ore/zi) comparativ cu timpul alocat activităţii fizice acasă şi la şcoală (0,57 ore/zi).

Concluzii. Obezitatea a fost asociată cu riscul familial, erori în programul şi conţinutul alimentaţiei, timpul scă- zut alocat activităţii fizice şi timpul prelungit petrecut în faţa calculatorului sau televizorului. Aceste repere trebuie avute în vedere în programele profilactice şi curative ale acestei patologii.

Cuvinte cheie: obezitate, populaţie pediatrică, anchetă alimentară, activitate fizică

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EPIDEMIOLOGICAL AND PSYCHOSOCIAL ASSESSMENT OF CHILDHOOD OBESITY – PROSPECTIVE STUDY

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 4, An 2015
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

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Promoting Global Health

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EPIDEMIOLOGICAL AND PSYCHOSOCIAL ASSESSMENT OF CHILDHOOD OBESITY – PROSPECTIVE STUDY

, , , , , and

ABSTRACT

Objective. The aim of this study was the evaluation of epidemiological and psychosocial parameters in a sample of overweight and obese children hospitalized for various pathologies. The duration of the study was 12 months.

Methods. We performed a prospective study that included overweight and obese children admitted in the Paediatric Unit of our hospital from July 2014 until June 2015. The exclusion criteria consisted of the presence of secondary pathologies related to obesity. A questionnaire was applied to all patients included with questions about family and personal risk factors for obesity; we realised also a psychological evaluation and quality of life assessment (PedsQL). For each patient we performed clinical evaluation, laboratory and imaging investigations (abdominal ultrasound).

Results. The study included 78 patients: 27 overweight (34.6%), 51 obese (65.3%). We studied the family history concerning the weight status: 55 had one obese parent and 15 had both parents with obesity. We identified dietary errors for almost all patients (65 patients = 83.3%). The average number of hours of physical activity was rather low (0.57 hours/day) and the average time spent in front of the TV and computer was increased (5.7 hours/day).

Conclusions. Obesity has been associated with familial background of obesity, dietary errors (both eating schedule and composition), decreased time spent doing physical activity and increased time dedicated to computer and television. These conclusions should be considered in the prophylactic and curative programs done for this pathology. Keywords: obesity, pediatric population, dietary errors, physical activity

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HEPATITA CRONICA VIRALA LA COPIL – CONSIDERATII TERAPEUTICE

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 4, An 2015
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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HEPATITA CRONICA VIRALA LA COPIL – CONSIDERATII TERAPEUTICE

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REZUMAT

Hepatita cronică virală reprezintă o problemă de sănătate publică în lume şi în ţara noastră, unde prevalenţa este încă mare. Prezentăm clasele de medicamente utilizate în prezent în tratamentul hepatitei cronice virale B atât în lume, cât şi în România, indicaţiile şi contraindicaţiile, avantajele şi dezavantajele fiecărei clase. Articolul de faţă îşi propune trecerea în revistă a mijloacelor de tratament actuale, însă nu şi a măsurilor profilactice ale hepatitei cronice virale B la copil. În prezent în România Interferonul standard este tratamentul de primă intenţie în hepatita cronică cu virus B la copil. Dintre analogii nucleotidici/nucleozidici, Entecavirul este aprobat pentru copiii cu greutate peste 32,6 kg. Tenofovirul, Adefovirul şi Lamivudina nu sunt aprobate în tratamentul hepatitei cronice cu virus B la copil. Tratamentul eficient al hepatitei cronice virale la copil este important pentru că evoluţia bolii hepatice este cu atât mai lungă cu cât infecţia este mai precoce. Existenţa mai multor opţiuni terapeutice oferă o şansă pacienţilor nonresponsivi la prima linie de tratament.

Cuvinte cheie: hepatită cronică virală B, copil, tratament

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PEDIATRIC CHRONIC VIRAL HEPATITIS – THERAPEUTIC CONSIDERATIONS

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 4, An 2015
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

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

Promoting Global Health

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PEDIATRIC CHRONIC VIRAL HEPATITIS – THERAPEUTIC CONSIDERATIONS

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ABSTRACT

Chronic viral hepatitis is a public health issue both worldwide and in Romania, where the prevalence of the disease is still high. We present the available therapies used for chronic viral hepatitis B treatment in children, worldwide and in Romania, indications and contraindications of treatment, benefits and disadvantages for each class. The present paper reviews only the treatment options and not profilactic measures for pediatric chronic viral hepatitis B. Currently, in Romania, standard Interferon is the treatment of choice. Entecavir is the only of the nucleotidic/nucleosidic analogues which is approved for children use, but not in those weighting less than 32.6 kg. Tenofovir, Adefovir and Lamivudine are not approved for pediatric chronic viral hepatitis B. Considering the fact that the disease progression is longer when the infection occurs earlier in life, efficient treatment is important for children with chronic viral hepatitis B. The availability of more treatment options provides a chance for patients who are nonresponsive to first line therapies.

Keywords: chronic viral hepatitis B, children, treatment

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SINDROMUL MUNCHAUSEN PRIN TRANSFER – O PROBLEMA REALA PEDIATRICA?

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 3, An 2015
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

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

Promoting Global Health

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SINDROMUL MUNCHAUSEN PRIN TRANSFER – O PROBLEMA REALA PEDIATRICA?

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REZUMAT

Sindromul Münchausen (SM) şi Münchausen prin transfer (SMPT) aparţin afecţiunilor numite „Factitious disorder şi reprezintă tulburări mentale severe care au ca „scop“ situaţia de a deveni pacient respectiv de a „fabrica“ o boală unei alte persoane, aflată în îngrijire, solicitând sau necesitând intervenţie medicală pentru aceasta. Sindromul Münchausen prin transfer nu este rar, dar este dificil de recunoscut şi de confirmat, este o formă de abuz, în special asupra copilului, potenţial letală, frecvent neînţeleasă şi nedepistată. Metodele folosite de adulţii falsificatori pentru a induce o afecţiune falsă copilului sunt variate: otrăvire, rănire, producerea de sângerări, infectare. Acuzele expuse de mamă ca aparţinând copilului nu au drept scop obţinerea de avantaje personale, ci sunt alimentate de dorinţa mamelor de a le fi acordat rolul de „erou“ şi de a fi recunoscute ca fiind persoanele ce acordă cea mai mare grijă copilului lor. Diagnosticul trebuie să includă evaluarea copilului, a părinţilor şi a familiei, unele elemente fiind sugestive: copil cu multiple probleme de sănătate, care nu răspunde la tratament sau reapar sub terapie adecvată, cu investigaţii paraclinice discrepante şi semne şi simptome ce dispar în absenţa părintelui. Afecţiunea falsă a copilului, descrisă intenţionat denaturat de către adult, nu-l afectează negativ pe acesta, dar procesul medical de diagnostic şi tratament poate produce durere şi disconfort. Aspectele etice şi legale asociate SMPT implică şi personalul medical, prin consecinţele actului medical asupra copilului, ca urmare a falsificării realităţii de către părinte. Educaţia pacientului, familiei şi personalului medical reprezintă o etapă foarte importantă în recunoaşterea, pre venirea şi tratamentul SMPT.

Cuvinte cheie: Münchausen prin transfer, copil

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MUNCHAUSEN SYNDROME BY PROXY – A REAL PEDIATRIC PROBLEM?

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 3, An 2015
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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ICMJE- Recommendations

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Promoting Global Health

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MUNCHAUSEN SYNDROME BY PROXY – A REAL PEDIATRIC PROBLEM?

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ABSTRACT

Munchausen syndrome and Munchausen by proxy syndrome belong belong to a group of disease called “factitious disorder” and are severe mental disorders having the “end” position for a healthy person to become patient, respectevely to “create” a disease to another person, asking or requiring medical intervention for him/her. Munchausen syndrome by proxy is rare, but it is difficult to be recognized and confirmed, is a form of abuse, particularly against children, potentially lethal, often misunderstood. Many methods are used by adults counterfeiters to induce a false child’s condition: poisoning, injury, producing bleeding, infection. Complaints exposed by the mothers as belonging to the child are not for a personal benefit, but are justified by a desire to be a “hero” mothers and to play the role of the people most attached and thoughtful of their child. Diagnosis should include evaluation of the child, parents and family and is based on suggestive elements: child with multiple health problems that do not respond to treatment or recur under proper therapy, laboratory investigations discrepancies, child’s signs and symptoms disappear in the absence of the parent. The false disease of the child, intentionally distorted described by adult, do not realy affect him/her, but the diagnostic process and medical treatment can cause pain and discomfort. Ethical and legal issues associated with MSBP involves healthcare professionals by the medical consequences on the child as a result of false complains described by the parent. Education of patient, family and medical personnel is a very important step in the recognition, prevention and treatment of MSBP.

Keywords: Munchausen by proxy syndrome, child

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Overlap and other autoimmune phenomena in pediatric chronic hepatic disease

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 2, An 2012
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

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

Promoting Global Health

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Overlap and other autoimmune phenomena in pediatric chronic hepatic disease

, , , and

ABSTRACT

Patients with chronic liver disease can present serological immune associations or a real overlap syndrome. The hepatic overlap syndrome includes biochemical and histological features either for two autoimmune hepatic diseases or for one autoimmune hepatitis and another chronic hepatic disease (chronic viral hepatitis B or C, Wilson’s disease, fatty liver disease). In the absence of appropriate treatment, the natural course of autoimmune hepatitis and overlap syndromes is towards cirrhosis and liver failure. The diagnostic criteria, prognostic scores and predictive factors for overlap syndromes are not yet established. The serological immune reactions are also found in liver disease other than autoimmune hepatitis. In chronic viral hepatitis C different types of immunological manifestations are oftenly associated. In non-alcoholic fatty liver disease the high prevalence of self-antibodies indicates the presence of an autoimmune response; on the other hand these antibodies can help predict the severity of the disease. The medical therapy of either the autoimmune reaction or the underlying hepatic disease should use an individualized algorithm regarding drug associations, dosing and duration of treatment.

Key words: hepatitis, overlap syndrome

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FENOMENE AUTOIMUNE DE OVERLAP IN HEPATITELE CRONICE ALE COPILULUI

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 2, An 2012
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

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

Promoting Global Health

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FENOMENE AUTOIMUNE DE OVERLAP IN HEPATITELE CRONICE ALE COPILULUI

, , , and

REZUMAT

Pacienţii cu hepatopatii cronice pot prezenta fenomene imunologice serologice sau chiar un veritabil sindrom de overlap. Aceste sindroame prezintă caractere comune biochimice şi histopatologice pentru cel puţin două dintre afecţiunile autoimune hepatice sau pentru o afecţiune autoimună hepatică şi o altă afecţiune hepatică cronică nonimună (infecţie hepatică VHC, VHB, boala Wilson, steatoza hepatică non-alcoolică). Evoluţia hepatitelor autoimune sau sindroamelor de overlap este adesea către ciroză şi insuficienţă hepatică fără terapie adecvată. Criteriile de diagnostic, scorurile de prognostic sau factorii de predicţie pentru apariţia sindroamelor de overlap nu sunt încă pe deplin stabilite. Fenomene de overlap serologic sunt descrise, şi în alte afecţiuni hepatice în afara celor imune recunoscute. În infecţia cronică cu virus hepatitic C pot fi identificate mai multe tipuri de reacţii imunologice. În steatoza hepatică nonalcoolică prevalenţa crescută a autoanticorpilor sugerează prezenţa fenomenului imun precum şi posibilitatea folosirii acestora ca factori de predicţie pentru severitate. Tratamentul medical al fenomenelor autoimune, dar şi al bolii de bază conduce la o terapie personalizată ca asociere terapeutică, doze, durată.

Cuvinte cheie: hepatită, hepatopatii, sindrom overlap

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Overlap syndromes in pediatric hepathology

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 3, An 2012
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

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.

Overlap syndromes in pediatric hepathology

, , , and

ABSTRACT

In hepathology, the term “overlap syndrome” describes different forms of hepatobiliary autoimmune disease: autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), autoimmune cholangitis (AIC). Patients with hepatic overlap syndrome present with both biochemical and histological features of at least two of AIH, PBC, PSC. In the absence of appropriate treatment, the course of the disease in autoimmune hepatitis and overlap syndromes is towards cirrhosis and liver failure. It remains unclear whether these overlap syndromes are distinct entities or variants of the major autoimmune hepatopathies. Standardization and diagnostic criteria for overlap syndromes are not yet established and the term “overlap syndrome” is common in clinical practice, but not always used correctly. Empiric medical treatment of overlap syndromes includes anticholestatic therapy with ursodeoxycholic acid and immunosuppressive therapy with corticosteroids and azathioprine in a case to case based therapy schedule. In end-stage disease, liver transplantation is the treatment of choice.

Key words: hepatitis, child, overlap

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SINDROAME DE OVERLAP IN HEPATOLOGIA PEDIATRICA

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 3, An 2012
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

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.

SINDROAME DE OVERLAP IN HEPATOLOGIA PEDIATRICA

, , , and

REZUMAT

Termenul „sindrom de overlap“ descrie, în hepatologie, forme diferite de afecţiuni hepatobiliare autoimune: hepatită autoimună (HAI), ciroză biliară primitivă (CBP), colangită sclerozantă primitivă (CSP), colangită autoimună. Pacienţii cu sindrom hepatic de overlap prezintă caractere comune biochimice şi histopatologice pentru cel puţin două din afecţiunile autoimune hepatice. Evoluţia hepatitelor autoimune sau sindroamelor de overlap este adesea către ciroză şi insuficienţă hepatică fără terapie adecvată. Rămâne încă neclar dacă aceste „sindroame de overlap“ sunt entităţi distincte sau doar variante ale hepatopatiilor majore autoimune. Stadializarea şi criteriile de diagnostic, scorurile de prognostic sau de predicţie pentru apariţia sindroamelor de overlap nu sunt încă pe deplin stabilite, ceea ce face a termenul să fie folosit frecvent dar, nu totdeauna corect în practica medicală. Sindroamele de overlap sunt afecţiuni hepatice rare, dar cu prognostic sever. Tratamentul medical empiric al sindroamelor de overlap hepatic include: terapie imunosupresivă cu corticosteroizi şi azathioprină, terapie anticolestatică cu acid ursodeoxicholic, strict personalizată ca asociere terapeutică, doze, durată. Stadiile finale necesită transplant hepatic.

Cuvinte cheie: hepatită, copil, overlap

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