Browsing by Author "Garcia, C"
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- Acute Hemorrhagic Edema of InfancyPublication . Garcia, C; Sokolova, A; Torre, ML; Amaro, CAcute Hemorrhagic Edema of Infancy is a small vessel leucocytoclastic vasculitis affecting young infants. It is characterized by large, target-like, macular to purpuric plaques predominantly affecting the face, ear lobes and extremities. Non-pitting edema of the distal extremities and low-grade fever may also be present. Extra-cutaneous involvement is very rare. Although the lesions have a dramatic onset in a twenty-four to forty-eight hour period, usually the child has a non-toxic appearance. In most cases there are no changes in laboratory parameters. The cutaneous biopsy reveals an inflammatory perivascular infiltrate. It is a benign and auto-limited disease, with complete resolution within two to three weeks leaving no sequelae in the majority of cases. No recurrences are described. We report a case of a 42-day old girl admitted at our hospital with Acute Hemorrhagic Edema of Infancy.
- 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.
- Edema agudo hemorrágico da infânciaPublication . Garcia, C; Sokolova, A; Torre, ML; Amaro, C
- Neonatal Screening for Haemoglobinopathies: The Experience of a Level II Hospital in the Lisbon Metropolitan AreaPublication . Teixeira, AT; Garcia, C; Ferreira, T; Dias, A; Trindade, C; Barroso, RIntrodução: As hemoglobinopatias são doenças genéticas, causadas por alterações da produção de hemoglobina, das quais se destacam, pela gravidade e prevalência, a doença falciforme e as síndromes talassémicas. O diagnóstico precoce das hemoglo - binopatias é essencial, permitindo a implementação de medidas que reduzem a morbilidade e a mortalidade nestes doentes. Este estudo caracteriza uma amostra de recém-nascidos incluídos num programa de rastreio de hemoglobinopatias no ano de 2013, num hospital de nível II na área metropolitana de Lisboa. Métodos: Estudo retrospetivo descritivo baseado em dados colhidos nos registos clínicos e laboratoriais hospitalares de crian - ças nascidas entre 1 de janeiro e 31 de dezembro de 2013 com origem familiar em áreas de risco indicadas pela Direção Geral da Saúde ou com história familiar de hemoglobinopatia. Aos recém-nascidos incluídos foi realizado hemograma e eletroforese de hemoglobinas entre o primeiro e o terceiro dia de vida. Resultados: Realizados 739 rastreios (27,7% das crianças nascidas neste período). Foram detetadas 86 (12%) variantes do padrão normal de hemoglobinas, incluindo três casos de doença falciforme (dois casos de hemoglobinopatia SS e um caso de hemoglobinopatia SC) e 83 casos de portadores de hemoglobinopatias. Todos os recém-nascidos com variantes de hemoglo - bina foram observados em consulta de hematologia pediátrica. Discussão: Este rastreio permitiu a deteção precoce de novos casos de doença falciforme, com consequente melhoria dos cuidados prestados a estes doentes, e a deteção de portadores, possibilitando o aconselhamento às famílias.
- Pseudohypoparathyroidism type 1B - a rare cause of tetany: case report.Publication . Garcia, C; Correia, CR; Lopes, LPseudohypoparathyroidism (PHP) is a rare group of disorders characterised by end-organ resistance to the parathyroid hormone (PTH). A 16-year-old boy presented with a 2-year history of involuntary dystonic movements involving mainly the left hand, initially after writing and later during physical exercise. Serum calcium was 1.37 mmol/L (2.20-2.69), phosphate 2.1 mmol/L (0.8-1.45) and PTH 302 ng/L (12-88). CT scan of the head demonstrated multiple subcortical and diffuse basal ganglia calcifications. Genetic analysis confirmed a methylation defect in the GNAS cluster on chromosome 20q13.32 which established the diagnosis. Treatment with calcitriol and calcium carbonate led to complete remission of symptoms. Causes of hypocalcaemia should be considered in evaluating patients with movement disorders. The diagnosis of PHP-1B is challenging but the overall prognosis is excellent.
- 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.
- Urinary tract infections under 24 months old: Is it possible to predict the risk of renal scarring?Publication . Miranda, AM; Garcia, C; Bento, V; Pinto, SBackground: Urinary tract infection is one of the most common bacterial infections in the first two years of life and it can lead to irreversible renal scarring. Renal scintigraphy is the gold standard method for detection of renal scars. The aim of our work was to revise the cases of pyelonephritis, detect the possible predictors for renal scarring and compare those results we would have obtained if we had followed current NICE guidelines. Methods: Retrospective analysis of all patients aged under 24 months evaluated in the paediatric department and diag- nosed with pyelonephritis during a three -year period. We excluded the cases in which no renal scintigraphy was performed. Results: Of the 59 children analysed, 50.8% were boys and 86.4% were under one -year old. Escherichia coli was the predominant bacteria. Renal ultrasonography showed abnormal findings in 23 patients (39%). The incidence of renal scarring was 15.3%. Age, atypical urinary tract infection and abnormal renal ultrasonography seem to be correlated with risk of renal scarring, although the results were not statistically significant. C -reactive protein level is significantly correlated with renal scarring risk (p=0.047). Working outside the NICE guidelines allowed us to catch 7 further renal scars. Conclusions: It’s arguable if renal scintigraphy must be performed in all cases of pyelonephritis diagnosed in the first 24 months of life or only when there are other risk factors for renal scarring. Age, atypical urinary tract infection, C -reactive protein level and renal ultrasonography results must be taken into account in the decision to perform renal scintigraphy in a child. More prospective studies with larger cohorts are needed.