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Gabriela Ciubotariu

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Articole semnate de acelasi autor in Revista Romana de Pediatrie:

DIAGNOSTIC SI TRATAMENT IN BOALA DE REFLUX GASTROESOFAGIAN – POSIBILITATI SI LIMITE

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Revista Romana de PEDIATRIE | Volumul LXV, Nr. 3, An 2016
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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DIAGNOSTIC SI TRATAMENT IN BOALA DE REFLUX GASTROESOFAGIAN – POSIBILITATI SI LIMITE

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REZUMAT

Departajarea refluxului gastro-esofagian (RGE) fiziologic (cel mai frecvent) de boala de reflux gastro-esofagian (BRGE) în primul an de viaţă este obligatorie pentru a evita farmacoterapia agresivă. La toate vârstele
copilăriei se aplică criterii moderne de evaluare clinică, sumând simptome digestive şi/sau extradigestive şi rezultatele unor investigaţii moderne. Tratamentul igieno-dietetic (suficient in RGE fiziologic), obligatoriu în toate cazurile, şi inhibitorii de pompă protonică dupa vârsta de un an induc remisiune în majoritatea cazurilor de RGE. Evoluţia cronică/recidivantă şi rezistenţa la tratamentul comun impun intervenţia chirurgicală, domeniu îmbogaţit recent la copil cu miotomia perorală endoscopică (POEM).

Cuvinte cheie: boală de reflux gastroesofagian, inhibitori de pompă de protoni, miotomia perorală endoscopică

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DIAGNOSIS AND TREATMENT IN GASTROESOPHAGEAL REFLUX DISEASE – POSSIBILITIES AND LIMITATIONS

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Revista Romana de PEDIATRIE | Volumul LXV, Nr. 3, An 2016
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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DIAGNOSIS AND TREATMENT IN GASTROESOPHAGEAL REFLUX DISEASE – POSSIBILITIES AND LIMITATIONS

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ABSTRACT

In children’s first year of life it is mandatory to make a difference between physiological gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD), in order to avoid an aggressive pharmacologic therapy. All ages of childhood benefit from modern criteria of clinical evaluation, by corroborating the digestive or extradigestive symptoms with the results of modern investigations. The dietary measures (sufficient in GER but mandatory in all cases) together with proton pump inhibitors administration after one year of age induce remission in majority of GER cases. The chronic and recurrent evolution of the disease or failure of the common treatment require surgical intervention, recently enriched in children with peroral endoscopic myotomy (POEM).

Keywords: gastroesophageal reflux disease, proton pump inhibitors, Peroral Endoscopic Myotomy

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Articular manifestations in inflammatory bowel disease in children

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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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Articular manifestations in inflammatory bowel disease in children

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ABSTRACT

Inflammatory bowel disease (Crohn disease and ulcero-hemorrhagic rectocolitis) remains a chapter open to research due to its frequency (higher in the last decades), the clinical and evolutive particularities of digestive and extra digestive disorders, pathogenic enigma which represents a source of therapeutic difficulties. Specific genetic patterns and gene mutations favour the aberrant immune response to the antigens in the environment or the autoantigens causing bowel inflammations with high chronicization potential; the cytokines released and other still unknown mechanisms can be responsible for extra digestive disorders. The authors systematize recent data related to the pathogenesis of clinical evolutive types, modern diagnosis possibilities, the limits and the possibilities of modern therapeutic measures in arthropathies accompanying the inflammatory bowel disease.

Key words: inflammatory bowel disease, child, arthritis

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MANIFESTARI ARTICULARE IN BOLILE INFLAMATORII INTESTINALE LA COPIL

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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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MANIFESTARI ARTICULARE IN BOLILE INFLAMATORII INTESTINALE LA COPIL

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REZUMAT

Bolile inflamatorii intestinale (boala Crohn şi rectocolita ulcero-hemoragică) rămân un capitol deschis cercetării din cauza frecvenţei (în creştere în ultimele decade), particularităţilor clinico-evolutive a suferinţei digestive şi extradigestive, a enigmelor patogenetice, sursă a dificultăţilor terapeutice. Tipare genetice specifice, mutaţii genice favorizează răspuns imun aberant la antigeni din mediu sau la autoantigeni provocând o inflamaţie intestinală cu potenţial înalt de cronicizare; citokinele eliberate şi alte mecanisme încă necunoscute pot fi responsabile de manifestările extradigestive. Autorii sistematizează date recente privind patogeneza formelor clinico-evolutive, posibilităţi moderne de diagnostic, posibilităţile şi limitele măsurilor terapeutice moderne în artropatiile care însoţesc boala inflamatorie intestinală.

Cuvinte cheie: afecţiune inflamatorie intestinală, copil, artrită

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CONSIMTAMANTUL INFORMAT PENTRU ENDOSCOPIA GASTROINTESTINALA IN PEDIATRIE

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Revista Romana de PEDIATRIE | Volumul LXII, Nr. 4, An 2013
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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CONSIMTAMANTUL INFORMAT PENTRU ENDOSCOPIA GASTROINTESTINALA IN PEDIATRIE

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REZUMAT

Consimţământul informat a devenit o componentă majoră, dar şi obligatorie în practica medicală contemporană, numeroase foruri şi publicaţii subliniind comandamentele sale etice şi psihologice, ca şi modalităţile de obţinere şi mai ales implicaţiile de ordin legal. Implicaţiile acestei proceduri în cazul pediatriei sunt complexe, câteodată confuze sau insuficient intelese. Astfel dacă în cazul consultului clinic sau al actelor medicale simple, con sim- ţământul poate fi considerat implicit, în situaţia unor manevre provocatoare de disconfort psihic sau fizic, investigaţii invazive – în care este inclusă şi endoscopia sau acte terapeutice presupunând posibilitatea unor ris curi sau complicaţii, obţinerea unui consimtământ informat din partea parinţilor sau aparţinătorilor legali şi respectiv a unui acord (accept) din partea unui copil evoluat din punct de vedere intelectual, psihologic şi social devine mandatorie. Trebuie totuşi clarificate nuanţele nu numai semantice între consimţământ şi acord, ponderea fiecaruia din acestea în decizia finală, discernământul pacientului minor la diferite grupe de vârstă şi în egală măsură rolul şi locul medicului curant în astfel de circumstanţă.

Cuvinte cheie: consimţământ informat, endoscopie gastrointestinală

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INFORMED CONSENT IN PEDIATRIC GASTROINTESTINAL ENDOSCOPY

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Revista Romana de PEDIATRIE | Volumul LXII, Nr. 4, An 2013
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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INFORMED CONSENT IN PEDIATRIC GASTROINTESTINAL ENDOSCOPY

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ABSTRACT

Informed consent has become a major, but also mandatory component in medical praxis nowadays. A great number of forums and publications emphasize its ethical and psychological commands, the most adequate way to obtain it and especially its legal implications. In pediatrics, the implications of this procedure are complex, sometimes confusing or not well understood. Thus, in clinical consultations or simple medical acts, the consent could be seen as implicit; when we talk about manoeuvres that lead to psychological or physical discomfort, invasive investigations, including endoscopy or therapeutical acts with possible risks or complications, informed consent from parents or legal tutors, respectively an intellectually, psychologically and socially evolved, educated child’s consent (acceptance) becomes mandatory. We must, however, clarify the nuances between consent and acceptance, not only from the semantic point of view, the proportion of either of the two terms in the final decision, the minor patient’s ability to discern at different age stages and finally the role and the importance of the doctor in such decision makings.

Key words: informed consent, gastrointestinal endoscopy

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FACTORI PREDISPOZANTI AI CONSTIPATIEI CRONICE LA COPIL – STUDIU CLINIC PE 2 ANI

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 4, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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FACTORI PREDISPOZANTI AI CONSTIPATIEI CRONICE LA COPIL – STUDIU CLINIC PE 2 ANI

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REZUMAT

În ultimul deceniu constipaţia a devenit o problemă actuală de adresabilitate în serviciile de gastroenterologie pediatrică.

Obiective. Ne-am propus un studiu pentru a identifica prevalenţa constipaţiei şi stabilirea unor corelaţii între dietă şi mediul socio-familial la copii cu vârste cuprinse între 1 şi 17 ani, internaţi în serviciul de Gastroenterologie, Spitalul Clinic de Urgenţă pentru Copii „Sfânta Maria“ Iaşi, în perioada 1 ianuarie 2012 – 1 ianuarie 2014.

Rezultate. Grupul de studiu a constat dintr-un lot de 994 de pacienţi, reprezentând 9,6% din totalul copiilor spitalizaţi. În ceea ce priveşte prevalenţa constipaţiei nu am observat o diferenţă semnificativă între sexe, raportul F/M a fost de 1,3/1, dar am remarcat o proporţie semnificativă de pacienţi provenind din mediul urban 68% (676) faţă de 32% (318) din mediul rural. În ceea ce priveşte mediul socio-familial: 34% (338) dintre copii trăiesc cu bunicii, 13,9% (139) provin din familii monoparentale, 6,7% (67) sunt în grija unui asistent maternal şi 2,6% (26) vin din centrele de plasament. În lotul studiat un procent mic de copii au fost alăptaţi, respectiv, 26,2% (261), în prima lună, 10,7% (107) timp de 3 luni în timp ce la 6 luni 98,1% (976) dintre copii au primit o formulă de lapte. Diversificarea a fost făcută incorect în cazul a 41% (408) dintre pacienţi. Doar 14,6% (145) au raportat consumul zilnic de fructe şi legume, în timp ce 51,1% (508) au luat masa cel puţin o dată pe săptămână la restaurante de tip fast-food. 21,6% (214) practică sport cel puţin 2 ore/săptămână, în timp ce 48,7% (484) petrec cel puţin 3 ore/zi la televizor. 12,8% (128) dintre pacienţi sunt supraponderali şi 5,7% (57) obezi.

Concluzii. Constipaţia este o boala care afectează copiii de toate vârstele. Nu sunt diferenţe notabile între sexe. Se remarcă o pondere crescută a pacienţilor din mediu urban cu predominanţa unui regim alimentar inadecvat, lipsa activităţii fizice, precum şi o pondere crescută a pacienţilor supraponderali. Un rol important în modificările psihologice îl deţine mediul socio-familial.

Cuvinte cheie: constipaţie, encoprezis, copil

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PREDISPOSING FACTORS FOR CHRONIC CONSTIPATION IN CHILDREN – 2-YEAR CLINICAL STUDY

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 4, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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PREDISPOSING FACTORS FOR CHRONIC CONSTIPATION IN CHILDREN – 2-YEAR CLINICAL STUDY

, , , , , , , and

ABSTRACT

In the last decade constipation has become a current problem addressed in the pediatric gastroenterology departments.

Objectives. We propose a study to establish the prevalence of constipation and the correlations between diet and the socio-familial environment in children aged from 1 to 17 years old, hospitalized in the Gastroenterology Department, „Saint Mary“ Emergency Hospital for Children of Iasi, between 1 January 2012 and 1 January 2014

Results. The study group consisted of 994 patients, representing 9.6% of all hospitalized children. Regarding the prevalence of constipation, we did not notice a significant difference between the sexes, the ratio F/M was 1.3/1, but we found a significantly higher proportion of patients from urban areas 68% (676) versus 32% (318) from rural areas. In terms of social and family environment: 34% (338) of children live with grandparents, 13.9% (139) come from single-parent families, 6.7% (67) are in the care of a foster parent and 2.6% (26) come from orphanages. In the group studied a low percentage of children were breastfeed, respectively 26.2% (261) in the first month, 10.7% (107) for 3 months, while at 6 months 98.1% (976) of children received a milk formula. Diversification was done incorrectly in the case of 41% (408) patients. Only 14.6% (145) reported daily consumption of fruits and vegetables, while 51.1% (508) had dinner at least once a week at fast food restaurants. 21.6% (214) practice sport at least 2 hours/week, while 48.7% (484) spend at least 3 hours/day watching television. 12.8% (128) of patients are overweight and 5.7% (57) obese.

Conclusions. Constipation is a condition that affects children of all ages. There are not notable differences between the sexes. An increased proportion of urban patients with predominance of inadequate diet, physical inactivity and an increased proportion of overweight patients was found. The socio-familial environment has an important role in the psychological changes.

Keywords: constipation, encopresis, child

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