The clinical importance of body mass index in nutritional assessment of children with cystic fibrosis

Catedra Pediatrie Rezidenţiat şi Secundariat ClinicThe aim of this study was to assess the nutrition of children with cystic fibrosis using the body mass index – easy and quick tool. The study lot included 50 children with cystic fibrosis confirmed at various periods of their life. The weight and height were evaluated in all children. The results of the study showed the correlation between the age and the degree of malnutrition. There is a predominance of mild degree of malnutrition in children aged 1-3 years old (57.1%) and more severe affecting of nutrition was noted in all older children (100%). Prezentul studiu a avut scop aprecierea statutului nutriţional al copiilor cu mucoviscidoză evaluaţi în cadrul examinărilor programate folosind o metodă simplă şi rapidă – indicele masei ponderale. Lotul de studiu a inclus 50 de copiii cu diagnosticul mucoviscidoză stabilit în diferite perioade de vârstă. Rezultatele studiului au coincis cu datele literaturii, existând o corelaţie inversă între vârsta copilului cu mucoviscidoză şi statutul nutriţional al acestuia. La copiii mici predomina malnutriţia uşoară (57,1% copii), iar în grupul copiilor mai mari deficitul staturo-ponderal mai avansat a fost determinat la toţi pacienţii (100%)

Оказание скорой медицинской помощи при стридоре у детей (стандартизированный клинический протокол для отделений неотложной помощи)

Universitatea de Stat de Medicină şi Farmacie “Nicolae Testemiţanu”, Departamentul Pediatrie, IMSP Institutul Mamei şi CopiluluiBackground. Stridor is a common presentation in pediatric patients that denotes upper respiratory tract obstruction and may indicate a life-threatening health condition. Infants and young children have some anatomic and physiological features of the respiratory system that increase the risk of airway obstruction. Stridor often is a challenge for the physician requiring prompt evaluation of the patient. The first priority in the evaluation of a child with stridor is to determine if there is a respiratory compromise, to determine the cause of stridor, and to ensure airway permeability. The development of the standardized clinical protocol for the management of stridor in the Emergency Department (ED) has resulted from the emerging need to unify and improve the care of pediatric patients with stridor. Material and methods. The protocol is based on recently published international guidelines and recommendations. Results. In most cases, stridor is the result of a relatively benign condition, but at the same time, it may be the first sign of a severe and even life-threatening disorder. The existence of a standardized protocol for the patient with stridor admitted to ED will guide the clinician in assessing the pathway of the patient with emergency hospitalization in intensive care unit or close follow-up in ED. At the same time, the protocol provides indications for medical treatment recommended by international guidelines with high recommendation, but also prevents the judicious use of imaging and counseling services, while maintaining a special focus on patient safety. Conclusions. It is important that physicians recognize stable patients with inspiratory stridor that can be monitored in ED, but do not miss the children with severe biphasic stridor that require a rapid assessment, emergency care and treatment, and the request of the competent services.Введение. Стридор является частым клиническим признаком в педиатрической практике, который указывает на обструкцию верхних дыхательных путей и может являться признаком патологии, которая представляет опасность для жизни ребенка и часто является вызовом для врача. Дыхательная система ребенка имеет анатомические и физиологические особенности, которые увеличивают риск обструкции дыхательных путей. Дети с признаками тяжелой обструкции дыхательных путей требуют обследования для определения причины заболевания, а также для обеспечения проходимости дыхательных путей. Потребность разработки педиатрического стандартизованного клинического протокола для отделения неотложной помощи возникла из-за необходимости унификации и улучшении медицинской помощи пациентам со стридором. Материал и методы. Протокол составлен на основе новых опубликованных международных рекомендаций. Результаты. В большинстве случаев стридор является результатом относительно легкой патологии, но в то же время он может быть первым признаком тяжелого и даже опасного для жизни состояния. Наличие стандартизованного протокола для пациента со стридором госпитализированного в отделении неотложной помощи поможет клиницисту в оценке необходимости неотложной госпитализации пациента в интенсивной терапии или в дальнейшем наблюдении. В то же время протокол содержит рекомендации по лечению, согласованные с международными рекомендациями. Выводы. Важно, чтобы врач различал стабильных пациентов с инспираторным стридором, которых можно наблюдать в отделении неотложной помощи, но и не упускал детей с тяжелым двухфазным стридором, состояние которых требует быстрой оценки, с предоставлением неотложной помощи и запросом консультации специалистов

The role of nutrition on physical development in infants and small children

Departamentul Pediatrie, USMF ,,Nicolae Testemiţanu” IMSP SCMC ,,Serghei Lazo”Within the last years artificial nutrition has a particular attention in pediatric population. The work present 30 children on breastfeeding and 31 children fed with milk powder formula. We determined the type of feeding, nutrition errors, and evaluation of anthropometric indices of these children. Efficiency of breastfeeding was showed by adequate value of ponderal index and by prevalence of children with paratrophy in infants on artificial feeding. According to our research we can conclude the importance of breastfeeding of infants. Necesitatea şi importanţa alimentaţiei artificiale a fost mult discutată în ultimii ani de către medicii pediatri. Studiu prezintă evaluarea a 30 copii alimentaţi natural şi 31 copii alimentaţi artificial cu formule lactate adaptate. Eficienţa alimentaţiei naturale a fost demonstrată prin aprecierea valorilor adecvate ale indicelui ponderal, dar şi prin prevalarea copiilor cu paratrofie în grupul celor alimentaţi artificial. Conform rezultatelor studiului nostru putem concluziona asupra necesităţii şi importanţei alimentaţiei naturale a copiilor în primul an de viaţă

Лечение острых респираторных инфекций у детей в контексте устойчивости к противомикробным препаратам.

Treatment of acute respiatory infections in children and phenomenon of antimicrobian resistance.Descoperirea remediilor antibacteriene în anii 1940 a dus la o reducere semnificativă a ratei mortalității și morbidității la nivel mondial, dar ulterior consumul acestora a crescut semnificativ, în unele cazuri nejustifi cat, cum ar fi utilizarea antibioticelor pentru tratarea infecțiilor virale, care prevalează la populația pediatrică. Această utilizare neargumentată și excesivă a antibioticelor a determinat dezvoltarea concomitentă a tulpinilor rezistente de agenți bacterieni. Nivelul mic de cunoștințe ale îngrijitorilor, gradul redus de încredere în medic și auto-medicația necorespunzătoare sunt motivele majore în dezvoltarea efectelor secundare ale preparatelor antibacteriene și dezvoltarea rezistenței față de ele.Лечение острых респираторных инфекций у детей в контексте устойчивости к противомикробным препаратам

Assessment of cystic fibrosis severity

Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction. Cystic fibrosis (CF) is one of the most common hereditary diseases and being characterized by chronic lung injury, exocrine pancreatic insufficiency and nutrition disorders. In this disease the mutation of the CFTR gene lead to changes of sodium chloride metabolism inside and outside epithelial cells found in he lungs, liver, pancreas, digestive tract and reproductive system. Thus, the result of this malfunction is represented by sticky and thick mucus, salty taste of the sweat and thickened digestive juices which can clog the lumen and alveoli of the lungs (clinically difficult breathing, formation of the environment proned to bacteria growth) or may disturb (when the pancreas is mainly involved) the process or proper digestion and absorbtion of nutrients, leading even to organ failure insevere cases (lungs, pancreas). Pulmonary involvement in CF reflects the severity of the disease and represents the major cause of death.Major criteria used to assess CF severity are based on the evaluation of the lung function. Materials and methods. Our study included 60 patients (the average age 9.08±1.01 years) diagnosed with cystic fibrosis. CF severity was assessed using Shwachman-Kulczycki score, which is based on the following criteria: overall activity of the patient, physical examination results, nutritional status, and data of the chest X-ray examination. Each category was assigned from 1 to 25 points, while the total score ranged from 4 to 100 points maximum (severe ≤40 points, 40-55 points – moderate; mild – 56-70 points, 71-85 points – good, and excellent – 86-100 points). Results and discussions. The Shwachman-Kulczycki score of just 25.46±2.09 points, that indicates a severe evolution of CF, was registered at 46.81% of children with severe malnutrition, but also in older patients with advanced lung diseases. For 25.92% of children the score was 53.57±0.63 points, that means moderate evolution of cystic fibrosis. In 15.6% of patients the Shwachman-Kulczycki score showed a favorable clinical evolution, with a summary of 62.12±0.98 points. Only 12.77% of children had mild form of the diseases with a good score of 78.0±1.30 points. In the study group there were no children identified to have with excellent clinical condition, because of the presence of changes in clinical status and paraclinical tests. Conclusion. The Shwachman-Kulczycki score that includes clinical and imaging criteria, is a very simple to use tool, demonstrated to be highly informative in assessing the clinical status of patients with cystic fibrosis and is recommended to be used in the work of specialists in pediatrics

Bronchiectasis In Children With Cystic Fibrosis

Departamentul Pediatrie, USMF „Nicolae Testemiţanu”Cystic fibrosis is the most common genetic disease with autosomal recessive way of transmission. It is characterised by exocrine glands dysfunction. Severe progressive pulmonary problems are noted in most patients with cystic fibrosis. In this work there were evaluated clinico-imagistic peculiarities of the bronchiectasis in 40 children with cystic fibrosis. The mean age of patients was 7.07±0.81 years and the mean age of diagnosis was 1.11±0.24 years. The frequency of bronchiectasis presented a significant (r2 =0.97, p<0.01) increase with the age of patients with cystic fibrosis. Fibroza chistică este cea mai frecventă maladie genetică cu transmitere autozomal recesivă, care se caracterizează prin disfuncţie generalizată a glandelor exocrine. Majoritatea pacientilor cu fibroza chistica dezvolta patologie pulmonară progresivă. A fost realizat un studiu clinicoimagistic a bronşiectaziilor la 40 copii cu fibroză chistică. Pacienţii au prezentat o vârstă medie de 7,07±0,81 ani, iar vârsta medie de diagnostic al fibrozei chistice a constituit 1,11±0,24 ani. Frecvenţa dezvoltării bronşiectaziilor a prezentat un indice de corelaţie foarte înalt (r2 =0,97, p<0,01) cu vârsta pacienţilor

Атипичное начало муковисцидоза у детей раннего возраста

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Departamentul Pediatrie, IMSP Institutul Mamei şi Copilului, Clinica "Em. Coţaga"The diagnosis of cystic fibrosis should be considered in young infants with nutritional deficiencies associated with electrolyte balance disorders. Increased vigilance of physicians in recognizing uncommon signs of cystic fibrosis onset allowed an early diagnosis and correct treatment according to the needs of an ill child.Диагноз муковисцидоза следует рассматривать у детей раннего возраста с дефицитом питания и с нарушениями кислотно-щелочного баланса. Повышенная бдительность врачей в распознавании нетипичных признаков начала муковисцидоза позволит улучшить диагностику на ранних стадиях и правильно определить оперативное лечение согласно потребностям больного ребенка

Peculiarities of cystic fibrosis evolution in infants and children

Departamentul Pediatrie USMF "Nicolae Testemiţanu" IMSP IMC Clinica "Emilian Coţaga"Cystic fibrosis (CF ) is an autosomal recessive genetic disorder that affects most critically the lungs, and also the pancreas, liver, and intestine. Clinical-evolutive assessment of CF in infants and young children is the most important for early diagnosis. A retrospective clinical study of 38 CF patients, hospitalized in the last decade in the Department of Malnutrition was performed. Evolutionary peculiarities of CF in infants have shown the prevalence of clinical signs of impaired digestive tract and varying degrees of malnutrition. Signs of broncho-pulmonary injuries and respiratory infections with aggressive germs were predominant in children older than 12 months. Clinical manifestations of lung and digestive injury with failure to thrive are three clinical signs for suspection of CF diagnosis in early age. Fibroza chistica (FC) este o tulburare genetică autozomal recesivă, care afectează preponderent sistemul pulmonar, pancreasul, ficatul şi intestinul. Evaluarea clinico-evolutivă a FC la sugari şi copiii mici este momentul cel mai important pentru diagnosticarea precoce a maladiei. A fost efectuat un studiu clinic retrospectiv pentru 38 de pacienţi cu FC, internaţi în ultimul deceniu în cadrul secţiei de malnutriţie. Particularităţile evolutive ale FC la sugari au demonstrat prevalenţa semnelor clinice ale tractului digestiv şi diferit grad de malnutritie. Semne de infecţii bronho-pulmonare cu germeni agresivi au predominat la copii mai mari de 12 luni. Manifestarile clinice pulmonare şi ale afectării digestive asociate cu malnutriţie sunt trei semne clinice de suspecţie a diagnosticului de FC ls vârstă fragedă

Boala bronşiectatică la copil: protocol clinic naţional PCN-126

IMSP Institutul Mamei şi Copilului, USMF „Nicolae Testemiţanu”Protocolul naţional a fost elaborat de grupul de lucru al Ministerului Sănătăţii al Republicii Moldova (MS RM), constituit din specialiştii Catedrei Pediatrie Rezidenţiat şi Catedrei Chirurgie, Ortopedie, Anesteziologie şi Reanimare pediatrică ale Universităţii de Stat de Medicina şi Farmacie „Nicolae Testemiţanu”. Protocolul de faţă a fost elaborat în conformitate cu ghidurile internaţionale actuale privind boala bronşiectatică la copii şi va servi drept bază pentru elaborarea protocoalelor instituţionale. La recomandarea MS RM pentru monitorizarea protocoalelor instituţionale pot fi folosite formulare suplimentare, care nu sunt incluse în protocolul clinic naţional

Синдром Псевдо-Барттера у детей с муковисцидозом (Клинический пример)

IMSP SCRC „Em.Coţaga”, secţia Malnutriţii, USMF “Nicolae Testemiţanu”, Departamentul PediatrieCystic fibrosis is the most common hereditary disease characterized by multiple organ failure and clinical polymorphism [3]. Children of the first months of life may develop Pseudo-Bartter's syndrome, which is a severe complication of cystic fibrosis, characterized by electrolyte disturbances such as hypokalemia, hyponatremia, and metabolic alkalosis [4]. Of 60 children with cystic fibrosis from Moldova, evaluated in the period 2007-2011, the disease started with Pseudo-Bartter's syndrome in 5.66% cases. Although Pseudo-Bartter's syndrome was described in infants with cystic fibrosis under 6 months of age, in our patient electrolyte disturbance recurrence were noted by the age of 12 months. Patient inability to compensate the electrolytes loss through sweat can be explained both by breastfeeding (the breast milk is known to be low in sodium chloride) and by recurrent episodes of respiratory infections.Муковисцидоз – самое частое наследственное заболевание, которое характеризуется полиорганным поражением и клиническим полиморфизмом [3]. У детей первых месяцев жизни может развиться синдром псевдо-барттера – тяжелое осложнение муковисцидоза, характеризующееся электролитными нарушениями в виде гипокалиемии, гипонатриемии, иметаболического алкалоза [4]. Из 60 детей смуковисцидозом, наблюдаемых в Молдове в период 2007-2011 годов, болезнь дебютировала синдромом псевдо-барттера в 5,66% случаев. Хотя синдром псевдо-барттера описан у детей с муковисцидозом в возрасте до 6 месяцев, рецидивы электролитных нарушений у пациента D. были отмечены в возрасте до 12 месяцев. Неспособность пациента компенсировать потери электролитов с потом можно объяснить естественным вскармливанием ребенка (грудное молоко известно низким содержанием натрия хлорида) и частыми эпизодами респираторных инфекций