Search

Introduction. A common condition, with a prevalence of 1.2 to 5.7%, the obstructive sleep apnea syndrome (OSAS) in children is important in terms of the consequences it has on development, physiology and appropriate function. OSAS in children can cause hyperactive behaviour, attention and learning problems, weight gain issues, hypertension. Any factor that causes excesive narrowing of the pharynx or increases compliance of its walls may further predispose to the occurrence of OSAS. Children with OSAS typically have an anatomical predisposition to airway collapse; maximum airway narrowing corresponds to overlapping areas of the tonsils, the adenoid vegetations and the palate. Genetic and hormonal factors also affect throat compliance and as a result, the risk of OSAS. In this regard, clinical history and physical examination are less relevant prognostic factors and assessement of respiratory function during wakefulness is not helpful to detect gas exchange changes during sleep. Polysomnography (PSG) is a clinical assessment extension that provides important data regarding the respiratory flow, the oxygen saturation, CO2 and respiratory movements during sleep. Material and methods. We present a few cases of patients with sleep apnea episodes observed by parents. In some cases, nocturnal symptoms persisted after surgical adenoidectomy. Performing polysomnography allowed the diagnosis of obstructive sleep apnea syndrome and subsequent therapeutic recommendation. Conclusions. The mechanisms underlying the occurance of OSAS-caused morbidities are likely multifactorial and incompletely elucidated; the activation of the inflammatory pathways by SASO turned out to be an important pathophysiological component in the target organ damage associated with this condition. Sometimes it is possible that adenotonsilectomy is not the best first line treatment. This conclusion does not imply that tonsils or adenoid vegetations is not sometimes the primary mechanism of occurrence of respiratory disorders during sleep in children. It should be seen as an important element in considering alternative therapies. Polysomnography is the investigation of choice in children with suspected OSAS and for the evaluation of apnea/hypopnea residual index after treatment. It is necessary that the equipment and rules of interpretation are appropriate to their age, and the results from polysomnography are integrated with the clinical observation. [ABSTRACT FROM AUTHOR]

Pediatric sleep-related breathing disorders (SRBD) are important because of their cardiovascular, metabolic and neurologic consequences that affect child growth and cognitive functions. Most of the children with sleep-related breathing disorders remain undiagnosed. The Pediatric sleep questionnaire (PSQ) developed at the University of Michigan is easy to apply and it has high sensitivity and specificity in the screening of children for symptoms of obstructive sleep apnea. The objective of this study was to translate the original version from English and adapt it to Romanian language, as an instrument to identify the risk of sleep apnea syndrome in children from Romania. [ABSTRACT FROM AUTHOR]

Obesity is a public health problem, with an important increase in prevalence in the last decades, pediatric population also fits these characteristics. Among the systemic complications of obesity is included the sleep - related respiratory pathology. The association obstructive sleep apnea - obesity is suspected in a child who snores, has sleep fragmentation and breathing pauses, but the diagnosis is confirmed using polysomnography. Obstructive sleep apnea has many kinds of complications (increased by the association with obesity) - cardiac, metabolic, neurocognitive, all of them affecting the quality of life. The treatment of obstructive sleep apnea includes weight loss, adenotonsillectomy and CPAP ventilation. [ABSTRACT FROM AUTHOR]

Obezitatea reprezintă o problemă de sănătate publică, cu o creştere impresionantă a prevalenţei în ultimele decenii, populaţia pediatrică înscriindu-se în aceste caracteristici. Printre complicaţiile multiorganice asociate obezităţii se numără şi patologia respiratorie legată de somn. Asocierea apnee obstructivă de somn - obezitate este suspectată anamnestic la un copil care sforăie, prezintă fragmentarea somnului şi pauze respiratorii, patologia respiratorie fi ind obiectivată prin polisomnografi e. Apneea obstructivă de somn prezintă numeroase complicaţii (multe dintre ele augmentate prin asocierea obezităţii) - cardiace, metabolice, neurocognitive, ce afectează calitatea vieţii. Tratamentul constă în scădere în greutate, adenoamigdalectomie şi folosirea ventilaţiei de tip CPAP. [ABSTRACT FROM AUTHOR]

Pediatric sleep medicine is an area of intense research. The importance of screening for obstructive sleep apnea syndrome (OSAS) has been emphasized in the recently published international guidelines for the diagnosis and management of childhood OSA. In Romania, the first steps of diagnosis and treatment of sleep disorders in children have been recently made and we wanted to assess the current awareness and management option in a group of HCPs. A self-administered questionnaire was sent by email to pediatricians, family doctors, medical doctors of other specialties, including pneumologysts, psychiatrists and ENT specialists. The results, important for the qualitative information, show that pediatric sleep disorders, mainly OSAS, are diagnosed rather by specialists than by family doctors, and that in most cases the management strategy was re-evaluation of the child and/or referral to another specialist. Half of the respondents completed the final open question showing the need for improvement, both theoretical and practical knowledge, for a better communication between specialists and improvement of access to diagnostic tools, as well as increase of education of parents and older children and adolescents. Further research is needed to confirm these qualitative data, however the questionnaire allowed the identification of poor areas for various working groups, finally elaborating recommendations for various interventions which might influence the development of this field in our country as well. [ABSTRACT FROM AUTHOR]

The pedagogical practice represents a fundamental component in the process of professionalization for a teaching career. The pedagogical practice cannot function properly unless it is sustained by a theoretical education. First of all, it is necessary to rethink the concept of practice from a contemporary point of view of epistemology, which regards practice as one of the essential sources of knowledge. Practice must be understood as a reflection upon action, a reflection that sets in motion the assimilated theoretical knowledge. The coaching approach to pedagogical practice represents an actual challenge for any trainer of trainers. Such a perspective requires the trainer to thoroughly analyze his professional behavior, his ability to select the most relevant ways of teaching pedagogy, the best methods for facilitating the knowledge transfer from the master to the disciple. The most important aspect, especially in the moral-religious context of today, is a proper training of religion teachers, with an emphasis on education, rather than on instruction. This can be acquired through the diversification of the activities during religion classes, through a better use of informal activities, such as: attending cultural-religious activities, volunteering, charity work, debates regarding real issues that concern the lives of the students. [ABSTRACT FROM AUTHOR]

It is now possible to diagnose bronchiectasis more accurately, due to high resolution computed tomography technique. Studies on adult population with bronchiectasis indicate that the disease begins in childhood, but symptoms may not appear until months or even years after patients have started having repeated lung infections. Published data from recent studies indicate a possible similar inflammation model for bronchiectasis and neutrophilic asthma, pointing the importance of innate immune activation. It is considered that an early diagnosis of bronchiectasis and an adequate treatment might improve the long-term prognosis of this disease. Despite new epidemiological evidences, bronchiectasis remain an „orphan disease“ when we refer to the number of researches that include this topic. Data are needed for prognosis and evaluation of the effectiveness of treatments. [ABSTRACT FROM AUTHOR]

The viability and the success of the tabacoo industry are mainly ensured by smoking in adolescents. A part of the smokers dies because of smoking and a part quits so the smokers mass hass to be permanently renewed. The article emphasizes that tobacco adverstising plays an important part in encouraging non-smokers to start smoking. Comprehensive bans on tobacco advertising and promotion can result in a considerable reduction of tobacco consumption on a national level. The understanding of these issues is the first step in achieving the restriction or banning of tobacco advertising as one of the fiercest battles to face. [ABSTRACT FROM AUTHOR]

Objective: Passive smoking or second hand smoke has a potentially significant negative impact on physical and emotional health among adults and children. The presentation review the studies of second hand smoke effects on sleep disturbances among pregnant women and children. Methods: A major limitation of these studies in children is that they rely on parental reports of exposure. There are also a few studies that used serum cotinine as a biomarker of tobacco exposure and a validated pediatric sleep survey to caracterize sleep patterns. Results: The results show that exposure to second hand smoke negatively impacts sleep possible through exacerbations of nighttime respiratory symptoms and nicotine arousal mechanisms. Conclusions: Children aged 3-11 years have higher exposure to second hand smoke and its harmful effects. Reduction in exposure may have a significant impact on the quality of sleep in children which have been linked with behavioral and mental health problems, poor school performance, some of which can persist into adulthood. [ABSTRACT FROM AUTHOR]

Congenital lung malformations or CLM have resulted in an apparent increase in their frequency with the advances in fetal ultrasound technology and more widely available investigations in prenatal and postnatal periods. The advantage of an early diagnosis came together with the difficulty of the treatment decision, in special in the postnatal management of asymptomatic CLM. In this article, we summarized findings from current literature, with a particular emphasis on the therapeutic strategies. Management of infants for thoracic surgery represents a challenge not only for pediatric surgeon but also for anesthesiologists because of the anatomic and physiologic variations particularities. There are two main important parts that must be obtained: one lung ventilation and specific techniques for optimal pain management, distinguishing pediatric thoracic anesthesia from other pediatric anesthetic disciplines. A comprehensive multimodal approach is necessarily followed by a long-term assessment of respiratory function of children who underwent surgery for lung resection. [ABSTRACT FROM AUTHOR]

Adherence to CPAP is and will remain the touchstone for patients with obstructive sleep apnea syndrome. The authors try to clarify the many difficulties encountered regarding this matter, its epidemiological implications, factors predicting non-adherence to treatment, and which are the most effective ways to alleviate it. Therefore a practitioner can increase the degree of adherence and he can decisively influence the favourable effect of this type of therapy on a short-term as well as long-term basis.

In the current pediatric practice, respiratory symptoms are one of the most common reasons that lead to referral to a pediatric specialist. Although most such symptoms are generated by respiratory causes, mainly infectious ones, sometimes extra-respiratory pathogenesis is involved. In the last twenty years, pediatric gastroesophageal reflux (GER) has been more frequently recognized both because the increased awareness of the disease and the progresses concerning the diagnostic techniques. The reflux-related complications and not necessarily the number and severity of reflux episodes are the features which help distinguishing between functional or physiologic and pathologic GER. The actual gold standard for gastro-esophageal reflux disease (GERD) diagnosis is the twenty-four-hour pH monitoring of the distal esophagus. Real time ultrasound examination of the eso-gastric junction might also raise the suspicion of GERD. We report three clinical cases of GERD with distinct respiratory complications and non specific clinical picture in which anti-reflux therapy have successfully contributed symptoms remission.