SUMMARY
\nIntroduction. Obesity is a complex condition that is an important risk factor for cardiovascular disease, hypertension, diabetes and sleep apnea. The risk is frequent, the prognosis being all the more unfavorable as the onset of onset is earlier and the overweight is bigger. Material and method. The case of the Z.A patient, aged 12 and 11 months, coming from the urban environment is presented. From the personal physiological history, we note that he is born by caesarean, 40 weeks weighing 5000 g, G II P II. Upon admission Vcr = 12 years and 11 months \/ Gr = 163 kg \/ Tr = 176 cm; Vt = 16 years and 9 months \/ Gt = 66 kg \/ Tv = 155.90 +\/- 8.02. \/ BMI = 52.75 kg \/ m 2 (> 97% percentile) that falls into morbid obesity. SDS = + 2.50. Historically, we note that the patient is presented in the UPU for diffuse headache, subjective visual impairment, vomiting and diplopia suddenly installed for which an ophthalmic examination was performed indicating papillary edema. Progressively, visual disturbances are increased, suspicion of cranial VI paresis is raised, therefore angio-CT-normal limits and MRI examinations result in a diagnosis of reversible posterior encephalopathy. Paraclinic and biological investigations reveal hyperinsulinemia, insulin resistance (HOMA = 4.97), bilateral papillary edema and hepatocitolysis. Cardiological consultation reveals a borderline arterial hypertension in the context of obesity and Nebilet, Prestarium and Diurex are administered. Corroborating clinical, biological and imaging data, the diagnosis of morbid obesity was made by hyperphagia with increased cardiovascular risk. Results. Childhood obesity is not perceived as a disease. To a large extent, obesity and related conditions respond to treatment if it is early instituted and is properly conducted. The immediate development of the treated child\u2019s obesity is favorable, but the remote evolution is reserved due to the difficulty of maintaining the weight achieved after the weakness. Unless urgent action is taken, with all advances in the pharmaceutical industry and modern medicine, it will increase the number of victims of neglected childhood obesity, reduced quality of life and reduced life expectancy. Conclusions. Obesity is a multifactorial disease and a public health problem and requires a close population screening to identify overweight children and include them in a cognitive behavioral therapy.
\nKeywords: Obesity, neurological complications, management
\nINTRODUCTION
\nObesity is a complex condition that is an important risk factor for cardiovascular disease, hypertension, diabetes and sleep apnea. The risk is frequent, the prognosis being all the more unfavorable as the onset of onset is earlier and the overweight is bigger.
\nThe case of the Z.A patient, aged 12 and 11 months, coming from the urban environment is presented. We note that the patient is presented for diffuse headache, subjective visual impairment, vomiting and diplopia suddenly installed.
\nCASE PRESENTATION
\nZ.A, aged 12 and 11 months, coming from urban area. Reasons for hospitalization are: diffuse headache, subjective visual disturbances (diplopia), convergent strabismus.
\nINTRODUCTION
\nObesity is a complex condition that is an important risk factor for cardiovascular disease, hypertension, diabetes and sleep apnea. The risk is frequent, the prognosis being all the more unfavorable as the onset of onset is earlier and the overweight is bigger.
\nThe case of the Z.A patient, aged 12 and 11 months, coming from the urban environment is presented. We note that the patient is presented for diffuse headache, subjective visual impairment, vomiting and diplopia suddenly installed.
\nCASE PRESENTATION
\nZ.A, aged 12 and 11 months, coming from urban area. Reasons for hospitalization are: diffuse headache, subjective visual disturbances (diplopia), convergent strabismus.
\nhimself at the UPU Deva where he is referred to the Pediatric Neurology Clinic in Timisoara.
\nDuring the admission at the Neurology Clinic he was evaluated neurological and took laboratory tests. Data\tfrom\thereditary-collateral\tantecedents: mother with obesity gr.\tIII, he also has a normoponderal brother, father, affirmative, in good
\nhealth, deny contact with people with TB.
\nData from physiological antecedents: the second child, born at ca. 40 weeks, GN = 5000 g, the mother can not tell the length at birth and the APGAR score, naturally fed up to 6 months, diversified 6 months (apple, vegetable soup). Prophylaxis of rickets with Vigantol oil 2 pic \/ day, 1 year. Vaccinated according to the national vaccination scheme.
\nData from personal pathological history: repeated IACRS, he denied smoking and alcohol.
\nINPATIENT STATUS
\nPatient with chronological age 12 years and 11 months, weight = 163 kg, height = 176 cm, on the percentiles he has the height age = 16 years and 9 months, weight = 66 kg, age height = 155.90 with standard deviation +\/- 8.02.Based on the antopometrics data the BMI = 52.7575 kg \/ m2 (> 97%) and standard deviation for height with value of + 2.50.
\nOverall relatively good status. Excessive appetite. Normal colored skin and mucous membranes, elastic skin folds, preserved turgor. Diffuse headache. Subjective vision disorders, congenital convergent strabismus. Excessively subcutaneous cellular deficiency represented. Normally conformed torace, present vesicular murmur, symmetrically bilaterally, without disseminated rallies on both fields. Precordial area of normal appearance, rhythmic, noisy heart beat, no overloaded breath TA = 140 \/ 90mmHg.
\nThe soft, supple, breathable mobile abdomen allows superficial and deep palpation, loosened by the fatty panicle. The intestinal transit present, the normal stool. Free renal beds, present diuresis. Giordano negativ bilateral. Puberty stage 1.
\nWithout signs of irritation meningeana. Temporospatial orientation, live ROT, bilateral symmetry.
\nEasy walking and orthostatism on short distances with bilateral support. Without extrapyramidal phenomena.
\nParaclinic: hepatocytolysis (TGP: 33 u \/ l-vn: <26 u \/ l), leucocytosis (19.36 10 3 \/ ul vn 4.8- 10.8 10 3 \/\n \nul), hypercholesterolaemia (5.25 mmol \/ l in <5 mmol\n\/ l), hypertriglyceridemia (2.07 mmol \/ l in <1.7 mmol\n\/ l), hyperinsulinemia (28.99 \u03bcg \/ ml in 2.6- 24.9 \u03bcg \/ ml), insulin resistance (HOMA = 4.97).\nIn the neurology department were taken:\nEEG: A theatrical background treadmill, underground, with motion artifacts, unmodified by hyperpnea\nMRI: Since brain engineering was not possible for technical reasons, on October 30, 2017, the transfer to Sibiu Clinical Pediatric Hospital was decided to continue imaging investigations (cerebral MRI) where reversible posterior encephalopathy syndrome PRES). He\ttook\tan\tinterdisciplinary\tcardiological consultation with the following results: BP = 140\/90 mmHg. Cardiac ecography: cord, as normal as possible. Border HBP in the context of obesity. Weight reduction and hypocaloric regimen are recommended. It is decided to take a HOLTER BP which shows secondary obesity hypertension. Antihypertensive treatment with Nebilet, Prestarium and Diurex is\nrecommended.\nPOSITIVE DIAGNOSIS\nAll the clinical, paraclinical and heteroanamnestics data are corelated and we formulated the following positive diagnostics:\n1.\tReversible posterior encephalopathy syndrome (PRES)\n2.\tVisual acuity discharging\n3.\tDouble papillary edema\n4.\tStrabism convergent both eyes\n5.\tHypertrophic hyperplasia, hyperplasia by hyper- phagia with increased cardiovascular risk\n6.\tHBP secondary obesity\n7.\tHepatocytolysis\n8.\tLeukocytosis\n9.\tHypercholesterolemia\n10.\tHypertriglyceridemia\n11.\tHyperinsulinemia\n12.\tInsulin Resistance (HOMA = 4.97)\n13.\tFood mistakes\n14.\tEating disorder\nDIFFERENTIAL DIAGNOSIS\nThe differential diagnosis can be made with the following disorders:\n1.\tGlicogenosis von Gierke: normal neuro- psychic development, excess fat on the hips, thighs\n\nand pubic region, hepatomegaly with hepatocitolysis, hyperlipaemia, hypercholesterolemia, hyperuricemia, hypoglycemia\n2.\tLaurence-Moon-Biedl Bardet syndrome: normal \/ delayed waist, hypogonality, delayed neuro- psychic development, generalized mood disorder sometimes monstrous, cranial abnormalities, polydactylia, syndactia, pigment retinitis, optic atrophy, nystagmus.\n3.\tPrader Willi syndrome: nanism, hypogonadism, morbid obesity, neuro-psychic delay, exaggerated appetite.\n4.\tMetabolic syndrome: abdominal circumference> 94 cm, triglycerides> 150 mg \/ dl, HDL-cholesterol
\n<40 mg \/ dl, blood glucose> 100 mg \/ dL TA> 130\/85 mmHg.
\n5.\tCraniofaringioma: delayed puberty, hypo- staphy, dry skin, obesity, headache, visual disturbance
\n6.\tPrimary hyperaldosteronism: headache, subjective visual disturbances, HTA, muscle cramps, asthenia, polydipsia, signs of transient paralysis, paraesthesia, hypopotasemia, hypernatraemia, increased aldosterone.
\nTREATMENT
\nThe treatment is hygienic-dietary: hypocaloric, hypolipidic, hypoglucidic, normoproteic nutrition with 3000 kcal \/ day, where max. 12% lipids divided into 5 meals per day (3 main and 2 snacks) and the medical treatment is:
\nNebilet tb. 5 mg 1-0-0 tb \/ day Diurex tb. after 1 tb to 2 days Prestarium tb. 5 mg \u00bd-0-0 tb \/ day
\nMetformin cpr. 500 mg for 3×1 cpr \/ day Liv 52 cpr. 2×1 cpr \/ day<\/p>\n
EVOLUTION
\nWithout adequate treatment, high blood pressure in children can be maintained as they age.
\nFavorable evolution under the hygienic-dietary regimen:
\n\u2013\tdecrease of tension values in parallel with the disappearance of symptomatology (especially persistent or recurrent headache)
\n\u2013\timproving cardiac function by improving left ventricular filling and ejection fraction
\n\u2013\treducing the number of apnea \/ hour
\n\u2013\tminimization of basal and postprandial<\/p>\n
hyperinsulinemia, reduction of insulin resistance
\n\u2013\tan improvement in osteo-articular symptoms The possible complications can be: bone
\ndeformities in lower limbs, aseptic necrosis of the femoral head, dislipidemia, hyperinsulinemia, insulin resistance, type II diabetes mellitus, hyperuricemia, hypoventilation syndrome (Pick Wick sd), obstructive sleep apnea, asthma, reactive hyperchortitis, micropenia, HBP, right ventricular hypertrophy, stroke, hepatic steatosis, biliary lithiasis, albuminuria, early glomerular dysfunction and renal tubular dysfunction, neuro-cognitive deficits, feeling of inferiority, family conflicts, social isolation, school difficulties, absenteeism, emotional and psychological immaturity, mycotic and bacterial skin infections, trophic disorders of the lower limbs, nail dysplasia.
\nPROGNOSIS
\nIn the long run, the prognosis is a reserved one, given that weight overweight has the ability to negatively influence various body functions that can shorten the life of patients. The higher the weight, the better the prognosis.
\nPrognosis is closely related to the age and degree of obesity. At the beginning of the illness, both functional and vital prognosis may be somewhat favorable, but as time goes on as complications occur, the prognosis will depend on their severity and less on the affliction in themselves.
\nHospitalization:
\nBy family doctor, neurologist and endocrinologist. To prevent childhood obesity and possible complications, it is recommended that family physicians\tand\tschool\thealth\tprofessionals incorporate BMI calculation into the usual child
\nhealth surveillance activity.
\nCONCLUSIONS:
\n1.\tObesity has a plurifactorial etiology, the weight surplus being the result of the action of genetic and environmental factors, considered as determinants, acting individually or in combination with certain risk factors.
\n2.\tChildhood is a public health issue, both with increased prevalence, with a continuing upward trend and with the often serious complications it carries
\n3.\tParticular attention is now being paid to monitoring the population\u2019s nutritional status<\/p>\n
in identifying overweight and obese children, considering that early intervention can improve outcomes in the medium and long term, particularly in preventing complications.
\n4.\tIt is recommended to include in the therapy of the obese child the cognitive behavioral psychological intervention. This is accomplished by daily enrollment of the child\u2019s or family\u2019sdiet in the conditions of the hygienic-dietary regimen prescribed by the physician. In this way, the child and the family have control over the affected person\u2019s eating habits, easily identify the discrepancies between the prescribed regimen and the one previously followed, and can successfully succeed in correcting food mistakes.<\/p>\n
REFERENCES:
\n1.\tPopa I, Brega D, Alexa A, Dr\u00e5gan M, Raica M \u2013 Obezitatea copi- lului \u0219i \u021besutul adipos, Ed. Mirton Timi\u0219oara, 2001.
\n2.\tThompson DR, Obarzanek E, Franko DL, Barton BA, Morrison J, Biro FM, et al \u2013 Childhood overweight and cardiovascular disease risk factors: the National Heart, Lung, and Blood Institute Growth and Health Study. J Pediatrics 2007;150(1):18-25.
\n3.\tCiofu C \u2013 Obezitatea. \u00cen: Ciofu EP, Ciofu (ed.): Tratat de Pediarie pag 126-130, Ed. Medical\u0103, Bucure\u0219ti, 2001.
\n4.\tCiofu C \u2013 Patologia endocrin\u0103 a copilului. \u00cen: Ciofu EP, Ciofu C (ed.), Tratat de Pediatrie, pag 1249-1254, Ed. Medical\u0103, Bucure\u0219ti, 2001.<\/p>\n
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SUMMARY Introduction. Obesity is a complex condition that is an important risk factor for cardiovascular disease, hypertension, diabetes and sleep apnea. The risk is frequent, the prognosis being all the more unfavorable as the onset of onset is earlier and the overweight is bigger. Material and method. The case of the Z.A patient, aged 12 […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"footnotes":""},"categories":[463,459],"tags":[484,485,483,518],"class_list":["post-3770","post","type-post","status-publish","format-standard","hentry","category-numar-4-vol-2018","category-vol-2018","tag-corches-axinia","tag-mang-niculina","tag-marginean-otilia","tag-vasilescu-raluca-nicoleta"],"_links":{"self":[{"href":"https:\/\/snpcar.ro\/en\/wp-json\/wp\/v2\/posts\/3770","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/snpcar.ro\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/snpcar.ro\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/snpcar.ro\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/snpcar.ro\/en\/wp-json\/wp\/v2\/comments?post=3770"}],"version-history":[{"count":3,"href":"https:\/\/snpcar.ro\/en\/wp-json\/wp\/v2\/posts\/3770\/revisions"}],"predecessor-version":[{"id":3773,"href":"https:\/\/snpcar.ro\/en\/wp-json\/wp\/v2\/posts\/3770\/revisions\/3773"}],"wp:attachment":[{"href":"https:\/\/snpcar.ro\/en\/wp-json\/wp\/v2\/media?parent=3770"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/snpcar.ro\/en\/wp-json\/wp\/v2\/categories?post=3770"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/snpcar.ro\/en\/wp-json\/wp\/v2\/tags?post=3770"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}