Daniela Pacurar - Academia.edu (original) (raw)
Papers by Daniela Pacurar
Romanian Journal of Pediatrics
Objectives. The diagnostic approach in familial cholestasis cases involves using expensive invest... more Objectives. The diagnostic approach in familial cholestasis cases involves using expensive investigations. The need for complex therapeutic resources is predictable. Material and methods. We present the case of a 3 years 5 months old boy diagnosed with cholestasis and liver cirrhosis, admitted in the Pediatrics Department of “Grigore Alexandrescu” Children’s Hospital for evaluation in order to check the criteria for liver transplantation. Outcomes. The patient is known to our clinic since he was 1 year 3 months; he was admitted at that time for green jaundice. He comes from a family with nine children, low socio-economic status and low education. The first four children have a different father, two of them were stillborn. The next five come from a consanguineous union (the father is maternal uncle of the mother): three (the patient included) presented with the same symptoms, two of them died before 3 years of age with liver cirrhosis. In time, infectious causes, autoimmune, neoplast...
Background: Given the potential for additional development to clarify a better knowledge of the o... more Background: Given the potential for additional development to clarify a better knowledge of the overall impact of COVID-19 on the pediatric population, the clinical symptoms of SARS-CoV-2 infection in children and adolescents are still being explored. Morbidity in children is characterized by a variable clinical course. Our study's goal was to compare clinical aspects of 230 pediatric patients who tested positive for SARS-CoV-2 and were hospitalized between April 2020 and March 2022. Methods: In a retrospective analysis, we compared two groups hospitalized in the infectious diseases clinical ward IX at the National Institute for Infectious Diseases "Prof. Dr. Matei Bals," Bucharest, Romania. The first group of 88 patients was admitted between (April–December 2020) and their clinical manifestations were compared with the second group of 142 children followed between July 2021 and March 2022. Results: Of 230 children, the median age was 4.5 (interquartile range 0.6-17) y...
REZUMAT Pneumoniile bacteriene la copil-studiu epidemiologc pe 9 ani Pneumonia se defineaete ca i... more REZUMAT Pneumoniile bacteriene la copil-studiu epidemiologc pe 9 ani Pneumonia se defineaete ca inflamaåie a parenchimului pulmonar, afectând spaåiul alveolar. WHO a estimat o incidenåã medianã a pneumoniei pe glob de 0,28 episoade/copil/an. Aceasta conduce la o incidenåã anualã de 150,7 mil cazuri noi, dintre care 11-20 milioane (7-13%), sunt severe necesitând internare. În åãrile în curs de dezvoltare apar 95% dintre episoadele de pneumonie la copilul mic. Studiul a fost realizat pe baza unei anchete epidemiologice descriptive, retrospective în cadrul Spitalului Clinic de Urgenåã pentru Copii "Grigore Alexandrescu", pe 9 ani (2004-2012). S-au analizat 6637 de cazuri, 0-18 ani de ambele sexe. În medie, internãrile din clinica de pediatrie au reprezentat 37,55% din totalul internarilor în spital, iar internãrile pentru boli respiratorii au reprezentat 22,19% din totalul internãrilor în spital aei respectiv 59,1% din totalul internãrilor în clinica de pediatrie. Pneumoniile...
Romanian Journal of Pediatrics, 2016
Objective. The aim of this study was the evaluation of epidemiological and psychosocial parameter... more Objective. The aim of this study was the evaluation of epidemiological and psychosocial parameters in a sample of overweight and obese children hospitalized for various pathologies. The duration of the study was 12 months. Methods. We performed a prospective study that included overweight and obese children admitted in the Paediatric Unit of our hospital from July 2014 until June 2015. The exclusion criteria consisted of the presence of secondary pathologies related to obesity. A questionnaire was applied to all patients included with questions about family and personal risk factors for obesity; we realised also a psychological evaluation and quality of life assessment (PedsQL). For each patient we performed clinical evaluation, laboratory and imaging investigations (abdominal ultrasound). Results. The study included 78 patients: 27 overweight (34.6%), 51 obese (65.3%). We studied the family history concerning the weight status: 55 had one obese parent and 15 had both parents with o...
Romanian Journal of Pediatrics, 2015
Objectives. The aim of this study was to determine the manner in which the level of exhaled nitri... more Objectives. The aim of this study was to determine the manner in which the level of exhaled nitric oxide (FENO) influences the atopic status in children with asthma. Methods. The study included 92 asthmatic children (aged 5-18 years) admitted on the Pediatric Clinic of “Grigore Alexandrescu” Emergency Clinical Hospital for Children. The atopic status was evaluated through anamnesis, clinical examination and laboratory determination of serum eosinophils and total Ig E. All children underwent measurement of FENO. Results. Children with atopic asthma had higher levels of FENO than children with nonatopic asthma. The FENO values correlate with eosinophilia and high values of immunoglobulin E. Conclusion. FENO is a useful marker for the evaluation of airway inflammation in children with atopic asthma.
Romanian Journal of Pediatrics, 2015
Munchausen syndrome and Munchausen by proxy syndrome belong belong to a group of disease called “... more Munchausen syndrome and Munchausen by proxy syndrome belong belong to a group of disease called “factitious disorder” and are severe mental disorders having the “end” position for a healthy person to become patient, respectively to “create” a disease to another person, asking or requiring medical intervention for him/her. Munchausen syndrome by proxy is rare, but it is difficult to be recognized and confirmed, is a form of abuse, particularly against children, potentially lethal, often misunderstood. Many methods are used by adults counterfeiters to induce a false child’s condition: poisoning, injury, producing bleeding, infection. Complaints exposed by the mothers as belonging to the child are not for a personal benefit, but are justified by a desire to be a “hero” mothers and to play the role of the people most attached and thoughtful of their child. Diagnosis should include evaluation of the child, parents and family and is based on suggestive elements: child with multiple health...
1 Department of Emergency, “Grigore Alexandrescu” Emergency Children’s Hospital, Bucharest, Roman... more 1 Department of Emergency, “Grigore Alexandrescu” Emergency Children’s Hospital, Bucharest, Romania 2 Department of Paediatrics, “Grigore Alexandrescu” Emergency Children’s Hospital, Bucharest, Romania 3 Critical Care Toxicology Unit, Bucharest Clinical Emergency Hospital, Bucharest, Romania 4 Department of Physiology, Faculty of Pharmacy, University of Medicine and Pharmacy „Carol Davila”, Bucharest, Romania Corresponding author: Iulia Florentina Tincu “Grigore Alexandrescu” Emergency Children’s Hospital, 30-32 Iancu de Hunedoara Boulevard, 1st District, Bucharest, Romania. E-mail: if_boian@yahoo.com Abstract
Pneumonia is defined as inflammation of the lung parenchyma, affecting the alveolar space. WHO es... more Pneumonia is defined as inflammation of the lung parenchyma, affecting the alveolar space. WHO estimated a median incidence of 0.28 episodes of pneumonia worldwide / child / year. This leads to an annual incidence of 150.7 million new cases, of which 11-20000000 (7-13%) are severe requiring hospitalization. In developing countries appear 95% of episodes of pneumonia in young children. The study was conducted based on a descriptive epidemiological surveys, retrospective in the Emergency Hospital for Children "Grigore Alexandrescu" 9 years (2004-2012). We analyzed 6637 cases of both sexes aged 0-18 years. The average pediatric clinic admissions represented 37.55% of all hospital admissions and admissions for respiratory
Romanian Journal of Medical Practice, 2021
Introduction. Important abdominal distension can be a challenge for both paediatricians and pedia... more Introduction. Important abdominal distension can be a challenge for both paediatricians and pediatric surgeons. Case presentation. Here, we report the case of a 3-year old child admitted to Pediatric Surgery Department for significant abdominal distension, food refusal and abdominal pain. He underwent radiological investigations; conditions like congenital megacolon and mechanical obstruction were excluded. At hospital admission, abdominal distension was minimal, but it became severe after episodes of air swallowing. Sleep bruxism and behavioural changes appeared also. An abdominal computerized tomography scan and barium swallow tests showed important distension of the stomach with excessive gas, a small intestine and colon. On upper endoscopy - the urease test for Helicobacter pylori detection was positive and specific treatment was administered. In addition, a psychiatric evaluation was done because of behaviour changes. Aerophagia was suspected, and clonazepam treatment was recom...
Romanian Journal of Pediatrics, 2019
Boala Wilson este o afecţiune genetică, transmisă autozomal recesiv, ce determină tulburări ale m... more Boala Wilson este o afecţiune genetică, transmisă autozomal recesiv, ce determină tulburări ale metabolismului cuprului, ducând la acumularea acestuia în ţesuturile ţintă. Este o afecţiune multisistemică şi are tablou clinic foarte polimorf. Stabilirea diagnosticului pozitiv poate fi dificilă, nefiind disponibil un singur test care să confirme sau să infirme cu certitudine această afecţiune. Au fost stabilite criterii de diagnostic pentru boala Wilson iniţial pentru pacienţii adulţi, ulterior au fost reevaluate pentru copil. Stabilirea diagnosticului precoce permite iniţierea terapiei chelatoare la timp, ceea ce oferă un prognostic bun, încetinind progresia bolii. De aceea, se pune foarte mult accentul pe importanţa screening-ului familial.
Romanian Journal of Pediatrics, 2017
"Factitious disorder" or "unnatural, artificial, fake disorders" as Münchausen syndrome (MS) and ... more "Factitious disorder" or "unnatural, artificial, fake disorders" as Münchausen syndrome (MS) and Münchausen syndrome by proxy (MSBP) represent severe mental disorders in which a person tries to convince those around him/her that he/she or the person depending on him/her is sick, without the purpose of obtaining benefits. Patients with disorders such as MS or MSBP may arise a series of controversies and appeals from the simple question of patient status to confidentiality issues, privacy, medical malpractice or participation and involving of the medical team at the suffering of the patient. Recognition of the phenomenon of simulation depends heavily on experience of the physician, but the existence of elements of guidance and personality traits of patients or parents are important. Many issues of ethics and medical deontology arise in diagnosis, evolution and treatment of these syndromes, many becoming subject to medical or legal disputes. The problem is more delicate and involves many consequences in terms of child protection in MSBP, considered the only form of lethal, highly complex mistreatment and abuse. Ethical, medical and ethics issues are different in the two types of diseases, but medical staff involvement and participation in perpetuation of the symptomatology is a common character, much debated. Despite the controversy, many of these issues remain unresolved and there are no clear guidelines so doctors can give an appropriate response.
Romanian Journal of Pediatrics, 2019
Cauză rară de obstruCție de traCt digestiv superior-importanța unei abordări multidisCiplinare dr... more Cauză rară de obstruCție de traCt digestiv superior-importanța unei abordări multidisCiplinare dr. livia e. brezeanu 1 , dr. oana m. guță 1 , asist. univ. dr. raluca m. vlad 1,2 , dr. anatolie nidelcu 1 , asist. univ. dr. mirela pavelescu 1,2 , Şef lucr. dr. daniela păcurar 1,2
Romanian Journal of Pediatrics, 2019
Teenager wiTh upper gasTroinTesTinal obsTrucTion-keep in mind The rare causes livia e. brezeanu 1... more Teenager wiTh upper gasTroinTesTinal obsTrucTion-keep in mind The rare causes livia e. brezeanu 1 , md, oana m. guta 1 , md, assist. prof. raluca m. Vlad 1,2 , md, phd, anatolie nidelcu 1 , md, assist. prof. mirela pavelescu 1,2 , md, phd, lecturer daniela pacurar 1,2 , md, phd
Romanian Journal of Pediatrics, 2020
Introducere. Alergia alimentară este în creștere la nivel global, majoritatea având debutul cel m... more Introducere. Alergia alimentară este în creștere la nivel global, majoritatea având debutul cel mai frecvent în primii ani de viață. Alergia la proteinele din laptele de vacă (APLV) reprezintă principala formă de alergie la sugar. Manifestările clinice ale APLV sunt nespecifice și pot fi cutanate, digestive, respiratorii sau sistemice. Gold standardul de diagnostic este testul de provocare orală, iar dieta de excludere a alimentului alergizant reprezintă tratamentul alergiei. Material și metodă. În perioada iunie 2014-decembrie 2017, am efectuat un studiu prospectiv în care au fost incluși 179 de sugari internați în clinica de Pediatrie a SCUC "Grigore Alexandrescu" cu simptome sugestive de alergie alimentară cu debut sub vârsta de 6 luni. Rezultate. Grupul final de studiu a fost alcătuit din 161 de sugari, 18 cazuri fiind infirmate. 95% dintre sugari au avut alergie la proteinele din laptele de vacă. Vârsta medie a sugarilor la debutul simptomelor a fost de 2,3 luni. 27,2% dintre sugari au avut simptomatologie cu debut acut de tip urticarie acută generalizată formă moderat-severă și edem Quinke (angioedem). 2/3 dintre sugarii incluși în studiu au prezentat manifestări clinice tardive ale APLV, majoritatea simptomelor fiind gastro-intestinale: vărsături (32,3%), refuzul alimentației (30,4%), scaune cu sânge (27,3%) și spor ponderal nesatisfăcător (34,1%). Aproximativ o treime dintre sugari au avut asociat reflux gastro-esofagian, formele fiind de obicei moderat-severe, neresponsive la terapia inițială. 48% dintre sugari au avut alergie IgE mediată la proteina laptelui de vacă, iar restul de 52% au fost alergii cu mecanism nonIgE. Doar 41% dintre sugarii din lot erau alimentați exclusiv la sân la vârsta de 3 luni, dintre aceștia o treime având reacție alergică acută la introducerea formulei de lapte praf. Reintroducerea proteinelor din laptele de vacă după excluderea terapeutică s-a realizat în medie la 9,6 luni pentru sugarii exclusiv alimentați la sân și la 13 luni pentru cei care au fost alimentați artificial de la naștere. Concluzii. Diagnosticul alergiei alimentare la sugar presupune un grad ridicat de suspiciune din partea pediatrului, având în vedere că tabloul clinic este dominat de manifestările gastro-intestinale, care sunt nespecifice și, totodată, cu mecanism imun nonIgE. Alimentația în primele luni de viață are un impact important în afecțiunile alergice.
Romanian Journal of Pediatrics, 2020
Introduction. Food allergies are increasingly more frequent all over the world, in most cases wit... more Introduction. Food allergies are increasingly more frequent all over the world, in most cases with childhood onset. Cow's milk protein allergy (CMPA) is the most frequent allergy in infants. Clinical manifestations are nonspecific and can affect the skin, digestive tract, respiratory system or can be systemic. Oral challenge test is the gold standard diagnostic test and the treatment is the exclusion diet. Material and method. Between June 2014 and December 2017 we conducted a prospective study in which 179 infants were included. They had been hospitalized in the Pediatrics Department of "Grigore Alexandrescu" Emergency Clinical Hospital for Children with suggestive symptoms for food allergy before the age of 6 months. Results. The final study group consisted of 161 infants, because in 18 cases food allergy was excluded. 95% of infants had cow's milk protein allergy (CMPA). The average age of the symptom's onset was 2.3 months. 27.2% of infants had acute allergic reaction like moderate-severe forms of acute urticaria or Quincke oedema (angioedema). 2/3 of infants from the study group had late clinical manifestation of CMPA: vomiting (32.3%), food refusal (30.4%), bloody stools (27.3%) and poor weight growth (34.1%). Approximately one third of the infants associated moderatesevere forms of gastroesophageal reflux, unresponsive to treatment. 48% of infants had IgE mediated cow's milk protein allergy and 52% had non-IgE mediated allergy. Only 41% of infants from the group study were exclusively breastfed at 3 months of age and one third of them had an acute allergic reaction when a milk formula was introduced. Cow's milk protein introduction after the exclusion diet was made at 9,6 months for the breastfed group and at 13 months for the group fed with formula. Conclusions. Food allergy diagnosis requires a high degree of suspicion from the pediatrician, as the predominant gastro-intestinal symptoms are non-specific and non-IgE mediated. The nutrition in the first months of life has an important impact in allergic diseases.
Romanian Journal of Pediatrics, 2019
Wilson’s disease is a genetic autosomal recessive transmitted pathology, that causes disorders of... more Wilson’s disease is a genetic autosomal recessive transmitted pathology, that causes disorders of copper metabolism, leading to its accumulation in target tissues. It is a multisystemic affection and has a polymorphic clinical picture. Establishing a positive diagnosis can be difficult, with no single test that confirms or definitely excludes the disease. Diagnostic criteria for the Wilson disease in adult patients were established, then reevaluated for the child. Establishing early diagnosis allows early chelation therapy, which provides a better prognosis, delaying the progression of the disease. This is the reason why the importance of family screening must be emphasized.
Romanian Journal of Pediatrics, 2017
Objectives. Pediatricians face various challenges in different stages of celiac disease (CD) diag... more Objectives. Pediatricians face various challenges in different stages of celiac disease (CD) diagnosis. Whom to test is intensely debated because of CD's heterogenous clinical spectrum. The main purpose of the study was to identify symptoms or symptom associations that should initiate an active strategy of CD early diagnosis in Romanian children. Material and method. We conducted a prospective study in "Grigore Alexandrescu" Emergency Children's Hospital. From March 2013 until February 2014, 249 children with symptoms/signs at risk of CD were included. Results. CD was diagnosed in 11 (1/21 patients evaluated). One in 12.6; 16; 18; 18.5 and 18.5 children respectively with chronic diarrhea, low stature, growth failure, recurrent abdominal pain and constipation had CD. Certain symptom associations increased the risk: classical symptom associations (chronic diarrhea and weight loss), as well as other associations: recurrent abdominal pain and weight loss, constipation and weight loss, constipation and refractory iron deficiency anemia. Conclusion. Active screening among patients with symptoms and especially symptom associations at risk of CD would improve diagnosis rates in pediatric CD.
Experimental and Therapeutic Medicine, 2019
Chronic viral hepatitis has been incriminated for inducing autoimmune events, but it is a known f... more Chronic viral hepatitis has been incriminated for inducing autoimmune events, but it is a known fact that interferon-based therapies also promote autoimmunity. We conducted an observational prospective study which included 114 pediatric patients with chronic viral hepatitis B and C. The patients were divided in 2 groups, the first group consisted of treatment-naive patients; the second group included patients who had received interferon-based therapy. We aimed to determine whether the ones who received treatment are more predisposed to developing autoimmune manifestations when compared to those naive. Fifty percent of the study group was found to have serological autoimmune phenomenon. Our research shows that the occurrence of the autoimmune phenomenon is delayed when the patient is treated with interferon-based regimens when compared to naive patients. Hence, even though interferon treatment has been reported to promote autoimmunity, the viruses themselves are more likely to induce the appearance of autoimmune markers over time in patients who do not receive treatment.
Medicine, 2019
Rationale: Congenital portosystemic shunt (Abernethy malformation) is a rare entity causing the p... more Rationale: Congenital portosystemic shunt (Abernethy malformation) is a rare entity causing the portal blood to drain directly into the systemic circulation, eluding the liver. These shunts arise through disturbances in the embryonic development. Patient concerns: A 9-year-old male patient was referred to our department for further evaluation of a vascular malformation which was diagnosed in another facility when the patient was 2 years old, following a routine abdominal ultrasound. The patient had no complaints and the physical examination was normal at all times. Diagnosis: Laboratory tests and esogastroduodenoscopy were normal. The abdominal ultrasound showed a side-to-side shunt between a short portal trunk and the inferior vena cava. A hepatic mass suggestive for focal noduar hyperplasia was seen in the left liver lobe. Abdominal angio-computed tomography (angio-CT) was performed and the ultrasonographic anomalies were confirmed. Multiple other vascular malformations were diagnosed-hepatic artery emerging from the superior mesenteric artery, with early division; hepatic veins forming a short common trunk before draining into the inferior vena cava; supranumerary right renal artery emerging from the aorta, tributary for the upper renal pole. Ecocardiography showed left superior vena cava persistence. The final diagnosis was Abernathy malformation type IB. In the meantime the patient was diagnosed with allergic asthma. Interventions: No surgical cure was pursued because the malformation was an incidental discovery. Outcomes: The patient was followed-up closely from the final diagnosis (when he was 9 years old) to present (he is currently 10 years old) with no change in his status-he remained asymptomatic. Lessons: Angio-CT should be the performed whenever a vascular malformation is suspected in order to establish a correct diagnosis, because portosystemic shunts carry a high risk of severe complications. Knowing that patients with portosystemic shunts may have pulmonary hypertension, respiratory complaints should be carefully evaluated-in this particular case, even though the most probable cause for the respiratory symptoms was pulmonary hypertension, it was ruled out by cardiac ultrasonography and further investigations confirmed the diagnosis of allergic asthma. Abbreviations: angio-CT = computed tomography angiography, cm = centimeter, CT = computed tomography, i.v. = intravenous, sec = seconds, VRT = volume rendering technique, MIP = maximum intensity projection.
Chirurgia (Bucharest, Romania : 1990)
Malformations of the inferior vena cava (IVC) are rare presentations, exceptional in children, an... more Malformations of the inferior vena cava (IVC) are rare presentations, exceptional in children, and are usually asymptomatic.They are caused by disturbances in the embryological formation of the venous system or can develop as a result of perinatal venous thrombosis with secondary impairment of the venous development. We report the case of a 14 year old boy,admitted for pediatric evaluation before undergoing plastic surgery in order to remove superficial varicose veins of the lower abdomen. The patient presents with inequality in circumference and length of the legs. Laboratory investigations are normal and the abdominal ultrasound describes hypoplasia of the retrohepatic segment of the inferior vena cava. The diagnosis of complex malformation of the abdominal deep venous system (retrohepatic vena cava atresia, cavo-caval anastomosis through azygos veins, abnormal formation of the inferior vena cava with the absence of the left iliac vein) was established through a CT angiography. Th...
Romanian Journal of Pediatrics
Objectives. The diagnostic approach in familial cholestasis cases involves using expensive invest... more Objectives. The diagnostic approach in familial cholestasis cases involves using expensive investigations. The need for complex therapeutic resources is predictable. Material and methods. We present the case of a 3 years 5 months old boy diagnosed with cholestasis and liver cirrhosis, admitted in the Pediatrics Department of “Grigore Alexandrescu” Children’s Hospital for evaluation in order to check the criteria for liver transplantation. Outcomes. The patient is known to our clinic since he was 1 year 3 months; he was admitted at that time for green jaundice. He comes from a family with nine children, low socio-economic status and low education. The first four children have a different father, two of them were stillborn. The next five come from a consanguineous union (the father is maternal uncle of the mother): three (the patient included) presented with the same symptoms, two of them died before 3 years of age with liver cirrhosis. In time, infectious causes, autoimmune, neoplast...
Background: Given the potential for additional development to clarify a better knowledge of the o... more Background: Given the potential for additional development to clarify a better knowledge of the overall impact of COVID-19 on the pediatric population, the clinical symptoms of SARS-CoV-2 infection in children and adolescents are still being explored. Morbidity in children is characterized by a variable clinical course. Our study's goal was to compare clinical aspects of 230 pediatric patients who tested positive for SARS-CoV-2 and were hospitalized between April 2020 and March 2022. Methods: In a retrospective analysis, we compared two groups hospitalized in the infectious diseases clinical ward IX at the National Institute for Infectious Diseases "Prof. Dr. Matei Bals," Bucharest, Romania. The first group of 88 patients was admitted between (April–December 2020) and their clinical manifestations were compared with the second group of 142 children followed between July 2021 and March 2022. Results: Of 230 children, the median age was 4.5 (interquartile range 0.6-17) y...
REZUMAT Pneumoniile bacteriene la copil-studiu epidemiologc pe 9 ani Pneumonia se defineaete ca i... more REZUMAT Pneumoniile bacteriene la copil-studiu epidemiologc pe 9 ani Pneumonia se defineaete ca inflamaåie a parenchimului pulmonar, afectând spaåiul alveolar. WHO a estimat o incidenåã medianã a pneumoniei pe glob de 0,28 episoade/copil/an. Aceasta conduce la o incidenåã anualã de 150,7 mil cazuri noi, dintre care 11-20 milioane (7-13%), sunt severe necesitând internare. În åãrile în curs de dezvoltare apar 95% dintre episoadele de pneumonie la copilul mic. Studiul a fost realizat pe baza unei anchete epidemiologice descriptive, retrospective în cadrul Spitalului Clinic de Urgenåã pentru Copii "Grigore Alexandrescu", pe 9 ani (2004-2012). S-au analizat 6637 de cazuri, 0-18 ani de ambele sexe. În medie, internãrile din clinica de pediatrie au reprezentat 37,55% din totalul internarilor în spital, iar internãrile pentru boli respiratorii au reprezentat 22,19% din totalul internãrilor în spital aei respectiv 59,1% din totalul internãrilor în clinica de pediatrie. Pneumoniile...
Romanian Journal of Pediatrics, 2016
Objective. The aim of this study was the evaluation of epidemiological and psychosocial parameter... more Objective. The aim of this study was the evaluation of epidemiological and psychosocial parameters in a sample of overweight and obese children hospitalized for various pathologies. The duration of the study was 12 months. Methods. We performed a prospective study that included overweight and obese children admitted in the Paediatric Unit of our hospital from July 2014 until June 2015. The exclusion criteria consisted of the presence of secondary pathologies related to obesity. A questionnaire was applied to all patients included with questions about family and personal risk factors for obesity; we realised also a psychological evaluation and quality of life assessment (PedsQL). For each patient we performed clinical evaluation, laboratory and imaging investigations (abdominal ultrasound). Results. The study included 78 patients: 27 overweight (34.6%), 51 obese (65.3%). We studied the family history concerning the weight status: 55 had one obese parent and 15 had both parents with o...
Romanian Journal of Pediatrics, 2015
Objectives. The aim of this study was to determine the manner in which the level of exhaled nitri... more Objectives. The aim of this study was to determine the manner in which the level of exhaled nitric oxide (FENO) influences the atopic status in children with asthma. Methods. The study included 92 asthmatic children (aged 5-18 years) admitted on the Pediatric Clinic of “Grigore Alexandrescu” Emergency Clinical Hospital for Children. The atopic status was evaluated through anamnesis, clinical examination and laboratory determination of serum eosinophils and total Ig E. All children underwent measurement of FENO. Results. Children with atopic asthma had higher levels of FENO than children with nonatopic asthma. The FENO values correlate with eosinophilia and high values of immunoglobulin E. Conclusion. FENO is a useful marker for the evaluation of airway inflammation in children with atopic asthma.
Romanian Journal of Pediatrics, 2015
Munchausen syndrome and Munchausen by proxy syndrome belong belong to a group of disease called “... more Munchausen syndrome and Munchausen by proxy syndrome belong belong to a group of disease called “factitious disorder” and are severe mental disorders having the “end” position for a healthy person to become patient, respectively to “create” a disease to another person, asking or requiring medical intervention for him/her. Munchausen syndrome by proxy is rare, but it is difficult to be recognized and confirmed, is a form of abuse, particularly against children, potentially lethal, often misunderstood. Many methods are used by adults counterfeiters to induce a false child’s condition: poisoning, injury, producing bleeding, infection. Complaints exposed by the mothers as belonging to the child are not for a personal benefit, but are justified by a desire to be a “hero” mothers and to play the role of the people most attached and thoughtful of their child. Diagnosis should include evaluation of the child, parents and family and is based on suggestive elements: child with multiple health...
1 Department of Emergency, “Grigore Alexandrescu” Emergency Children’s Hospital, Bucharest, Roman... more 1 Department of Emergency, “Grigore Alexandrescu” Emergency Children’s Hospital, Bucharest, Romania 2 Department of Paediatrics, “Grigore Alexandrescu” Emergency Children’s Hospital, Bucharest, Romania 3 Critical Care Toxicology Unit, Bucharest Clinical Emergency Hospital, Bucharest, Romania 4 Department of Physiology, Faculty of Pharmacy, University of Medicine and Pharmacy „Carol Davila”, Bucharest, Romania Corresponding author: Iulia Florentina Tincu “Grigore Alexandrescu” Emergency Children’s Hospital, 30-32 Iancu de Hunedoara Boulevard, 1st District, Bucharest, Romania. E-mail: if_boian@yahoo.com Abstract
Pneumonia is defined as inflammation of the lung parenchyma, affecting the alveolar space. WHO es... more Pneumonia is defined as inflammation of the lung parenchyma, affecting the alveolar space. WHO estimated a median incidence of 0.28 episodes of pneumonia worldwide / child / year. This leads to an annual incidence of 150.7 million new cases, of which 11-20000000 (7-13%) are severe requiring hospitalization. In developing countries appear 95% of episodes of pneumonia in young children. The study was conducted based on a descriptive epidemiological surveys, retrospective in the Emergency Hospital for Children "Grigore Alexandrescu" 9 years (2004-2012). We analyzed 6637 cases of both sexes aged 0-18 years. The average pediatric clinic admissions represented 37.55% of all hospital admissions and admissions for respiratory
Romanian Journal of Medical Practice, 2021
Introduction. Important abdominal distension can be a challenge for both paediatricians and pedia... more Introduction. Important abdominal distension can be a challenge for both paediatricians and pediatric surgeons. Case presentation. Here, we report the case of a 3-year old child admitted to Pediatric Surgery Department for significant abdominal distension, food refusal and abdominal pain. He underwent radiological investigations; conditions like congenital megacolon and mechanical obstruction were excluded. At hospital admission, abdominal distension was minimal, but it became severe after episodes of air swallowing. Sleep bruxism and behavioural changes appeared also. An abdominal computerized tomography scan and barium swallow tests showed important distension of the stomach with excessive gas, a small intestine and colon. On upper endoscopy - the urease test for Helicobacter pylori detection was positive and specific treatment was administered. In addition, a psychiatric evaluation was done because of behaviour changes. Aerophagia was suspected, and clonazepam treatment was recom...
Romanian Journal of Pediatrics, 2019
Boala Wilson este o afecţiune genetică, transmisă autozomal recesiv, ce determină tulburări ale m... more Boala Wilson este o afecţiune genetică, transmisă autozomal recesiv, ce determină tulburări ale metabolismului cuprului, ducând la acumularea acestuia în ţesuturile ţintă. Este o afecţiune multisistemică şi are tablou clinic foarte polimorf. Stabilirea diagnosticului pozitiv poate fi dificilă, nefiind disponibil un singur test care să confirme sau să infirme cu certitudine această afecţiune. Au fost stabilite criterii de diagnostic pentru boala Wilson iniţial pentru pacienţii adulţi, ulterior au fost reevaluate pentru copil. Stabilirea diagnosticului precoce permite iniţierea terapiei chelatoare la timp, ceea ce oferă un prognostic bun, încetinind progresia bolii. De aceea, se pune foarte mult accentul pe importanţa screening-ului familial.
Romanian Journal of Pediatrics, 2017
"Factitious disorder" or "unnatural, artificial, fake disorders" as Münchausen syndrome (MS) and ... more "Factitious disorder" or "unnatural, artificial, fake disorders" as Münchausen syndrome (MS) and Münchausen syndrome by proxy (MSBP) represent severe mental disorders in which a person tries to convince those around him/her that he/she or the person depending on him/her is sick, without the purpose of obtaining benefits. Patients with disorders such as MS or MSBP may arise a series of controversies and appeals from the simple question of patient status to confidentiality issues, privacy, medical malpractice or participation and involving of the medical team at the suffering of the patient. Recognition of the phenomenon of simulation depends heavily on experience of the physician, but the existence of elements of guidance and personality traits of patients or parents are important. Many issues of ethics and medical deontology arise in diagnosis, evolution and treatment of these syndromes, many becoming subject to medical or legal disputes. The problem is more delicate and involves many consequences in terms of child protection in MSBP, considered the only form of lethal, highly complex mistreatment and abuse. Ethical, medical and ethics issues are different in the two types of diseases, but medical staff involvement and participation in perpetuation of the symptomatology is a common character, much debated. Despite the controversy, many of these issues remain unresolved and there are no clear guidelines so doctors can give an appropriate response.
Romanian Journal of Pediatrics, 2019
Cauză rară de obstruCție de traCt digestiv superior-importanța unei abordări multidisCiplinare dr... more Cauză rară de obstruCție de traCt digestiv superior-importanța unei abordări multidisCiplinare dr. livia e. brezeanu 1 , dr. oana m. guță 1 , asist. univ. dr. raluca m. vlad 1,2 , dr. anatolie nidelcu 1 , asist. univ. dr. mirela pavelescu 1,2 , Şef lucr. dr. daniela păcurar 1,2
Romanian Journal of Pediatrics, 2019
Teenager wiTh upper gasTroinTesTinal obsTrucTion-keep in mind The rare causes livia e. brezeanu 1... more Teenager wiTh upper gasTroinTesTinal obsTrucTion-keep in mind The rare causes livia e. brezeanu 1 , md, oana m. guta 1 , md, assist. prof. raluca m. Vlad 1,2 , md, phd, anatolie nidelcu 1 , md, assist. prof. mirela pavelescu 1,2 , md, phd, lecturer daniela pacurar 1,2 , md, phd
Romanian Journal of Pediatrics, 2020
Introducere. Alergia alimentară este în creștere la nivel global, majoritatea având debutul cel m... more Introducere. Alergia alimentară este în creștere la nivel global, majoritatea având debutul cel mai frecvent în primii ani de viață. Alergia la proteinele din laptele de vacă (APLV) reprezintă principala formă de alergie la sugar. Manifestările clinice ale APLV sunt nespecifice și pot fi cutanate, digestive, respiratorii sau sistemice. Gold standardul de diagnostic este testul de provocare orală, iar dieta de excludere a alimentului alergizant reprezintă tratamentul alergiei. Material și metodă. În perioada iunie 2014-decembrie 2017, am efectuat un studiu prospectiv în care au fost incluși 179 de sugari internați în clinica de Pediatrie a SCUC "Grigore Alexandrescu" cu simptome sugestive de alergie alimentară cu debut sub vârsta de 6 luni. Rezultate. Grupul final de studiu a fost alcătuit din 161 de sugari, 18 cazuri fiind infirmate. 95% dintre sugari au avut alergie la proteinele din laptele de vacă. Vârsta medie a sugarilor la debutul simptomelor a fost de 2,3 luni. 27,2% dintre sugari au avut simptomatologie cu debut acut de tip urticarie acută generalizată formă moderat-severă și edem Quinke (angioedem). 2/3 dintre sugarii incluși în studiu au prezentat manifestări clinice tardive ale APLV, majoritatea simptomelor fiind gastro-intestinale: vărsături (32,3%), refuzul alimentației (30,4%), scaune cu sânge (27,3%) și spor ponderal nesatisfăcător (34,1%). Aproximativ o treime dintre sugari au avut asociat reflux gastro-esofagian, formele fiind de obicei moderat-severe, neresponsive la terapia inițială. 48% dintre sugari au avut alergie IgE mediată la proteina laptelui de vacă, iar restul de 52% au fost alergii cu mecanism nonIgE. Doar 41% dintre sugarii din lot erau alimentați exclusiv la sân la vârsta de 3 luni, dintre aceștia o treime având reacție alergică acută la introducerea formulei de lapte praf. Reintroducerea proteinelor din laptele de vacă după excluderea terapeutică s-a realizat în medie la 9,6 luni pentru sugarii exclusiv alimentați la sân și la 13 luni pentru cei care au fost alimentați artificial de la naștere. Concluzii. Diagnosticul alergiei alimentare la sugar presupune un grad ridicat de suspiciune din partea pediatrului, având în vedere că tabloul clinic este dominat de manifestările gastro-intestinale, care sunt nespecifice și, totodată, cu mecanism imun nonIgE. Alimentația în primele luni de viață are un impact important în afecțiunile alergice.
Romanian Journal of Pediatrics, 2020
Introduction. Food allergies are increasingly more frequent all over the world, in most cases wit... more Introduction. Food allergies are increasingly more frequent all over the world, in most cases with childhood onset. Cow's milk protein allergy (CMPA) is the most frequent allergy in infants. Clinical manifestations are nonspecific and can affect the skin, digestive tract, respiratory system or can be systemic. Oral challenge test is the gold standard diagnostic test and the treatment is the exclusion diet. Material and method. Between June 2014 and December 2017 we conducted a prospective study in which 179 infants were included. They had been hospitalized in the Pediatrics Department of "Grigore Alexandrescu" Emergency Clinical Hospital for Children with suggestive symptoms for food allergy before the age of 6 months. Results. The final study group consisted of 161 infants, because in 18 cases food allergy was excluded. 95% of infants had cow's milk protein allergy (CMPA). The average age of the symptom's onset was 2.3 months. 27.2% of infants had acute allergic reaction like moderate-severe forms of acute urticaria or Quincke oedema (angioedema). 2/3 of infants from the study group had late clinical manifestation of CMPA: vomiting (32.3%), food refusal (30.4%), bloody stools (27.3%) and poor weight growth (34.1%). Approximately one third of the infants associated moderatesevere forms of gastroesophageal reflux, unresponsive to treatment. 48% of infants had IgE mediated cow's milk protein allergy and 52% had non-IgE mediated allergy. Only 41% of infants from the group study were exclusively breastfed at 3 months of age and one third of them had an acute allergic reaction when a milk formula was introduced. Cow's milk protein introduction after the exclusion diet was made at 9,6 months for the breastfed group and at 13 months for the group fed with formula. Conclusions. Food allergy diagnosis requires a high degree of suspicion from the pediatrician, as the predominant gastro-intestinal symptoms are non-specific and non-IgE mediated. The nutrition in the first months of life has an important impact in allergic diseases.
Romanian Journal of Pediatrics, 2019
Wilson’s disease is a genetic autosomal recessive transmitted pathology, that causes disorders of... more Wilson’s disease is a genetic autosomal recessive transmitted pathology, that causes disorders of copper metabolism, leading to its accumulation in target tissues. It is a multisystemic affection and has a polymorphic clinical picture. Establishing a positive diagnosis can be difficult, with no single test that confirms or definitely excludes the disease. Diagnostic criteria for the Wilson disease in adult patients were established, then reevaluated for the child. Establishing early diagnosis allows early chelation therapy, which provides a better prognosis, delaying the progression of the disease. This is the reason why the importance of family screening must be emphasized.
Romanian Journal of Pediatrics, 2017
Objectives. Pediatricians face various challenges in different stages of celiac disease (CD) diag... more Objectives. Pediatricians face various challenges in different stages of celiac disease (CD) diagnosis. Whom to test is intensely debated because of CD's heterogenous clinical spectrum. The main purpose of the study was to identify symptoms or symptom associations that should initiate an active strategy of CD early diagnosis in Romanian children. Material and method. We conducted a prospective study in "Grigore Alexandrescu" Emergency Children's Hospital. From March 2013 until February 2014, 249 children with symptoms/signs at risk of CD were included. Results. CD was diagnosed in 11 (1/21 patients evaluated). One in 12.6; 16; 18; 18.5 and 18.5 children respectively with chronic diarrhea, low stature, growth failure, recurrent abdominal pain and constipation had CD. Certain symptom associations increased the risk: classical symptom associations (chronic diarrhea and weight loss), as well as other associations: recurrent abdominal pain and weight loss, constipation and weight loss, constipation and refractory iron deficiency anemia. Conclusion. Active screening among patients with symptoms and especially symptom associations at risk of CD would improve diagnosis rates in pediatric CD.
Experimental and Therapeutic Medicine, 2019
Chronic viral hepatitis has been incriminated for inducing autoimmune events, but it is a known f... more Chronic viral hepatitis has been incriminated for inducing autoimmune events, but it is a known fact that interferon-based therapies also promote autoimmunity. We conducted an observational prospective study which included 114 pediatric patients with chronic viral hepatitis B and C. The patients were divided in 2 groups, the first group consisted of treatment-naive patients; the second group included patients who had received interferon-based therapy. We aimed to determine whether the ones who received treatment are more predisposed to developing autoimmune manifestations when compared to those naive. Fifty percent of the study group was found to have serological autoimmune phenomenon. Our research shows that the occurrence of the autoimmune phenomenon is delayed when the patient is treated with interferon-based regimens when compared to naive patients. Hence, even though interferon treatment has been reported to promote autoimmunity, the viruses themselves are more likely to induce the appearance of autoimmune markers over time in patients who do not receive treatment.
Medicine, 2019
Rationale: Congenital portosystemic shunt (Abernethy malformation) is a rare entity causing the p... more Rationale: Congenital portosystemic shunt (Abernethy malformation) is a rare entity causing the portal blood to drain directly into the systemic circulation, eluding the liver. These shunts arise through disturbances in the embryonic development. Patient concerns: A 9-year-old male patient was referred to our department for further evaluation of a vascular malformation which was diagnosed in another facility when the patient was 2 years old, following a routine abdominal ultrasound. The patient had no complaints and the physical examination was normal at all times. Diagnosis: Laboratory tests and esogastroduodenoscopy were normal. The abdominal ultrasound showed a side-to-side shunt between a short portal trunk and the inferior vena cava. A hepatic mass suggestive for focal noduar hyperplasia was seen in the left liver lobe. Abdominal angio-computed tomography (angio-CT) was performed and the ultrasonographic anomalies were confirmed. Multiple other vascular malformations were diagnosed-hepatic artery emerging from the superior mesenteric artery, with early division; hepatic veins forming a short common trunk before draining into the inferior vena cava; supranumerary right renal artery emerging from the aorta, tributary for the upper renal pole. Ecocardiography showed left superior vena cava persistence. The final diagnosis was Abernathy malformation type IB. In the meantime the patient was diagnosed with allergic asthma. Interventions: No surgical cure was pursued because the malformation was an incidental discovery. Outcomes: The patient was followed-up closely from the final diagnosis (when he was 9 years old) to present (he is currently 10 years old) with no change in his status-he remained asymptomatic. Lessons: Angio-CT should be the performed whenever a vascular malformation is suspected in order to establish a correct diagnosis, because portosystemic shunts carry a high risk of severe complications. Knowing that patients with portosystemic shunts may have pulmonary hypertension, respiratory complaints should be carefully evaluated-in this particular case, even though the most probable cause for the respiratory symptoms was pulmonary hypertension, it was ruled out by cardiac ultrasonography and further investigations confirmed the diagnosis of allergic asthma. Abbreviations: angio-CT = computed tomography angiography, cm = centimeter, CT = computed tomography, i.v. = intravenous, sec = seconds, VRT = volume rendering technique, MIP = maximum intensity projection.
Chirurgia (Bucharest, Romania : 1990)
Malformations of the inferior vena cava (IVC) are rare presentations, exceptional in children, an... more Malformations of the inferior vena cava (IVC) are rare presentations, exceptional in children, and are usually asymptomatic.They are caused by disturbances in the embryological formation of the venous system or can develop as a result of perinatal venous thrombosis with secondary impairment of the venous development. We report the case of a 14 year old boy,admitted for pediatric evaluation before undergoing plastic surgery in order to remove superficial varicose veins of the lower abdomen. The patient presents with inequality in circumference and length of the legs. Laboratory investigations are normal and the abdominal ultrasound describes hypoplasia of the retrohepatic segment of the inferior vena cava. The diagnosis of complex malformation of the abdominal deep venous system (retrohepatic vena cava atresia, cavo-caval anastomosis through azygos veins, abnormal formation of the inferior vena cava with the absence of the left iliac vein) was established through a CT angiography. Th...