Browsing by Author "Loureiro, HC"
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- Neuromielite longitudinalmente extensa: dificuldades diagnósticas e terapêuticasPublication . Matos, E; Luís, C; Escobar, C; Moniz, M; Nunes, P; Abadesso, C; Loureiro, HC
- Polissonografia na síndrome de apneia obstrutiva do sono em crianças com trissomia 21Publication . Marecos, C; Loureiro, HC; Cunha, MIntrodução e objectivos: As crianças com trissomia 21 (T21) têm uma prevalência de 50% de síndrome de apneia obstru- tiva do sono (SAOS). Os sinais nem sempre são percepcio- nados pelos pais e o estudo polissonográfico do sono (PSG) não está generalizado. O objectivo foi avaliar a existência de SAOS em crianças com T21. Métodos: Amostra de conveniência de 12 crianças com T21 estudadas através da realização de PSG. Resultados: A idade mediana das crianças estudadas foi de 4,5 anos (1,6-13), com índice de massa corporal (IMC) ≥25 em 25% (n=3). Apresentavam défice cognitivo grave 25% (n=3), moderado 33% (n=4) e ligeiro 33% (n=4). Tiveram infecções respiratórias de repetição 42% (n=5) e efectuaram adenoamigdalectomia prévia à PSG 58% (n=7). Referido em consulta, sono agitado 83% (n=10), roncopatia nocturna 92% (n=11) e pausas na respiração 42% (n=5). Na PSG verificou - -se sono lento superficial aumentado em 83% (n=10), sono lento profundo diminuído em 33% (n=4) e em 92% (n=11) diminuição do sono REM. A média da eficiência do sono foi de 84% e em 42% (n=5) estava diminuída. Todos apresen- taram aumento do índice de apneia/hipopneia (IAH) sendo a média de 7,0 (2,5-18,7). As crianças com défice cognitivo grave apresentaram maior número de despertares por hora (DPH) em relação às crianças com défice cognitivo ligeiro (p=0,05), não havendo diferença significativa na eficiência do sono, IAH, movimentos periódicos do sono (MPS) e satura- ção média de oxigénio. Não se verificou associação entre IMC e IAH. A existência prévia de adenoidoamigdalectomia não influenciou significativamente o resultado da PSG. Conclusão: Conclui-se que nas crianças com T21 a PSG permite o diagnóstico atempado da SAOS. A adenoamig- dalectomia não resolve eficazmente a SAOS, devendo ser introduzidas precocemente outras medidas.
- Severe hypercalcemia as a form of acute lymphoblastic leukemia presentation in childrenPublication . Martins, AL; Moniz, M; Nunes, PS; Abadesso, C; Loureiro, HC; Duarte, X; Almeida, HIHypercalcemia is a rare metabolic disorder in children and is potentially fatal. It has a wide differential diagnosis, including cancer. Here, we report the case of a previously healthy 3-year-old who was admitted to the emergency room with fatigue, hyporeactivity, fever and limping gait that had evolved over 5 days and that was progressively worsening. On examination the patient was unconscious (Glasgow coma score: 8). Laboratory tests indicated severe hypercalcemia (total calcium 21.39mg/dL, ionized calcium 2.93mmol/L) and microcytic anemia. Hyperhydration was initiated, and the child was transferred to the pediatric intensive care unit. Continuous venovenous hemodiafiltration with calcium-free solution was instituted, which brought progressive normalization of serum calcium and an improved state of consciousness. Zoledronate was administered, and metabolic and infectious causes and poisoning were excluded. The bone marrow smear revealed a diagnosis of acute lymphoblastic leukemia. Hypercalcemia associated with malignancy in children is rare and occurs as a form of cancer presentation or recurrence. Continuous venovenous hemodiafiltration should be considered in situations where there is imminent risk to life.
- Sleep pathology characterization in sickle cell disease: case-control studyPublication . Mascarenhas, MI; Loureiro, HC; Ferreira, T; Dias, ABACKGROUND: Children and adolescents with sickle cell disease (SCD) have a higher incidence of sleep pathology and obstructive sleep apnea syndrome (OSAS). The nocturnal hypoxemia is a risk to vaso-occlusive crisis among other SCD morbidities. Our aim was to compare polysomnography (PSG) results in a sample of children with SCD with a sample of children with suspected OSAS without SCD. DESIGN AND METHODS: A retrospective study compared clinical and PSG parameters. A descriptive analysis and t-test were done considering P < 0.05 as significant. RESULTS: PSG was done in 65 children with SCD and 65 control-children. Control sample was selected to be equal to SCD sample considering gender (53.8% were male), age (mean age was 9.4 years (SD ± 4.6) and AHI (mean 3.57 events/hr). Mean efficiency, latency and percentage of sleep phases in both groups showed no statistically significant differences. Mean SpO2 and minimum SpO2 were lower in SCD group and it was statistically significant (P < 0.01). Enuresis was more frequent in the SCD children group (35.4% vs. 6.2%, P < 0.01). CONCLUSION: Comparing children with and without SCD, sleep architecture was similar in both groups and minimum SpO2 was significantly lower in SCD children although both groups had a similar AHI. This is an important issue in these children, so it is essential to have a sleep evaluation in order to prevent complications and co-morbidities.
- The effect of NaCl 0.9% and NaCl 0.45% on sodium, chloride, and acid-base balance in a PICU populationPublication . Almeida, HI; Mascarenhas, MI; Loureiro, HC; Abadesso, C; Nunes, P; Moniz, M; Machado, MCOBJECTIVES:To study the effect of two intravenous maintenance fluids on plasma sodium (Na), and acid-base balance in pediatric intensive care patients during the first 24h of hospitalization. METHODS: A prospective randomized controlled study was performed, which allocated 233 patients to groups: (A) NaCl 0.9% or (B) NaCl 0.45%. Patients were aged 1 day to 18 years, had normal electrolyte concentrations, and suffered an acute insult (medical/surgical). MAIN OUTCOME MEASURED: change in plasma sodium. Parametric tests: t-tests, ANOVA, X2 statistical significance level was set at α=0.05. RESULTS: Group A (n=130): serum Na increased by 2.91 (±3.9)mmol/L at 24h (p<0.01); 2% patients had Na higher than 150mmol/L. Mean urinary Na: 106.6 (±56.8)mmol/L. No change in pH at 0 and 24h. Group B (n=103): serum Na did not display statistically significant changes. Fifteen percent of the patients had Na<135mmol/L at 24h. The two fluids had different effects on respiratory and post-operative situations. CONCLUSIONS: The use of saline 0.9% was associated with a lower incidence of electrolyte disturbances.
- The family role in children׳s sleep disturbances: Results from a cross-sectional study in a Portuguese Urban pediatric populationPublication . Martins, AL; Chaves, P; Papoila, AL; Loureiro, HCBACKGROUND: Sleep Disorders (SlD) are frequently undervalued complaints in childhood. Several factors influence sleep, particularly socio-cultural environment and medical conditions such as breathing disorders. Poor sleep hygiene has physical, educational and social consequences. In Portugal, there are few published studies about children׳s sleep habits and rarely based on validated questionnaires. AIM: To study the prevalence of SlD and associated factors, in an outpatient pediatric population of a Primary Health Care Center (PHCC). METHODS: Cross-sectional study of children admitted to a PHCC on a suburban area of Lisbon. Children Sleep Habits Questionnaire, validated for the Portuguese population (CSHQ-PT) for the screening of SlD (cut-off=44), was applied to parents, as well as a demographic inquiry. Body mass index z-score was evaluated. Children scoring 44 or above were sent to Pediatric Sleep Disorders consultation (PSDC). Parametric and non-parametric tests were used whenever appropriate. RESULTS: From 128 children, 57.8% were male; the median age was 6.0 years (P 25=5.0; P 75=8.0). The median of cohabitants per family was 4.0 (P 25=3.0; P 75=5.0); 21.1% lived in a single-parent family. From CSHQ-PT, 59.4% (76) scored above the cut-off. Data showed that children from a single-parent family have more SlD (p=0.048), particularly parasomnia (p=0.019). Children with sleep disordered breathing (SDB) suffer more daytime sleepiness (p=0.034). From 63 children sent to PSDC, 33 attended. Regarding these children, a difference was found between BMI z-scores of those with and without SDB (p=0.06). CONCLUSION: Family structure plays a non-negligible role in children's sleep habits. Daily performance of children with SDB may become compromised.
- Trabalho por turnos no serviço de Pediatria: o impacto no sonoPublication . Amorim, AC; Vieira, J; Moniz, M; Loureiro, HC