Browsing by Author "Luís, C"
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- Acute mastoiditis in children: Middle ear cultures may help in reducing use of broad spectrum antibioticsPublication . Garcia ., C; Salgueiro, AB; Luís, C; Correia, P; Brito, MJAcute mastoiditis (AM) is a suppurative infection of the mastoid air cells, representing the most frequent complication of acute otitis media. AM remains an important entity in children due to its potential complications and sequelae. We aim to describe the cases of AM admitted at our department, identify risk factors potentially associated with complications and analyse the changes in clinical approach of AM over time. METHODS: Case review of clinical files of children admitted with acute mastoiditis from June 1996 to May 2013 at a Lisbon metropolitan area hospital. Data was divided into two groups (prior and after May 2005) in order to evaluate changes in AM approach over the years. RESULTS: 135 AM episodes were included. The median age was 3.8 years and 42% children were less than 24 months of age. Symptoms at presentation included fever (69%), ear pain (56%) and otorrhea (40%). Complications occurred in 22% patients and were more common in children under 24 months (33% vs 15%, p ≤ 0.01). Leukocyte count was significantly higher in children with complications (16.7 vs 14.5 × 109/μL, p ≤ 0.05) as was C-Reactive Protein value (13 vs 6.3 mg/dL, p ≤ 0.001). There was a significant association between the development of complications and C-Reactive Protein value at admission (OR 1.892; IC95%: 1.018-2.493, p ≤ 0.01). The optimal cut-off value was 7.21 mg/dL. Over time there was a significant increase in middle ear cultures obtained by tympanocentesis during surgery (2% vs 16%, p ≤ 0,01) and also a decrease in the use of broad spectrum antibiotherapy as initial treatment (52% vs 25%,p ≤ 0,001). CONCLUSIONS: Children under 24 months, with high leukocyte count or with high C-Reactive Protein value should be monitored closely since complications tend to be more frequent. A CRP value of 7.21 mg/dL at admission seems to be a good cut-off to monitor children for potential complications. Throughout the period analysed more cultures were performed allowing identification of the pathogens and implementation of appropriate antibiotic therapy.
- Celulite Orbitária Pré e Pós-Septal em Idade Pediátrica: 17 Anos de ExperiênciaPublication . Domingues, M; Luís, C; Brito, MJ; Correia, PIntrodução: A celulite orbitária, pré e pós-septal, é a principal infeção dos tecidos e anexos do olho, tendo diferentes abordagens e implicações clínicas. Métodos: Análise retrospectiva de crianças internadas num hospital de nível II da região metropolitana de Lisboa por celulite orbitária ao longo de 17 anos. Comparação entre celulite pré-septal e infeção pós-septal no que respeita à sua apresentação clínica, achados imagiológicos e tratamento. Os dados clínicos e abordagens diagnóstica e terapêutica foram ainda analisados antes e após a implementação de um protocolo de atuação, 1996-2002 e 2003-2013, respetivamente. Resultados: Foram incluídas 305 crianças, 241 com celulite pré-septal e 64 pós-septal, homogeneamente distribuídas pelas fases anterior e posterior à implementação do protocolo de atuação (150 vs 155, respetivamente). Na celulite pós-septal, o fator predisponente mais comum foi a sinusite (82,8 vs 46,9%, p < 0,001) e a existência de portas de entrada foi menos frequente (17,2 vs 40,6%, p < 0,001). Laboratorialmente, constatou-se um maior aumento da proteína C reativa (9,6 vs 4,4 mg/ dL, p < 0,001). Após a implementação do protocolo, constatou-se um maior número de internamentos com atingimento pós- -septal (29 vs 12,7%, p = 0,001), com quadros clínicos mais exuberantes: mais fotofobia (p = 0,001), dor ocular (p < 0,001) e proptose (p < 0,05); a sinusite foi mais frequentemente diagnosticada (p < 0,05). Nesse período, registou-se ainda alteração na escolha e duração da antibioterapia, tendo sido o ceftriaxone a primeira opção na maioria dos casos. Apesar da maior taxa de complicações (1,3% vs 12,9%, p < 0,001), não se verifi cou aumento do número de sequelas a longo prazo. A implementação do protocolo de atuação com critérios de internamento mais restritos levou à admissão preferencial de casos mais graves e maior racionalização da terapêutica
- Hemiconvulsion-hemiplegia-epilepsy Syndrome: Case Report and Use of DextromethorphanPublication . Coelho, J; Santos, T; Ezequiel, M; Luís, C; Levy, A
- Neuromielite longitudinalmente extensa: dificuldades diagnósticas e terapêuticasPublication . Matos, E; Luís, C; Escobar, C; Moniz, M; Nunes, P; Abadesso, C; Loureiro, HC
- Pseudotumor cerebri as the presentation of Lyme disease in a non-endemic areaPublication . Ezequiel, M; Teixeira, AT; Brito, MJ; Luís, CIntracranial hypertension is a rare entity in prepubertal children, and its differential diagnosis includes a number of systemic diseases, drugs, vitamin deficiencies and excesses, and hereditary conditions. Infectious aetiology is rare. The case of a 9-year-old boy with intracranial hypertension secondary to acute neuroborreliosis is described. He presented with daily pulsatile frontotemporal headache, pallor, photophobia and phonophobia. His neurological examination revealed papilledema with no nuchal rigidity. The lumbar puncture showed increased pressure (50 cm H2O) and lymphocytic pleocytosis. Serum and cerebrospinal fluid (CSF) Borrelia burgdorferi antibodies were positive. This kind of infection is rare in Portugal but a trip to an endemic area was identified. A careful history, considering the exposure to rural areas together with the intracranial hypertension and inflammatory CSF, are important clues to the diagnosis, allowing the institution to select appropriate treatment.