LIVER DISEASE IN CHILDREN WITH CYSTIC FIBROSIS

Liver disease is an early complication in children with cystic fi brosis (CF).The clinical manifestations in hepatobiliary disease of CF include neonatal cholestasis, liver steatosis, liver fi brosis, biliary lithiasis, focal biliary cirrhosis and multilobular cirrhosis, with or without portal hypertension. Changes in the tests evaluating the liver function are inconsistent and are not correlated with the severity of the liver lesions. The diagnosis of liver disease in CF requires the presence of at least two of the following four diagnosis criteria:clinical manifestations, pathologic liver function tests, ultrasound and histologic changes.The annual follow-up to evaluate the liver function is s recommended for diagnosis of asymptomatic liver disease and early initiation of treatment with ursodeoxycholic acid.The improvement of the liver function infl uences life quality and increases the survival rate in patients with CF

The Stigma of the Medical Personnel in Psychiatry

This research was structured as a descriptive study based on a questionnaire with seven questions, addressed to the medical personnel involved in the medical assistance of the patient with mental disorders (psychiatrists, family doctors, physicians from other specialties, psychologists). This study refers to the relationship medical team – psychiatric patient from the point of view of the health professionals. The main appreciation criteria refer to the lack of knowledge or minimizing the importance of patients’ rights, aspect that can influence the voluntary addressability of psychiatric patients to treatment and therapeutic success.The lot of this study had a number of 217 subjects from which are part psychiatrists, family doctors, physicians from other specialties and psychologists, who work in therapy centers and hospitals from the following counties: Iaşi, Botoşani, Suceava, Vaslui.</p

AFECTAREA HEPATICĂ LA COPIII CU FIBROZĂ CHISTICĂ

Afectarea hepatică reprezintă o manifestare precoce la copiii cu fi broză chistică (FC). Spectrul manifestărilor clinice în afectarea hepato-biliară din FC cuprinde colestaza neonatală, steatoza hepatică, fi broza hepatică, litiaza biliară, ciroza biliară focală şi ciroza multilobulară, cu sau fără hipertensiune portală. Modifi carea testelor de evaluare a funcţiei hepatice este inconstantă şi nu se corelează cu severitatea leziunilor hepatice. Diagnosticarea bolii hepatice în FC necesită prezenţa a cel puţin două din cele patru criterii de diagnostic: manifestări clinice, modifi carea testelor funcţionale hepatice, ecografi ce şi anatomopatologice. Screeningul anual pentru suferinţa hepatică este recomandat pentru diagnosticarea bolii asimptomatice şi iniţierea precoce a tratamentului cu acid ursodeoxicholic. Ameliorarea funcţiei hepatice infl uenţează calitatea vieţii şi creşte rata supravieţuirii la pacienţii cu FC

DIABETUL ZAHARAT DIN FIBROZA CHISTICǍ (MUCOVISCIDOZǍ)

Diabetul asociat fi brozei chistice este o entitate distinctǎ comparativ cu diabetul zaharat tip 1 şi 2, dar care are şi simptome caracteristice acestora. Odatǎ cu prelungirea speranţei de viaţǎ, şi prevalenţa diabetului a crescut, asociindu-se cu un declin mai sever al funcţiei pulmonare şi cu stare nutriţionalǎ mai precarǎ comparativ cu ale pacienţilor cu fi brozǎ chisticǎ, dar fǎrǎ diabet. Autorii prezintǎ date actuale cu privire la prevalenţa şi fi ziopatologia bolii, tabloul clinic, examenele utile în stabilirea diagnosticului, posibilitǎţile terapeutice şi prognosticul bolii. Con cluzionǎm cǎ diagnosticarea precoce şi intervenţiile terapeutice adecvate pot diminua impactul negativ al diabetului asupra funcţiei pulmonare şi satusului nutriţional în FC

CYSTIC FIBROSIS-RELATED DIABETES

Cystic fi brosis-related diabetes is an entity distinct from diabetes mellitus type 1 and 2, but with symptoms characteristic to them. Along with the extension of the life expectancy, the prevalence of diabetes increased in association with a more severe decline of the lung function and a poorer nutritional status in comparison to that of people with cystic fi brosis but without diabetes. The authors present current data regarding the prevalence and physiopathology of the disease, the clinical picture, and the useful examinations in establishing the diagnosis, the therapeutic possibilities and disease prognostic. We conclude that the early diagnosis and appropriate therapeutic interventions may diminish the negative impact of diabetes on the lung function and the nutritional status in cystic fi brosis

ANXIETY ASSOCIATED WITH VISIT TO THE DENTIST

Aim of the study Anxiety disorder is a mental condition that makes dental treatment difficult both for children and adults. The purpose of this study was to compare the efficacy of behavior management techniques and use of Nitrous Oxide to reduce anxiety in adult pediatric patients Material and methods 170 patients, adults and children in evidence with anxiety disorders were analyzed. Subjects underwent a complex psychological intervention ("tell-show-do" method, music therapy, and respiratory therapy) and in non-responders inhalation with nitrogen protoxide and oxygen was used. Results From the mature subject’s analysis, the main reason for low addressability in dentistry for almost half of the subjects is fear. Of the mature subjects, 76% of women and only 24% of men required psychological therapy of anxiety and the effectiveness of psychological methods used to reduce anxiety has a percentage of 46% for men and 34% for women. In the children group there is a very low addressability to the dental services of the people from rural areas. Anxiety related to dental interventions is higher than in older people but the effectiveness of behavioral therapies is very good. In both groups prevalence of dental fear is significantly higher in females Conclusions behavior management techniques like “tell-showdo”, music therapy, respiratory therapy are safe and easy to implement. The effectiveness of this method is good in adults (40%) and exceptional in children (90 % success rate)

Effects of prophylactic ibuprofen and paracetamol administration on the immunogenicity and reactogenicity of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugated vaccine (PHiD-CV) co-administered with DTPa-combined vaccines in children: An open-label, randomized, controlled, non-inferiority trial

Prophylactic paracetamol administration impacts vaccine immune response; this study (www.clinicaltrials.gov: NCT01235949) is the first to assess PHiD-CV immunogenicity following prophylactic ibuprofen administration. In this phase IV, multicenter, open-label, randomized, controlled, non-inferiority study in Romania (November 2010–December 2012), healthy infants were randomized 3:3:3:1:1:1 to prophylactically receive immediate, delayed or no ibuprofen (IIBU, DIBU, NIBU) or paracetamol (IPARA, DPARA, NPARA) after each of 3 primary doses (PHiD-CV at age 3/4/5 months co-administered with DTPa-HBV-IPV/Hib at 3/5 and DTPa-IPV/Hib at 4 months) or booster dose (PHiD-CV and DTPa-HBV-IPV/Hib; 12–15 months). Non-inferiority of immune response one month post-primary vaccination in terms of percentage of infants with anti-pneumococcal antibody concentrations ≥0.2 µg/mL (primary objective) was demonstrated if the upper limit (UL) of the 98.25% confidence interval of difference between groups (NIBU vs IIBU, NIBU vs DIBU) was <10% for ≥7/10 serotypes. Immunogenicity and reactogenicity/safety were evaluated, including confirmatory analysis of difference in fever incidences post-primary vaccination in IBU or DIBU group compared to NIBU. Of 850 infants randomized, 812 were included in the total vaccinated cohort. Non-inferiority was demonstrated for both comparisons (UL was <10% for 9/10 vaccine serotypes; exceptions: 6B [NIBU], 23F [IIBU]). However, fever incidence post-primary vaccination in the IIBU and DIBU groups did not indicate a statistically significant reduction. Prophylactic administration (immediate or delayed) of paracetamol decreased fever incidence but seemed to reduce immune response to PHiD-CV, except when given only at booster. Twenty-seven serious adverse events were reported for 15 children; all resolved and were not vaccination-related