LIMITS AND POSSIBILITIES IN A PRIMARY SELECTIVE IgA DEFICIENCY TREATMENT – CASE PRESENTATION

The primary deficit of IgA is the most common congenital immunodeficiency defined by the values of serum IgA below 0.07 g/l and normal values of IgG and IgM. Most cases are asymptomatic, only 10-15% is manifested by recurrent or persistent sinopulmonary infections, autoimmune diseases, allergies, malignancies. Some cases develop over the time a common variable immunodeficiency. The frequency of anti-IgA antibody justifies the cautiously use of transfusions of blood, plasma or intravenous immunoglobulin. The authors present a case of primary selective IgA deficiency, where the severity of infectious exacerbations appears to be due to the combination of a lack of IgG4, and discuss the possibilities and limits of therapy in light of recent data from the literature

OSTEOPENIA IN CHILDREN WITH MALABSORPTION SYNDROM

Introduction. Malabsorption syndromes result in the disturbance of bone normal development and function. Objective. The assessment of bone density in children with malabsorption syndromes. The analysis of risk factors for osteopenia. The correlation between osteopenia, nutritional markers and bone metabolism markers. Material and method. 118 children with malabsorbtion syndromes of different etiologies, mainly Celiac disease (41 cases) and Cystic fibrosis (14 cases). Bone density was assessed by Quantitative Ultrasonography (QUS) with a Sunlight Omnisense Ultrasonometer 7000P. QUS was performed at two sites – radius (86 cases) and tibia (78 cases). 25hydroxivitamin D was measured in 10 cases by RIA method. Statistical analysis was made using SPSS for Windows. Results. Osteopenia was present in 32% cases. Decreased bone density at the radius was associated with the celiac syndrome. Osteopenia at the tibia was associated with cystic fibrosis. Osteopenia was more frequent in girls. Osteopenia was related to the duration of the disease. Osteopenia wasn’t related to BMI. Radius Z-score positively correlated to alkaline phosphatase levels and tibia Z-score to serum cholesterol levels. Radius and tibia Z-score negatively correlated with inflammatory marker levels. In children with celiac disease, the value of anti-transglutaminase antibodies was negatively correlated to radius and tibia Z-score values. 25(OH) vitamin D values were deficient in 8 patient and insufficient in 2, but its values didn’t correlate to radius/tibia Z-score. Clinical, biological and radiological signs of rickets were found in 35% of patients with osteopenia. Conclusions. Osteopenia was found in 1/3 of patients with malabsorption syndromes of the studied group. In 30% of patients, clinical, biological and radiologic rickets signs were present. 25(OH) vitamin D values didn’t correlate with the Z-score. A negative correlation between bone parameters and inflammation markers and anti-transglutaminase antibodies values was observed

ATOPY, RISK FACTOR FOR OTITIS MEDIA WITH EFFUSION

Chronic otitis, one of the major causes of pediatric hypoacusia is frequent associated with some allergic diseases. The continuous rice of atopic diseases prevalence in childhood, involves a multidisciplinary approach of Eustachian tube dysfunction, adenoid inflammation or recurrent otitis, for a complex pathogenic management. The objective of this study was to determinate the association between otitis media and the allergic diseases with the implication in the treatment and evolution of this patients. Methods. Retrospective study on 92 children, between 6 month and 6 years, admitted in II Pediatric Clinic, Clinical Hospital of Children “Sf. Maria” Iasi with diagnosis of acute otitis media, for a period of 1 year. Results. Majority of cases (61patients) have been suppurate otitis, 31 cases have been otitis media with effusion out of which 23 have been recurrent. Association with allergic diseases has been more frequent in children with serous otitis media (26/31 cases). 4 cases with suppurate otitis media have developed adverse reaction to antibiotics with major implication in the cases evolution. Association with gastroesophageal reflux was relatively similar between cases with serous otitis and the suppurate ones (10/31 cases and 11/61 cases). From the atopic patients with gastroesophageal reflux, 10 presented cow’s milk protein allergy. In conclusion, the children with otitis media, especially those with recurrent none suppurate form should be investigated for atopy and, eventually, for gastroesophageal reflux, possibly with determination of the allergic markers or of pepsin in the otic exudates, in order to a targeted therapeutic management

COGNITIVE AND BEHAVIOURAL INTERVENTIONS IN DENTAL PATHOLOGY

The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with an actual or potential tissue injury that is described as such, emphasizing the subjective nature. The cognitive-behavioural therapy has begun to be applied for psychosomatic problems in dental problems. There are several types of techniques: relaxation, biofeedback, exposure and cognitive restructuring. In general, therapists may combine several of the above techniques to treat patients with dental anxiety