Browsing by Author "Almeida, H"
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- Analysis of contextual variables in the evaluation of child abuse in the pediatric emergency setting.Publication . Almeida, A; Ramos, V; Almeida, H; Escobar, C; Garcia, COBJECTIVE: This article comprises a sample of abuse modalities observed in a pediatric emergency room of a public hospital in the Lisbon metropolitan area and a multifactorial characterization of physical and sexual violence. The objectives are: (1) to discuss the importance of social and family variables in the configuration of both types of violence; (2) to show how physical and sexual violence have subtypes and internal diversity. METHODS: A statistical analysis was carried out in a database (1063 records of child abuse between 2004 and 2013). A form was applied to cases with suspected abuse, containing data on the child, family, abuse episode, abuser, medical history, and clinical observation. A factorial analysis of multiple correspondence was performed to identify patterns of association between social variables and physical and sexual violence, as well as their internal diversity. RESULTS: The prevalence of abuse in this pediatric emergency room was 0.6%. Physical violence predominated (69.4%), followed by sexual violence (39.3%). Exploratory profiles of these types of violence were constructed. Regarding physical violence, the gender of the abuser was the first differentiating dimension; the victim's gender and age range were the second one. In the case of sexual violence, the age of the abuser and co-residence with him/her comprised the first dimension; the victim's age and gender comprised the second dimension. CONCLUSION: Patterns of association between victims, family contexts, and abusers were identified. It is necessary to alert clinicians about the importance of social variables in the multiple facets of child abuse.
- Atrioventricular block related to liposomal amphotericin BPublication . Sanches, B; Nunes, P; Almeida, H; Rebelo, MAtrioventricular block can occur in normal children, young adults or athletes. It is also associated with underlying heart disease or occurs as a drug adverse effect. Amphotericin B is used in the treatment of invasive fungal infections. Cardiac toxicity is a rare adverse reaction. We report the case of a 9-month girl, admitted in the paediatric intensive care unit with cytomegalovirus pneumonitis. During hospitalisation the patient developed a systemic fungic infection and was medicated with liposomal amphotericin B. On the third day of treatment she began repeated episodes of bradycardia with spontaneous reversion. The investigation revealed a second-degree atrioventricular block. We excluded the misplacement of the central catheter, myocarditis or structural cardiomyopathy and suspended amphotericin. After 8 days, the bradycardia episodes ceased what was consistent with the drug's half-life. Amphotericin cardiotoxic mechanism is still unclear. It may be related with alteration of myocardial membrane depolarisation.
- Disfunção miocárdica por défice de vitamina dPublication . Moniz, M; Rebelo, M; Mascarenhas, MI; Nunes, P; Abadesso, C; Loureiro, H; Almeida, HO défice de vitamina D manifesta-se geralmente por alterações na mineralização óssea. No entanto, este défice pode associar-se a outras alterações, como a insuficiência cardíaca. É apresentado o caso clínico de uma lactente com 3 meses de vida admitida na unidade de cuidados intensivos pediátricos com sinais de instabilidade hemodinâmica e necessidade de suporte ventilatório e inotrópico. A avaliação laboratorial inicial revelou uma hipocalcemia grave refratária à terapêutica instituída. O ecocardiograma foi sugestivo de insuficiência cardíaca. A investigação etiológica revelou um défice grave de vitamina D. O défice de vitamina D é um problema cada vez mais frequente nos dias de hoje. Perante uma hipocalcemia grave deve-se suspeitar desta deficiência.
- H1N1 disseminated infection in a 3-month-old boyPublication . Moniz, M; Nunes, P; Silvestre, C; Abadesso, C; Matias, E; Loureiro, H; Almeida, HEarlier this year a new influenza virus emerged. In children, the clinical manifestations of H1N1 infection are similar to those reported during periods of seasonal influenza. We report on a 3-month-old boy with an upper respiratory tract infection who presented enteropathy, coagulopathy and encephalitis related to H1N1. The infection was confirmed in nasopharyngeal aspirate, stools and cerebrospinal fluid by real-time PCR. Treatment with oseltamivir was started.
- Mês da prevenção dos maus tratos na infânciaPublication . Escobar, C; Fonseca, F; Almeida, H; Romeiro, J; Tavares, L; Torre, ML; Ezequiel, M; Santos, P; Vidal, T; Silva, T
- Partial Red Blood Cell Exchange in Children and Young Patients with Sickle Cell Disease: Manual Versus Automated Procedure.Publication . Escobar, C; Moniz, M; Nunes, P; Abadesso, C; Ferreira, T; Barra, A; Lichtner, A; Loureiro, H; Dias, A; Almeida, HINTRODUCTION: The benefits of manual versus automated red blood cell exchange have rarely been documented and studies in young sickle cell disease patients are scarce. We aim to describe and compare our experience in these two procedures. MATERIAL AND METHODS: Young patients (≤ 21 years old) who underwent manual- or automated-red blood cell exchange for prevention or treatment of sickle cell disease complications were included. Clinical, technical and hematological data were prospectively recorded and analyzed. RESULTS: Ninety-four red blood cell exchange sessions were performed over a period of 68 months, including 57 manual and 37 automated, 63 for chronic complications prevention, 30 for acute complications and one in the pre-operative setting. Mean decrease in sickle hemoglobin levels was higher in automated-red blood cell exchange (p < 0.001) and permitted a higher sickle hemoglobin level decrease per volume removed (p < 0.001), while hemoglobin and hematocrit remained stable. Ferritin levels on chronic patients decreased 54%. Most frequent concern was catheter outflow obstruction on manual-red blood cell exchange and access alarm on automated-red blood cell exchange. No major complication or alloimunization was recorded. DISCUSSION: Automated-red blood cell exchange decreased sickle hemoglobin levels more efficiently than manual procedure in the setting of acute and chronic complications of sickle cell disease, with minor technical concerns mainly due to vascular access. The threshold of sickle hemoglobin should be individualized for clinical and hematological goals. In our cohort of young patients, the need for an acceptable venous access was a limiting factor, but iron-overload was avoided. CONCLUSION: Automated red blood cell exchange is safe and well tolerated. It permits a higher sickle hemoglobin removal efficacy, better volume status control and iron-overload avoidance.
- Recém-nascidos no serviço de urgência pediátrica: casuística de um anoPublication . Garcia, C; Mascarenhas, I; Teixeira, AT; Bento, V; Alves, C; Almeida, HIntrodução: Os serviços de urgência pediátrica são ambientes particularmente deletérios para os recém-nascidos. A identifica - ção precoce da doença neste grupo é fundamental, uma vez que o atraso diagnóstico pode estar associado a consequências graves. A maioria dos sistemas de triagem utilizados nos serviços de urgência pediátrica não possui algoritmos específicos para os recém-nascidos. Este estudo teve como objetivos caracterizar os recém-nascidos que recorreram ao serviço de urgência pediátrica, analisar a sua categorização pelo Sistema de Triagem de Manchester e identificar fatores de risco associados ao internamento. Métodos: Estudo retrospetivo efetuado pela análise dos dados de recém-nascidos admitidos no serviço de urgência pediátrica no ano de 2012. Resultados: Foram incluídos 779 recém-nascidos com idade média de 16,78 dias. Os principais diagnósticos de admissão foram as infeções respiratórias (21,9%) e a cólica do lactente (21%). Ficaram internados 22,2%, sendo os principais motivos as infe - ções respiratórias baixas (19,7%), os episódios de apparent life threatening event (15%) e as gastroenterites agudas (10,8%). A presença de hipoxemia e a realização de exames complementares no serviço de urgência pediátrica associaram-se a maior taxa de internamento (p = 0,001), assim como a atribuição de nível de prioridade “urgente”, “muito urgente” ou “emergente” pelo Sistema de Triagem de Manchester (p = 0,001). Discussão: O recurso dos recém-nascidos ao serviço de urgência pediátrica neste hospital ocorre maioritariamente por situa- ções de doença aguda. Os diagnósticos de admissão mais frequentes apresentam pouca gravidade clínica, já que contribuem pouco para o número de internamentos. Verifica-se uma correlação entre o nível de prioridade atribuído pelo Sistema de Triagem de Manchester e a necessidade de internamento neste grupo etário.
- Reply to: Severe hypercalcemia as a form of acute lymphoblastic leukemia presentation in children.Publication . Martins, A; Moniz, M; Nunes, P; Abadesso, C; Loureiro, H; Almeida, H; Duarte, X
- Rhabdomyolysis as a manifestation of a metabolic disease: a case reportPublication . Moniz, M; Mascarenhas, MI; Escobar, C; Nunes, P; Abadesso, C; Loureiro, H; Almeida, HRhabdomyolysis is a process of muscle destruction that can present with varying clinical manifestations. In pediatric patients, its main etiology is infectious diseases. We present a previously healthy adolescent who was admitted to our emergency department with a four-day history of myalgia, muscle weakness and dark urine. At presentation, she was dehydrated. Blood analysis revealed acute renal failure and increased muscular enzymes. She was transferred to our pediatric intensive care unit. Medical therapies for correction of dehydration and the ionic and metabolic consequences of renal failure were performed. Due to oliguria, renal replacement therapy was initiated. An etiological investigation revealed a beta-oxidation defect. Metabolic diseases are a known cause of rhabdomyolysis. Muscular destruction should be diagnosed early in order to avoid its potential consequences. Generally, the treatment of rhabdomyolysis is conservative, although in some situations, a more invasive approach is needed.
- Síndrome Takotsubo após procedimento anestésico em idade pediátrica - um caso clínicoPublication . Oliveira, J; Pacheco, S; Moniz, M; Nunes, P; Abadesso, C; Rebelo, M; Loureiro, H; Almeida, HA síndrome Takotsubo (STT) é uma forma adquirida e transitória de disfunção sistólica, cuja apresentação clínica e eletrocardiográfica mimetiza um enfarte agudo do miocárdio. A STT é também conhecida como miocardiopatia de stress, síndrome do «coração partido», balonamento apical, insuficiência cardíaca aguda reversível, miocárdio «atordoado» (forma neurogénica) ou miocardiopatia aguda das catecolaminas. Os autores descrevem uma apresentação rara de STT após procedimento anestésico. Adolescente de 14 anos, sexo feminino, com antecedentes pessoais de enxaqueca hemiplé- gica e quisto pineal, submetida a ressonância magnética (RM) cranioencefálica de controlo. Durante a indução anestésica com propofol verificou-se bradicardia, revertida com atropina, seguida de taquidisritmia ventricular, revertida com lidocaína e murro pré-cordial. Nas primeiras horas de internamento evoluiu para edema pulmonar associado a insuficiência respiratória global por disfunção ventricular esquerda aguda. O ecocardiograma transtorácico mostrou dilatação do ventrículo esquerdo com hipocinesia global e fração de ejeção reduzida (< 30%). O eletrocardiograma revelou taquicardia sinusal persistente e alterações inespecíficas do segmento ST. Os biomarcadores cardíacos encontravam-se elevados (troponina 2,42 ng/ml, proBNP 8248 pg/ml). Foi medicada com diuréticos, IECA, digitálico e dopamina, com melhoria clínica, bioquímica e ecocardiográfica ao quarto dia. Os ecocardiogramas subsequentes mostraram normalização da função ventricular. A doente teve alta medicada com carvedilol, que suspendeu após normalização da função cardíaca e RM cardíaca não ter revelado alterações. Estão descritos poucos casos de STT em idade pediátrica. Alguns são desencadeados por patologia aguda do sistema nervoso central, mas nem todos cumprem os critérios de diagnóstico clássicos. Neste caso, o procedimento anestésico poderá ter desencadeado a STT.