UTILITATEA MĂSURĂRII FENO ÎN MONITORIZAREA COPIILOR CU ASTM BRONŞIC

Scopuri şi obiective. Astmul bronşic este cea mai frecventă boală cronică la copii. În peste 50% din cazurile pediatrice, infl amaţia căilor aeriene este eozinofi lică. În monitorizarea astmului, cel mai important aspect este prevenirea exacerbărilor printr-o bună comunicare medic-pacient-familie şi o complianţă ridicată a acestora din urmă la tratament. Foarte importantă este şi evaluarea corectă a calităţii vieţii copilului cu astm. Studiul de faţă şi-a propus verifi carea corelaţiei între nivelul de control al astmului şi nivelul de infl amaţie eozinofi lică de la nivelul căilor aeriene la copiii afl aţi în tratament cu corticosteroizi inhalatorii (CSI). Material şi metodă. Am evaluat un număr de 24 pacienţi care s-au prezentat la compartimentul de primiri urgenţe al spitalului IOMC „Alfred Rusescu“ Bucureşti în cursul a zece săptămâni din anotimpul rece. Evaluarea a constat în efectuarea scorului Asthma Control Test (ACT), măsurarea fracţiei de Oxid Nitric din aerul expirat (FeNO) şi probe funcţionale respiratorii. Rezultate şi discuţii. Valoarea scorului ACT în funcţie de măsurarea FENO arată o corelaţie liniară şi negativă cu r = -0.6286 (p < 0,01). Concluzii. Măsurarea FeNO este o metodă simplă, rapidă şi neinvazivă. Valoarea FeNO este corelată cu scorul ACT, în mod liniar şi negativ. Crearea unor algoritmi simpli ar putea îmbunătăţi controlul şi monitorizarea evoluţiei şi ar permite personalizarea terapiei la copilul cu astm

THE UTILITY OF MEASURING FENO IN MONITORING ASTHMATIC CHILDREN

Purposes and objectives. Bronchial asthma is the most frequent chronic disease in children and in almost 50% of these cases, it occurs eosinophilic airway infl ammation. The most important objective in monitoring asthma is preventing exacerbations by means of good communication between phisician, patient and family, a good compliance of the latter and an accurate assesment of the asthmatic patient’s quality of life. Present study is examining correlation between asthma control and airways eosinophilic infl ammation level in asthmatic children treated with ICS. Method and material. We evaluated 24 patients presented in emergengy department of our hospital, during ten weeks in cold season. The assesment consisted in performing Asthma Control Test (ACT), measuring fraction of the exhaled nitric oxide (FeNO) and pulmonary function testing. Results and discussions. We documented a negative linear correlation of ACT score with FeNO (r = -0. 6286 (p < 0.01)). Conclusions. Measuring FeNO is a simple to perform, fast and noninvasive method. FeNO value is related to ACT score, between them being a negative linear correlation. Generating simple algorithms may improve control of disease and tailoring therapy asthmatic children

TRATAMENTUL DESHIDRATĂRII ACUTE LA COPILUL CU GASTROENTERITĂ

Boala diareică acută (BDA) reprezintă o cauză frecventă de morbiditate la toate grupele de vârstă şi a treia cauză de mortalitate, la copilul sub 5 ani, după decesele perinatale şi afecţiunile respiratorii. Copiii, în special cei cu vârstă mică, sunt deseori afectaţi de forme severe de BDA, principalul mecanism generator de complicaţii cu risc letal fi ind deshidratarea acută. Articolul de faţă doreşte a fi o punere la punct a celor mai noi recomandări de evaluare şi de tratament în deshidratările acute la copil. Este subliniat rolul evaluării semnelor precoce de şoc, precum şi al semnelor de mare gravitate, folosind algoritmii European Resuscitation Council şi criteriile Pediatric Advanced Life Support. Sunt date exemple practice de evaluare şi de tratament, fi ind detaliate opţiunile de rehidratare în funcţie de severitate şi comorbidităţi

STUDIU ASUPRA PERCEPŢIEI ŞI AL MODULUI DE ABORDARE PARENTAL PRIVIND PNEUMONIA COMUNITARĂ LA PREŞCOLARII DIN ROMÂNIA

Introducere. Pneumonia comunitară este foarte frecventă şi este responsabilă de 16% dintre decesele la copiii cu vârstă de pană la 5 ani. Scopul prezentului studiu a fost să identifice potenţiali factori modificabili/influenţabili în legătură cu percepţia parentală privind managementul pneumoniei la copil. Conturarea unor astfel de factori ar permite elaborarea unor strategii de scădere a morbidităţii asociate pneumoniei în România. Materiale şi metode. A fost realizat un studiu transversal în perioada 25.08.2016 – 27.08.2016 ce a constat în distribuirea la nivelul platformelor de socializare a unui formular de tip Google Form pentru părinţii copiilor cu vârstă între 4 luni şi 5 ani. Chestionarul a cuprins 26 întrebări distribuite în 5 secţiuni. Colectarea datelor şi analiza statistică a fost realizată prin intermediul Microsoft Office Excel Worksheet. Rezultate. Au răspuns 1.083 de părinţi. La întrebarea privind statusul vaccinal am primit următoarele răspunsuri: 973 de copii sunt vaccinaţi (89.8%) conform Schemei Ministerului Sănătăţii şi 90 sunt vaccinaţi incomplet sau nevaccinaţi. 378 de copii au fost alimentaţi natural mai puţin de 4 luni sau niciodată. 32% (352) au diversificat la o vârstă mai mică de 4 luni şi 19% (201) după 6 luni. 46,91% (508) din copii au avut infecţii acute de căi respiratorii şi 42,41% (215) dintre aceştia au avut nevoie de internare. Pe primele două poziţii ale simptomelor care i-ar determina să se prezinte cu copilul la medic se află febra 47,83% (518) şi tusea 19,58% (212). 38,87% (421) dintre respondenţi au administrat medicamente fără a cere sfatul unui medic, iar 61,3% (358) din respondenţi administrat analgezice şi antipiretice. Pneumonia a fost recunoscută drept o boală gravă care poate determina uneori deces de către 69,07% (748) dintre respondenţi. Discuţii. Deoarece în literatură există dovezi ale unei corelaţii a morbidităţii şi mortalităţii în pneumonia copilului mic cu statusul socio-economic şi cu cel educaţional familial, am dorit să explorăm şi alţi factori potenţial incriminabili, în această epocă de semnificative modificări de percepţie parentală şi de comportament social sau de comunicare. Concluzii. Scăderea ratei de acoperire vaccinală în România (89% la acest grup selectat de pacienţi cu acces la Social Media) a dus la coborârea sub pragul la care se menţine imunitatea de grup. Părinţii din România care au răspuns la chestionar au obţinut un scor bun la recunoaşterea simptomelor şi aprecierea gravităţii pneumoniei. Numărul mare de respondenţi incluşi în studiu într-un timp scurt este un indicator al dorinţei părinţilor de a se informa. Această schimbare de comportament a noii generaţii de părinţi din ţara noastră ar putea genera alternative la strategiile educaţionale existente. Elaborarea unor surse Social Media de informaţii medicale în limba romană precum şi îndrumarea părinţilor către acestea ar putea duce la îmbunătăţirea calităţii informaţiilor deţinute de părinţi

STUDY ON PARENTAL PERCEPTION AND APPROACH REGARDING COMMUNITY ACQUIRED PNEUMONIA IN PRESCHOOL CHILDREN FROM ROMANIA

Introduction. Community acquired pneumonia is a common disease that accounts for 16% of all deaths in children aged 5 years or younger. The purpose of the study was to identify potential modifiable factors in relation with parental perception of pneumonia management in children. Outlining such factors would allow development of approaches in order to reduce pneumonia-associated morbidity. Methods. A cross-sectional study was conducted between 25th and 27th August 2016. It consisted in distributing a Google Form to parents of children aged between 4 months and 5 years via online social platforms. The questionnaire was structured in 5 sections with 26 questions. Data collection and statistical analysis were done using Microsoft Office Excel Worksheet. Results. 1083 parental answers were received and analyzed. Regarding vaccinal status we received following data: 973 (89.8%) children were vaccinated according to Romanian Ministry of Health Schedule and 90 children are incompletely vaccinated or unvaccinated. 378 children were never breastfed or exclusively breastfed for less than 4 months. 32% (352) were complementary fed before the age of 4 months and 19% (201) after 6 months. 46.91% (508) of children had experienced in the past Acute Respiratory Tract Infections and 42.41% (215) of them were admitted. The most frequent two symptoms that would cause parents to generate an unscheduled ED visit were fever [in 47.83% (518)] and cough [in 19.58% (212)]. 38.87% (421) of respondents gave their child medication without physician’s advice and 61.3% (358) used analgesics and antipyretics. Pneumonia has been recognized as a serious illness, potentially life threatening, by 69.07% (748) of parents. Discussion. There is evidence of correlation between morbidity and mortality in childhood pneumonia and parental educational and socio-economic status. Aim of our study was to explore other factors that impact parental perception, in this era of significant changes in social behavior and communication. Conclussion. The decrease in the vaccine coverage rate in Romania (89% in this group selected by patients with access to Social Media) led to a decrease below the threshold for maintaining herd immunity. Romanian parents responding to this questionnaire achived a good score in symptom recognition and severity assessment of pneumonia. A large number of respondents surveyed in a short time is an indicator of parental desire to be informed and involved in deccision-making. This recent change in parental behavior in our country could generate alternatives to existing educational strategies. Developing medical information platforms for Social Media, translated in local language, could impact parental perception and child pneumonia morbidity in our country

The source mechanism of the seismic events during the sequence of the moderate-size crustal earthquake of November 22, 2014 of Vrancea region (Romania)

The moderate-size earthquake (local magnitude 5.7) which occurred on November 22, 2014 in Vrancea region (Romania), is the largest crustal event instrumentally recorded.Its aftershock sequence lasted around 70 days, 222 earthquakes with local magnitude ≥ 0.1 being located using the records collected by the Romanian seismic network.The seismic sequence occurred mainly in the lower crust (depths greater than 25 km), and the epicenter distribution – along a NNE-SSW direction followed the orientation of the Vrancea crustal earthquakes alignment.The sequence, occurred in the Focsani Basin (part of the Moesian Platform) and is related to the normal fault system associated to the major Peceneaga - Camena fault, which separates the Moesian Platform from the North Dobrogea promontory.The spatio-temporal distribution of the seismic activity, as well as the seismic energy released during the seismic sequence are analysed in detail, and the focal mechanisms of the largest events – 34 shocks with ML ≥ 1.8 – are determined using reliable P-wave polarities and amplitude ratios.Taking into consideration that the moderate-size shock of November 22, 2014 is the strongest instrumentally recorded crustal earthquake in the region, its focal mechanism provides highly relevant seismological information on the deformation field in front of the Carpathian bend. The obtained fault plane solution indicates normal faulting with a dominant dip-slip component; both nodal planes being oriented NW-SE

Laboratory Findings in Children with Excess Body Weight in Romania

Background and Objectives: Childhood obesity has been increasing at a worrisome pace and emerging as a non-infectious pandemic in the pediatric population in recent years. Raising awareness on this problem is of utmost importance, in order to take action to control body weight from an early age. Materials and Methods: We performed a retrospective study among overweight or obese children evaluated on an outpatient basis in the Department of Pediatric Endocrinology of a tertiary care hospital in Bucharest Romania in 2021 in order to identify laboratory changes occurring according to age and sex. Results: A total of 268 children were included in the analysis, with a median age of 10.9 years (IQR: 8.3, 13.3 years); 61.8% were obese and 38.2% overweight. We identified a subclinical pro-inflammatory status characterized by increased neutrophil count (12.7%) and increased C-reactive protein (16.4%). Biochemically, we identified the highest increases for uric acid (35.4%). More than half of the children included in the study had dyslipidemia-specific changes: high low-density lipoprotein cholesterol (LDL) (50.0%), low high-density lipoprotein cholesterol (HDL) (58.9%) and increased triglyceride levels (12.7%), especially children with a body mass-index (BMI) percentile above 95%. Increased thyroid stimulating hormone (TSH) was identified in 20.3% and low thyroxine (T4) level in 13.4%, especially in females. Conclusions: Early measures to control excess body weight are needed since preventing obesity is easier than treating it. However, this is often difficult to do in our country because parents frequently do not recognize the problem until it is advanced. Furthermore, doctors are not always adequately prepared and sometimes they do not have the support of the health systems to provide children in need with the adequate care. Educational strategies and awareness of issue should be revisited in current post-pandemic context that facilitates increase of obesity prevalence in children. Increase of efficient communication could be achieved by pointing to these objective findings

Laboratory Findings in Children with Excess Body Weight in Romania

Background and Objectives: Childhood obesity has been increasing at a worrisome pace and emerging as a non-infectious pandemic in the pediatric population in recent years. Raising awareness on this problem is of utmost importance, in order to take action to control body weight from an early age. Materials and Methods: We performed a retrospective study among overweight or obese children evaluated on an outpatient basis in the Department of Pediatric Endocrinology of a tertiary care hospital in Bucharest Romania in 2021 in order to identify laboratory changes occurring according to age and sex. Results: A total of 268 children were included in the analysis, with a median age of 10.9 years (IQR: 8.3, 13.3 years); 61.8% were obese and 38.2% overweight. We identified a subclinical pro-inflammatory status characterized by increased neutrophil count (12.7%) and increased C-reactive protein (16.4%). Biochemically, we identified the highest increases for uric acid (35.4%). More than half of the children included in the study had dyslipidemia-specific changes: high low-density lipoprotein cholesterol (LDL) (50.0%), low high-density lipoprotein cholesterol (HDL) (58.9%) and increased triglyceride levels (12.7%), especially children with a body mass-index (BMI) percentile above 95%. Increased thyroid stimulating hormone (TSH) was identified in 20.3% and low thyroxine (T4) level in 13.4%, especially in females. Conclusions: Early measures to control excess body weight are needed since preventing obesity is easier than treating it. However, this is often difficult to do in our country because parents frequently do not recognize the problem until it is advanced. Furthermore, doctors are not always adequately prepared and sometimes they do not have the support of the health systems to provide children in need with the adequate care. Educational strategies and awareness of issue should be revisited in current post-pandemic context that facilitates increase of obesity prevalence in children. Increase of efficient communication could be achieved by pointing to these objective findings

PARENTAL PERCEPTION ON NEBULIZED MEDICATION AND POTENTIAL REASONS FOR OFF-LABEL USAGE OF DEXAMETHASONE IN CHILDREN FROM ROMANIA

Background and aim. In the last decade a significant increase of nebulized medication usage has been documented in Romania. Authors are aiming to describe parental and physician’s change of perspective regarding nebulized medication in the new era of online communication and education. Material and methods. Two different questionnaires were posted in a large and representative group (more than 60,000 followers) of Romanian parents and physicians, Virtual Children’s Hospital („Spitalul Virtual de Copii”). Results. More than 4,000 answers were submitted. 94.4% responders confirmed using at least once wetnebulized medication in children. A particular aspect documented was dexamethasone off-label usage via nebulizer in 67.8% children. Additional 7% of responders confirmed that they received an indication to nebulize a normal saline suspension with dexamethasone phosphate for parenteral usage, but they didn’t follow the indication and used an approved treatment. Conclusions. Upon our knowledge this is the first large study on nebulized dexamethasone in Romanian literature. 95% of Romanian children receive nebulized medication. Nebulizer is regarded by parents as a simple and friendly tool that can solve virtually all issues related to airway diseases in our country. 75% of children that received nebulized medication had a prescription for off-label use of dexamethasone

INTRAOSSEOUS ACCESS – A CLASSICAL METHOD FOR VASCULAR ACCESS THAT REGAINS AN IMPORTANT ROLE AS RESUSCITATION TOOL

75-80% of life threatening situations, with unexpected arrest, are documented out of hospital (1). This situation generates frequently a diffi cult resuscitation. Main cause for failure is delay in gaining vascular access for fl uid and drug delivery (2). Intraosseous access (IO) is used for treatment in patients without a previously placed intravenous line that experience abrupt-onset life threatening situations (3). Authors revisit data from initial development of this method and document the role of IO access as a valuable tool during resuscitation according to European Resuscitation Council Guidelines 2010 (4). Particular aspects of technique, improvisations and real life trouble shooting issues are presented from a single pediatric Emergency Department experience