Papers by Cristina Becheanu
Current Health Sciences Journal, 2020
Chronic tonsillitis are frequent in pediatric pathology with numerous involved risk factors and p... more Chronic tonsillitis are frequent in pediatric pathology with numerous involved risk factors and pathogenic mechanisms. In this study, epidemiological data and biochemical values addressed to inflammation and mineral, lipid and hepatic metabolism were analyzed for 37 children of school age with chronic tonsillitis. We found that in the majority of cases, chronic tonsillitis was associated with increasing number of blood circulating inflammatory cells, high values of transaminases, cholesterol, triglycerides and low values of procalcitonin, C-reactive protein, calcium, vitamin D and serum iron. The results indicated relations of the biochemical profile analyzed with risk factors and systemic mechanisms for initiation and maintenance of chronic tonsillitis, aspects that can be used to optimize the prognosis of chronic tonsillitis in children.
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 2019
Benign serous ovarian epithelial tumors represent a major area of interest in pediatric pathology... more Benign serous ovarian epithelial tumors represent a major area of interest in pediatric pathology through the incidence and the hormonal and reproductive implications that they induce. In this study, we analyzed 24 tumors diagnosed and surgically operated in children and adolescents, in relation to clinical, histological and immunohistochemical parameters, which can provide information on the potential for growth of lesions. The average age of diagnosis was 13.2 years, the majority of tumors being present in patients over 10 years (75%), with accompanying symptoms (83.3%), unilateral (91.7%) and dimensions of maximum 10 cm (66.7%). The histopathological aspect indicated a cystic growth pattern, sometimes papillary, and in three cases, the presence of atypical focal areas of the tumor epithelium. The Ki67 proliferation index values were higher in the case of tumors larger than 10 cm, those with papillary pattern, and in those with atypical areas, while p53 reactions were present only...
Romanian Journal of Morphology and Embryology, 2021
Chronic palatal and nasopharyngeal inflammations are common lesions in pediatric pathology, with ... more Chronic palatal and nasopharyngeal inflammations are common lesions in pediatric pathology, with major effects on children's development. The study included 34 cases of chronic tonsillitis and adenoiditis for which we quantified immunohistochemically and analyzed the distribution of inflammatory elements in the follicular, extrafollicular and epithelial compartments, in relation to the composite histological scores and the clinico-epidemiological profile of the lesions. The cases were more frequent under the age of 10, in female patients, coming from urban areas, with the diagnosis of tonsillitis. B-lymphocytes have been associated with follicular areas in tonsillitis and epithelial areas in adenoiditis. In all compartments, T-lymphocytes were more frequently associated with tonsillitis and plasma cells associated with adenoiditis. Macrophages and dendritic cells had a relatively uniform distribution for the three compartments in all cases. The results obtained indicate different inflammatory phenotypes for chronic tonsillitis and adenoiditis, an aspect that may be useful for stratifying patients for optimal therapy.
Posters, 2017
Background and aim Over the last decades, the diagnosis of cæliac disease (CD) changed significan... more Background and aim Over the last decades, the diagnosis of cæliac disease (CD) changed significantly both in terms of clinical picture and laboratory diagnosis. The authors present the perspective of a Pædiatric Gastroenterology Department over a 32 years period. Method We performed a retrospective study including patients diagnosed with CD from Jan.1985 until Dec.2016 in „Gr. Alexandrescu’ Children’s Hospital. Three groups were formed, according to the diagnostic procedures used over time: first-intestinal biopsy, second-serology and biopsy, third-serology and biopsy or high values of anti-transglutaminase antibodies, a second positive serologic marker and HLA typing. Clinical characteristics at presentation were analysed. Results 231 children were included. First group contained 20 patients (mean age at diagnosis 5.9 years) diagnosed with classic forms of CD from 1985 until 1995 (1.8/year). Gastrointestinal (GI) symptoms were described in all, particularly chronic diarrhoea (90%). Four presented with cæliac crisis (20%). Second group included 152 patients diagnosed from 1996 until 2006 (once serologic screening was available the number of patients/year increased to 13.8). Mean age at diagnosis was 4.4 years. 86.8% presented with GI symptoms, but only 51.9% had chronic diarrhoea. Cæliac crisis was rarely seen (0.6%). Instead of classic forms with malabsorbtion, atypical presentations with non-GI symptoms were reported in 13.1%. Third group consisted of 59 patients diagnosed from 2007 until 2016 (at a mean age of 4). The number of patients presenting to a Gastroenterology Department decreased considerably (5.9/year). Half of the patients that reached our department presented with mild GI symptoms other than chronic diarrhoea: constipation, abdominal pain (50.9%). Conclusion Three decades ago the Pædiatric Gastroenterologist was diagnosing classic forms of CD with chronic diarrhoea in small numbers of children. Once cæliac serology was available, the diagnosis shifted to a large number of patients with a broad clinical spectrum. Now CD diagnosis is again set progressively less frequent in the Gastroenterology Department as mild GI symptoms suggesting rather functional than organic disease are often the form of presentation. As long as the CD awareness is high, the diagnosis might be successfully established in the primary care setting, in many cases without biopsy, according to the ESPGHAN guidelines.
Romanian Journal of Pediatrics
Obiective. Condiţiile socio-economice, obiceiurile alimentare şi comportamentale sunt citate ca f... more Obiective. Condiţiile socio-economice, obiceiurile alimentare şi comportamentale sunt citate ca factori cu rol determinant în influenţarea stării de nutriţie, mai ales în populaţia pediatrică, în întreaga lume. Studiul de faţă îşi propune evaluarea schimbărilor într-un interval de 5 ani a stării de nutriţie şi a factorilor externi specifici care le-au influenţat, pe un eşantion semnificativ de copii din zona de sud a României. Material şi metodă. Studiul prospectiv cross-section a fost realizat în cadrul Spitalului Clinic de Urgenţă pentru Copii „Grigore Alexandrescu“ din Bucureşti, în perioada decembrie 2010-februarie 2011. Au fost înrolaţi 1.529 de pacienţi şi evaluaţi antropometric şi din punct de vedere al obiceiurilor alimentare pe baza completării unui chestionar. Protocolul de studiu a fost cel aplicat în anul 2005, în acelaşi interval de timp pe un lot asemănător numeric. Loturile de studiu s-au alcătuit pe criteriul vârstă: 0-2 ani şi 2-18 ani. S-a aplicat pentru prelucrare...
Romanian Journal of Pediatrics
Obiective. În ultimii ani, s-a observat o creştere a numărului de pacienţi diagnosticaţi cu boală... more Obiective. În ultimii ani, s-a observat o creştere a numărului de pacienţi diagnosticaţi cu boală inflamatorie intestinală (BII). Ne-am propus să determinăm epidemiologia acestei patologii în rândul populaţiei pediatrice din sudul României, după o perioadă de 10 ani. Material şi metodă. Studiul de faţă este unul retrospectiv, efectuat în cadrul Clinicilor de Gastroenterologie Pediatrică din Bucureşti şi are drept scop identificarea caracteristicilor epidemiologice ale pacienţilor pediatrici care suferă de BII. Am selectat toţi pacienţii aflaţi în evidenţa cu boală inflamatorie intestinală în anul 2011. Un studiu asemănător a fost realizat în urmă cu 10 ani, raportând cazurile aflate în evidenţă în anul 2001, ceea ce a permis o analiză comparativă a datelor obţinute. Rezultate. Am identificat un număr de 74 de cazuri de boală inflamatorie intestinală, în timp ce în anul 2001 au fost menţionate 21 de cazuri. Dintre aceştia, 35 de cazuri au fost reprezentate de boala Crohn (47,29%) şi ...
Romanian Journal of Pediatrics
Aims. The determinants of children nutrition status varies around the globe in relation with soci... more Aims. The determinants of children nutrition status varies around the globe in relation with socio-economic particularities, dietary habits and family lifestyle. The present study attempted to evaluate the changes and determinants of nutritional status of a representative children population from South Romania. Materials and methods. A prospective cross section study was performed in Grigore Alexandrescu Emergency Children’s Hospital from Bucharest between December 2010-February 2011. We enrolled 1529 children and anthropometric, dietary assessment and interview schedule were used for all the participants. Study design was similar with the one used in 2005, on similar condition (timing and participants). The population was divided in 2 age groups: 0-2 years and 2-18 years. Data analyze used SPSS software and the Data Analysis module of MICROSOFT EXCEL 2007. Chi-Squared Test was performed for hypothesis testing involving nominal variables (categorical), non-parametric Wilcoxon-Mann-W...
Background: A strong association between celiac disease (CD) and human leukocyte antigens (HLA)-D... more Background: A strong association between celiac disease (CD) and human leukocyte antigens (HLA)-DQ2 and HLA-DQ8 molecules was demonstrated and therefore DQ typing is nowadays used in CD diagnosis. We aimed to evaluate the usefulness of HLA DQ2/DQ8 typing in CD diagnosis of symptomatic patients with positive anti-tissue transglutaminase antibodies (anti-tTGA) and histologic findings compatible with CD. Methods: We performed a retrospective study including patients investigated for CD who underwent HLA DQ2/DQ8 typing and intestinal biopsy. We selected patients that presented with CD suggestive symptoms, positive anti-tTGA and specific histologic findings. We extracted from the medical records: age, clinical symptoms, anti-tTGA titers and histologic findings (according to Marsh-Oberhuber classification). Regarding anti-tTGA titers, three groups were defined: anti-tTGA < 3-fold the upper limit of normal range, anti-tTGA between 3-fold and 10-fold the upper limit of normal range and a...
Romanian Journal of Pediatrics, 2012
Pancreatita cronică (PC) se caracterizează prin infl amaţie cronică, fi broză progresivă, durere ... more Pancreatita cronică (PC) se caracterizează prin infl amaţie cronică, fi broză progresivă, durere şi pierderea funcţiilor endocrină şi exocrină. În 1999 a fost formulată ipoteza episodului santinelă de pancreatită acută (sentinel acute pancreatitis event - SAPE), care sugerează că episodul iniţial de pancreatită generat de stres metabolic sau oxidativ este urmat de infl amaţie recurentă sau cronică care produce fi broză. Celulele stelate pancreatice au fost identifi cate ca având rol cheie în progresia pancreatitei cronice şi în dezvoltarea fi brinogenezei. PC este o afecţiune heterogenă cu un spectru clinic care include: durere, afectarea funcţiilor endocrine şi exocrine pancreatice şi variate complicaţii ce implică organele adiacente pancreasului. Pentru a stabili diagnosticul de PC la adult sunt necesare dovezi histologice, morfologice sau o combinaţie de argumente clinice, funcţionale şi morfologice. Recent, Grupul Internaţional de Studiu pentru Pancreatită la Copil (Internationa...
Processes, 2021
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
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: [email protected] Abstract
Romanian Journal of Medical Practice, 2021
Introduction. Infestation with the roundworm Ascaris lumbricoides is one of the most prevalent he... more Introduction. Infestation with the roundworm Ascaris lumbricoides is one of the most prevalent helminthic diseases belonging to the soil-transmitted helminths class. Infections are especially affecting children in tropical countries and low and middle-income countries but also may occur in developing countries where sanitation and hygiene are poor. We aim to present a case report to sound the alarm on this widespread pathology. Case presentation. We report the case of a 9-year-old boy with Down syndrome and duodenal stenosis admitted to our hospital with recurrent bouts of pancreatitis secondary to ascariasis. Child is living in poor sanitation conditions. The first episode of pancreatitis was at the age of seven. The abdominal ultrasound shows enlargement and heterogeneity of the head and body of the pancreas, and multiple images of "the strip sign" in the duodenum, suggesting the presence of Ascaris lumbricoides. Live worms were expelled several times. During the next tw...
Romanian Journal of Pediatrics, 2020
Esophageal atresia (EA) is one of the most common digestive malformations; 50% of the patients wi... more Esophageal atresia (EA) is one of the most common digestive malformations; 50% of the patients with EA have other congenital anomalies associated. Due to the progress regarding the surgical techniques and the treatments given in the neonatal intensive care units, along with perfecting the nutrition techniques, the concern shifted from mortality to the morbidity and the quality of life of the patients with esophageal atresia. In order to apply specific therapeutic programs, an increased attention is given to the early identification of the complications, which are described from the neonatal period up to the adulthood. The most common are the gastrointestinal, nutritional and respiratory complications. One of the complications with major impact on the evolution of patients with esophageal atresia is gastro-esophageal reflux (GER), found in 50% of patients with esophageal atresia; GER may be met in adults, even without symptoms. The persistence of GER is associated with increasing incidence of complications such as dysphagia, esophagitis, esophageal strictures, esophageal metaplasia, esophageal carcinoma.
Romanian Journal of Pediatrics, 2020
Introducere. Atrezia de esofag (AE), însoţită adesea de fistulă traheo-esofagiană (FTE), este una... more Introducere. Atrezia de esofag (AE), însoţită adesea de fistulă traheo-esofagiană (FTE), este una dintre cele mai frecvente malformaţii de tub digestiv, în 50% dintre cazuri fiind asociată cu alte anomalii congenitale, sindroame sau asocieri de malformaţii. AE se întâlnește și în rândul pacienților cu sindrom Edwards, cu sindrom Down, cu sindrom Di George și cu sindrom Pierre Robin. Diagnosticarea ȋntârziatǎ a anomaliilor congenitale asociate AE conduce la creșterea morbiditǎții și a mortalitǎții, mai ales când sunt asociate două sau mai multe anomalii. Scopul studiului nostru constă în evidenţierea anomaliilor asociate AE şi în evaluarea impactului pe care acestea îl au asupra mortalităţii. Materiale şi metode. În studiul prezentat, am efectuat o analiză retrospectivă a nou-născuţilor internaţi în Secţia de Terapie Intensivă Neonatală a SCUC "Grigore Alexandrescu", în perioada ianuarie 2013-decembrie 2018, cu diagnosticul de atrezie de esofag; am evaluat informaţiile demografice, manifestările clinice, rezultatele investigaţiilor ecografice şi radiologice. Rezultate. Lotul examinat a cuprins un numar de 56 nou-născuţi având diagnosticul de atrezie de esofag. 31 dintre aceştia au fost băieţi, iar 22 de pacienţi au avut vârsta gestaţională cuprinsă între 32 şi 36 de săptămâni. 5 nounăscuţi au provenit din sarcini gemelare. Anomalii asociate atreziei de esofag/FTE au fost semnalate la 35 de pacienţi, cele mai frecvente fiind anomaliile cardiace (identificate la 25 de nou-născuţi). Asocierea a 3 anomalii din spectrul VACTERL (defecte vertebrale, atrezie analǎ, defecte cardiace, fistulǎ traheoesofagianǎ, anomalii renale, anomalii ale membrelor) a fost semnalată la 11 nou-născuţi. Riscul estimat de deces a fost ușor mai crescut la sexul feminin și la pacienții proveniți din mediul urban. Decesul a survenit mai frecvent la vârste gestaționale din intervalul 32-36 săptămâni, iar pacienţii care au prezentat anomalii ale membrelor au avut un risc estimat de deces de aproximativ 5 ori mai crescut (p = 0,043). Concluzii. Atrezia de esofag reprezintǎ o patologie complexǎ atât prin malformațiile și sindroamele genetice care i se pot asocia, cât și prin complicațiile care survin în evoluţie. Diagnosticarea antenatală a AE şi a anomaliilor asociate şi îngrijirea pacienților cu atrezie de esofag de cǎtre echipe multidisciplinare reprezintǎ mǎsuri esențiale pentru a evita subdiagnosticarea problemelor asociate.
Romanian Journal of Pediatrics, 2020
Introduction. Esophageal atresia (EA), typically occurring with tracheoesophageal fistula (TEF), ... more Introduction. Esophageal atresia (EA), typically occurring with tracheoesophageal fistula (TEF), is one of the most common digestive malformations; 50% of the esophageal atresia cases associate other malformations, syndromes or association of congenital abnormalities. EA is also met in patients with Edwards syndrome, Down syndrome, Di George syndrome and Pierre Robin syndrome. Delayed diagnosis of EA associated anomalies leads to increased morbidity and mortality, especially in patients with two or more associated abnormalities. Our study aims to highlight EA associated anomalies and to evaluate their impact on mortality. Materials and methods. We conducted a retrospective study of all newborns admitted in the Neonatal Intensive Care Unit of "Grigore Alexandrescu" Emergency Clinical Hospital for Children, with the diagnosis of esophageal atresia/ tracheoesophageal fistula (TEF), between January 2013 and December 2018; we evaluated demographic information, clinical manifestation, the ultrasound and radiological results. Our study aimed to highlight AE associated anomalies and to evaluate their impact on mortality. Results. 56 newborns with esophageal atresia/ tracheoesophageal fistula diagnosis were identified. 31 of them were boys, and 22 patients had gestational age (GA) between 32 and 36 weeks. Five newborns came from twin pregnancies. EA/ TEF associated anomalies were identified in 35 patients; the most frequent of those were cardiac anomalies (identified in 25 patients). The association of 3 anomalies from VACTERL spectrum (vertebral, anorectal, cardiac, EA/ TEF, renal and urinary, and limb lesions) was seen in 11 newborns. The estimated risk of death was lightly increased in females and in patients from urban area; the patients with limb anomalies had an estimated risk of death 5 times higher (p = 0.043). Conclusions. EA is a complex pathology both by the malformations and genetic syndromes that can be associated with it, and by the complications that occur in evolution. Antenatal diagnosis of EA and of the associated anomalies, along with multidisciplinary care, represent important measures in order to avoid underdiagnosis of associated problems.
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, 2020
Atrezia de esofag (AE) este una dintre cele mai frecvente malformații de tub digestiv, fiind asoc... more Atrezia de esofag (AE) este una dintre cele mai frecvente malformații de tub digestiv, fiind asociatǎ în 50% dintre cazuri cu alte malformații. Progresele tehnicilor chirurgicale și tratamentelor acordate în terapia intensivǎ neonatalǎ, alături de perfecţionarea tehnicilor de nuţritie, au determinat ca preocuparea privind pacienții cu atrezie de esofag sǎ se mute de la mortalitate la morbiditate și calitatea vieții acestor pacienţi. O atenție sporitǎ este acordatǎ identificǎrii precoce a complicațiilor care survin, în vederea intervenirii cu mijloace terapeutice specifice. Complicațiile sunt descrise din perioada neonatalǎ pânǎ la vârsta de adult, cele mai comune fiind complicațiile gastrointestinale, nutriționale și respiratorii. Una dintre complicaţiile cu impact major asupra evoluţiei pacienţilor cu atrezie de esofag este refluxul gastro-esofagian (RGE), întâlnit la 50% dintre pacienţii cu AE; acesta poate persista și la vârsta de adult, chiar în lipsa simptomatologiei. Persistenţa RGE se asociazǎ cu creșterea riscului de complicații pe termen lung (disfagie, esofagitǎ, stricturi esofagiene, metaplazie esofagianǎ, carcinom esofagian).
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.
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Papers by Cristina Becheanu