ACTUALITIES IN THE MANAGEMENT OF SECONDARY HYPERPARATHYROIDISM DUE TO CHRONIC KIDNEY DISEASE IN CHILDREN.

Pediatric chronic kidney disease (CKD) has a substantial global impact because is associated with notable morbidity. Secondary hyperparathyroidism (SPHT) frequently emerges as a complication in the early stages of renal insufficiency, it is an adaptive response to uphold mineral balance. It is a component of the chronic kidney disease-mineral and bone disorder (CKD-MBD). The development of SHPT in CKD involves multiple factors and it is important to understand them in order to properly manage it, starting with early diagnosis and continuing with proper treatment. In children with CKD and SHPT, the difficulty in case management is due to non-adherence to proper diet which makes it difficult for the pediatric nephrologist to manage the case. In this review we want to focus on new data regarding this CKD complication.

THYROID DYSFUNCTION IN AN AIDS PATIENT.

OBJECTIVE: Highly active antiretroviral therapy (HAART) is involved in the potential pathogenic mechanisms linking thyroid autoimmunity with immune restoration.The objective is to emphasize the emergence of autoimmune thyroid disease in a HIV patient long period after restoration of immune competence, unlinked to the immune reconstitution inflammatory syndrome (IRIS) occurring shortly after HAART initiation.We report a case of acute autoimmune thyroiditis with thyrotoxicosis in a patient with stage C3 HIV infection, who had been under HAART for more than 7 years.From the beginning there was a good immune response to the regimen, due to a good adherence and compliance (over 90%). Nine months after HAART initiation the viral load was undetectable (under 34 copies/µL) and the CD4 count reached 645 cells/mm3 (within normal range) after one year of treatment. Eight years after HAART initiation, based on clinical and laboratory findings, autoimmune thyroiditis was diagnosed. At this time immune competence with a normal CD4 count and a CD4/CD8 ratio over 1 was achieved. The chronic inflammation status of an HIV infection is the reason that autoimmunity appears outside the IRIS period. Treatment was initiated with antithyroid drugs.Thyroid function should be monitored periodically in HIV patients undergoing HAART. Future observations must be made for HIV related thyroid disorders using new classifications and studies with a larger number of patients.

HYDROCEPHALY, SCHIZENCEPHALY, SPONDYLOCOSTAL DYSPLASIA, AND HYPOPARATHYROIDISM IN AN INFANT OF A DIABETIC MOTHER.

CONTEXT: Diabetes mellitus is the most frequent chronic complication in pregnancy and continues to contribute to increased perinatal morbidity and mortality in newborns. Macrosomia, respiratory distress syndrome, metabolic and electrolytic disturbances, and increased rates of congenital structural defects are well-known neonatal complications associated with maternal diabetes, even if well-controlled. CASE REPORT: A macrosomic infant born from an insulin-dependent mother, with uncontrolled diabetes and lack of adequate prenatal care, prenatally diagnosed with hydrocephaly showed a complicated postnatal course. Initial respiratory distress syndrome and transient hypoglycemia, rapidly corrected under treatment, were followed by persistent hypocalcemia and hyperphosphatemia due to hypoparathyroidism and evolving hydrocephaly. Ventriculoperitoneal shunting was followed by resolution of hypocalcemia, but seizures associated with schizencephaly and recurrent respiratory tract infections, aggravated by spondylocostal dysplasia, concurred to infant's demise at the age of 5 months. CONCLUSIONS: The reported case is rare due to multiple aspects: persistent hypoparathyroidism, uncommon association of schizencephaly, and even rarely association with spondylocostal dysplasia, all these conditions requiring a multidisciplinary therapeutic approach. Also, the reported case is evocative for challenges associated with infants born from diabetic mothers.

Overweight and obesity in school age children in western Romania.

UNLABELLED: Obesity prevalence in both adults and children has reached epidemic proportions worldwide. Romania seems to follow the same trend, but studies proving this fact are scarce. Our aim was to determine the prevalence of overweight and obesity and to find correlations to certain health-risk behaviors in children from western Romania. MATERIAL AND METHODS: In this cross-sectional study, a total of 3626 children aged 7-18 years were examined by medical students (February 2010- June 2011). Children were classified by their body mass index using International Obesity Task Force (IOTF) reference. The children were asked to complete a short questionnaire inquiring about 5 health-risk behaviors: consumption of fast-food, sweetened beverages, sweets and fruits and about physical exercise. RESULTS: The overall prevalence of overweight was 18.2% (16.2% in girls and 20.7% in boys) and 7.2% for obesity (5.8% in girls and 9.0% in boys). The prevalence of both overweight and obesity was higher in boys versus girls and rural versus urban. Overweight and obesity was correlated with the consumption of sweetened beverages and sweets and also with sedentary behavior. CONCLUSIONS: The prevalence of overweight and obesity children is alarming, particularly in boys, higher in rural versus urban. The findings confirm the urgent need for national preventive strategy for childhood obesity and targeted interventions tailored to local circumstances.

Restenosis in the coronary stent is an argument for the surgical myocardial revascularization.

BACKGROUND: This study will evaluate the difference between the frequency of restenosis in myocardial revascularization procedures by stents and CABG by coronarographic control after clinical criteria (angina). METHODS AND RESULTS: Out of the total of 6564 coronarographies performed (1999-2002) for diagnosis purposes, 3110 patients (44.8%) underwent myocardial revascularization procedures, PCI or CABG. PCI was performed in 981 patients (31%) and CABG in 1148 patients (37.3%). At the same time, we performed in our units 2067 surgical procedures, out of which 1148 (55%) revascularizations by CABG. The angiographic control for patients with myocardial revascularization by stent (55 patients) or CABG (50 patients) was performed by clinical criteria (angina reappears) on 105 patients. The restenosis we found in 47 patients (74.5%) treated by stent revascularization and in 29 patients from CABG procedures. In our study restenosis rate was 4.8% in patients with PCI and 2.5% in patients with CABG. CONCLUSIONS: Both surgical (CABG) and percutaneous coronary artery revascularization (PCI) have proved to be extremely effective in the treatment of patients with multivessel coronary disease. In our study restenosis rate was smaller in the patients with CABG than in the PCI group, taking into account the fact that we did not use drug eluting stent (DES) on a large scale. Results from the series of randomized trials (SOS, SIRIUS, ERACI, ARTS, BARI, etc.) have shown that the restenosis phenomenon is an apparent advantage in patients with DES. Restenosis prevention is a complex phenomenon (inflammation, procoagulation, cellular migration, etc.) and DES appearance opens a new era in PCI.