Overweight and obesity in childhood are associated with early cardiovascular dysfunction and promote heightened risk of cardiovascular morbidity and mortality in adulthood. Waist circumference (WC) correlates with visceral obesity, which is why obese children with elevated WC need to be carefully monitored to prevent long-term cardio-metabolic complications. The purpose of our study was to establish if WC could be a predictor of cardiovascular complications in children. The authors conducted a retrospective study that included 160 overweight and obese children and adolescents, aged 6 to 18 years. Patients were evaluated completely anthropometrically, biologically, and imagistic. The anthropometric data tracked were height, weight, WC, and body mass index. Echocardiography evaluated the following parameters: the interventricular septum, left ventricular mass, the relative thickness of the ventricular wall, the pathological epicardial fat. Our results confirm that the presence of visceral obesity was significantly associated (χ 2 = 11.72, P = .0006) with pathological epicardial fat. In children, visceral obesity is not a risk factor for vascular or cardiac impairment, but in adolescents, the results showed that visceral obesity is an important predictive factor for the occurrence of vascular (AUC = 0.669, P = .021) and cardiac (AUC = 0.697, P = .037) impairment. Concentric left ventricular (LV) hypertrophy is significantly influenced by the presence of visceral obesity (AUC = 0.664, P = .013 children; AUC = 0.716, P = .026 adolescents). WC above the 90th percentile is a predictive factor for increased LVM index and concentric hypertrophy in both children and adolescents.
Obesity-related cardiovascular disease is becoming more prevalent in conjunction with the rise in childhood obesity. Children with obesity may exhibit early signs of cardiovascular dysfunction: increased arterial stiffness, early atherosclerosis, changes in the myocardial structure and function. These are the result of their excess adiposity, often independent of other obesity-related comorbidities such as dyslipidemia and insulin resistance. Obesity in childhood predisposes to an increased risk of morbidity and cardiovascular mortality in adult. This review is to highlight the importance and need of programs for early detection, diagnosis, treatment and prevention of childhood obesity in order to decrease the incidence of the cardiovascular pathology in adults.
Osteopenia, termen aparţinând patologiei copilului, este o scădere a masei osoase în raport cu vârsta cronologică, reprezentând o stare intermediară între normal şi osteoporoză. Este o afecţiune plurietiologică, cuprinzând un grup heterogen de boli ale ţesutului conjunctiv cu determinism genetic, dar şi osteopenia dobândită în diverse stări patologice care afectează homeostazia osoasă. Diagnosticul precoce se stabileşte prin măsurarea densităţii osoase prin metode imagistice noninvazive, cele mai utilizate fiind dual-energy x-ray absorbtiometry (DEXA) şi ultrasonografi a cantitativă. Tratamentul la copil se particularizează prin necesitatea adaptării aportului de calciu şi vitamina D atât la nevoile fiziologice ale creşterii, cât şi la cerinţele unei patologii. Tratamentul medicamentos specific cu bifosfonaţi nitrogenici a fost introdus la copii, dar nu este încă bine statuat. Atenţia care trebuie acordată acestei patologii osoase la copil şi adolescent este justificată de valoarea prognostică pentru tot restul vieţii a masei osoase de vârf a vârstei 20-21 ani.
Congenital heart malformations, with an incidence of 6-8/1,000 births, represent about 30% of cases of infant mortality due to congenital abnormalities. Of these, most require immediate corrective surgery in the neonatal period. Kidney and urinary tract malformations have an incidence of approximately 1%. The development of ultrasound techniques allowed for prenatal diagnosis of many fetal malformations, some of them life-threatening. Thus, important ethical problems occur, concerning abortion or guidance of the pregnant woman to a center where the newborn will be operated in the first hours of life.
Visceral pain is different from the somatic one: visceral receptors have different functional engagement, the nociception degree differ from one organ to another, the few visceral afferent fibers are predominantly unmyelinated and have an extensive divergence in the central nervous system; the responses involve autonomic activation. The matrix of abdominal visceral pain, functional at birth, is overburdened by mechanical, chemical, osmotic impulses; overlapping infections or inflammation, by the released mediators create the conditions for acquiring the peripheral and central “sensibility” and the “pain memory”; behavioral and emotional factors can aggravate the visceral pain matrix hyperreactivity. In this pathogenic context it defines nonorganic pain and its severe form, visceral hyperalgesia. Genetic peculiarities influence the pain sensitivity. Based on the biopsychosocial model of functional disorders, Rome III criteria tagged the abdominal functional pain and the irritable bowel syndrome as a positive diagnosis and not a diagnosis of exclusion. Nonorganic pain, often associated with recurrent abdominal pain is among the most common medical problems encountered in pediatrics. Most patients with mild pain have a good evolution over time; a small percentage present serious and sometimes disabling symptoms. Pediatricians frequently have difficulties in delineation the diagnosis of nonorganic pain and that, sometimes, involves treatment failure. The authors present the epidemiological data, the pathophysiological mechanisms involved, the clinical approach and the therapeutic options on nonorganic pain and visceral hyperalgesia in children.
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