Browsing by Author "Correia, F."
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- Alergia alimentar em idade pediátricaPublication . Santalha, M.; Correia, F.; Costa, A.; Macedo, L.; Alendouro, P.; Matos, A.Introdução: A prevalência da alergia alimentar, em idade pediátrica, é cerca de 4-6%. Os principais alimentos responsabilizados por alergia são o leite e clara do ovo, sendo a clínica de alergia, geralmente transitória. Objetivo e métodos: Caracterizar casos de alergia alimentar persistentes ou menos frequentes em idade pediátrica, seguidos na consulta de pediatria/doenças alérgicas num hospital nível II. O diagnóstico baseou-se na anamnese, testes cutâneos, doseamento de IgE sérica especifica e, na ausência de contra-indicações, prova de provocação oral. Num caso realizou-se ISAC® (immuno solid - phase allergen chip) e Imunoblotting para melhor esclarecimento diagnóstico. Foram excluídas as alergias à clara do ovo e às proteínas do leite de vaca com aquisição de tolerância ao longo da infância. Um caso de alergia às proteínas do leite de vaca foi incluído pela não aquisição de tolerância, tornando-o assim uma forma menos frequente. Resultados: Selecionaram-se 12 casos, dos quais 75% (9) eram do sexo masculino. Registaram-se antecedentes familiares de alergias em 58,3% (7) e 83,3% (10) tinham concomitantemente outra manifestação de atopia. Constatamos sete casos de alergia ao kiwi e quatro casos de polissensibilização alimentar. As formas de apresentação clínica foram: urticária [66,7% (8)]; edema perioral [63,6% (7)]; angioedema [41,7% (6)] e dispneia [45,5% (5)]. Todos os testes cutâneos foram positivos. O mesmo não se verificou com os exames laboratoriais (um caso apresentou testes cutâneos e prova de provocação ao kiwi positiva, com IgE sérica específica, determinação pelo método ISAC e Imunoblotting negativos). Conclusões: A maioria das crianças apresentou co-sensibilização com outros alergénios e outra manifestação concomitante de alergia, refletindo o passo primordial da alergia alimentar na marcha alérgica. O diagnóstico de alergia alimentar é de extrema importância, pela evicção que implica e potencial gravidade.
- ANESTÉSICOS: NEUROTOXICIDADEPublication . Correia, F.
- Um caso raro de retenção urinária agudaPublication . Santalha, M.; Fonte, M.; Correia, F.; Ferreira, C.A retenção urinária é pouco frequente na infância, podendo ser congénita ou secundária a processos traumáticos, inflamatórios, cirúrgicos, neurológicos, mecânicos, medicamentosos ou psicogénicos. Apresenta-se o caso clínico de uma adolescente de treze anos, com quadro de algia hipogástrica, retenção urinária e obstipação. Ao exame objectivo constatou-se uma massa arredondada hipogástrica. A radiografia simples do abdómen evidenciou imagem radiopaca no terço inferior do abdómen e a ecografia abdomino-pélvica mostrou conteúdo impuro sugerindo hematocolpos e hematometra. Realizada himeniotomia cirúrgica com evolução favorável. A inspecção atenta dos genitais externos é fundamental, logo após o nascimento, para o diagnóstico de hímen imperfurado. Quando não detectado e tratado no período neonatal, na sua maioria o diagnóstico é realizado tardiamente em idade pubertária perante o aparecimento de complicações. ABSTRACT Introduction: Acute urinary retention is uncommon in childhood, and it can be congenital or secondary to traumatic, inflammatory, surgical, neurological or mechanical processes, drug-induced or psychogenic. Case report: We report a clinical case of a thirteen year old girl with hypogastric pain, urinary retention and constipation. On physical examination a rounded hipogastric mass was palpable. An abdominal X-ray revealed a radiopaque image in the lower third of the abdomen and the abdominal-pelvic ultrasonography revealed an impure content suggesting hematocolpos and hematometra. A surgical incision of the hymen was performed, with favorable outcome. Conclusion: A careful inspection of the external genitalia immediately after birth is essential for the diagnosis of imperforated hymen. When not detected and treated in the neonatal period, most of them have a delayed diagnosis during puberty when complications may occur.
- Home-based Rehabilitation With A Novel Digital Biofeedback System versus Conventional In-person Rehabilitation after Total Knee Replacement: a feasibility studyPublication . Correia, F.; Nogueira, A.; Magalhães, I.; Guimarães, J.; Moreira, M.; Barradas, I.; Teixeira, L.; Tulha, J.; Seabra, R.; Lains, J.; Bento, V.In-person home-based rehabilitation and telerehabilitation can be as effective as clinic-based rehabilitation after total knee arthroplasty (TKA), but require heavy logistics and are highly dependent on human supervision. New technologies that allow independent home-based rehabilitation without constant human supervision may help solve this problem. This was a single-center, feasibility study comparing a digital biofeedback system that meets these needs against conventional in-person home-based rehabilitation after TKA over an 8-week program. Primary outcome was the change in the Timed Up and Go score between the end of the program and baseline. Fifty-nine patients completed the study (30 experimental group; 29 conventional rehabilitation). The study demonstrated a superiority of the experimental group for all outcomes. Adverse events were similar in both groups. This is the first study to demonstrate that a digital rehabilitation solution can achieve better outcomes than conventional in-person rehabilitation, while less demanding in terms of human resources.
- Membranoproliferative glomerulonephritis and x-linked agammaglobulinemia: an uncommon associationPublication . Lavrador, V.; Correia, F.; Sampaio, R.; Candido, C.; Sameiro-Faria, M.; Marques, L.; Mota, C.Introduction. X-linked agammaglobulinemia (XLA) is a primary immunodeficiency characterized by agammaglobulinemia requiring replacement treatment with immunoglobulin. The association of XLA and membranoproliferative glomerulonephritis (MPGN) is unexpected and, to our knowledge, only one case was previously published. Case Report. The authors report the case of a 10-year-old boy with family history and prenatal diagnosis of XLA, treated from birth with intravenous immunoglobulin replacement therapy. He presented with pneumonia, macroscopic hematuria, nephrotic proteinuria, hypoalbuminemia, and hypercholesterolemia with normal renal function and serum complement levels. Renal histology showed immune complex mediated MPGN. He was started on high dose prednisolone and ramipril and switched to weekly subcutaneous immunoglobulin. After a 4-month treatment, hematuria and proteinuria significantly improved and prednisolone was gradually tapered without relapse. Conclusion. The pathogenic process underlying MPGN development in this patient is unknown but residual humoral immunity might play an important role. Thus, this case highlights the risk of autoimmune disorders among patients with XLA
- OnabotulinumtoxinA for hemicrania continua: open label experience in 9 patientsPublication . Miller, S.; Correia, F.; Lagrata, S.; Matharu, M.BACKGROUND: Hemicrania continua is a strictly unilateral, continuous headache, typically mild to moderate in severity, with severe exacerbations commonly accompanied by cranial autonomic features and migrainous symptoms. It is exquisitely responsive to Indomethacin. However, some patients cannot tolerate treatment, often due to gastrointestinal side effects. Therapeutic alternatives are limited and controlled evidence lacking. METHODS: We present our experience of nine patients treated with OnabotulinumtoxinA for hemicrania continua. All patients were injected using the PREEMPT (Phase 3 REsearch Evaluating Migraine Prophylaxis Therapy) protocol for migraine. RESULTS: Five of nine patients demonstrated a 50% or more reduction in moderate to severe headache days with OnabotulinumtoxinA with a median reduction in moderate to severe headache days of 80%. Patient estimate of response was 80% or more in five subjects. The median and mean duration of response in the five responders was 11 and 12 weeks (range 6-20 weeks). Improvements were also seen in headache-associated disability CONCLUSIONS: OnabotulinumtoxinA adds a potential option to the limited therapeutic alternatives available in hemicrania continua.
- O Papel dos Testes de Estimulação Farmacológica no Diagnóstico da Deficiência de Hormona do Crescimento em Crianças e AdolescentesPublication . Gonçalves, J.; Correia, F.; Cardoso, H.; Borges, T.; Oliveira, M.INTRODUCTION: The incidence of short stature associated with growth hormone deficiency has been estimated to be about 1:4000 to 1:10000. It is the main indication for treatment with recombinant growth hormone. OBJECTIVES: The aims of the study were to evaluate the results of growth hormone stimulation tests and identify the growth hormone deficiency predictors. MATERIAL AND METHODS: A cross-sectional, analytical and observational study was conducted. We studied all the children and adolescents submitted to growth hormone pharmacological stimulation tests between January 2008 and May 2012. Growth hormone deficiency diagnosis was confirmed by two negatives growth hormone stimulation tests (growth hormone peak < 7 ng/ml). The statistical analysis was performed using student t-test, chi-square, Pearson correlation and logistic regression. Statistical significance determined at the 5% level (p ≤ 0.05). RESULTS: Pharmacological stimulation tests were performed in 89 patients, with a median age of 10 [3-17] years. Clonidine (n = 85) and insulin tolerance test (n = 4) were the first growth hormone stimulation tests performed. Growth hormone deficiency was confirmed in 22 cases. In cases with two growth hormone stimulation tests, the growth hormone peak showed a moderate correlation (r = 0.593, p = 0.01). In logistic regression model height (z-score) and the growth hormone peak in first stimulation test were predictors of growth hormone deficiency diagnosis (each one unit increase in z-score decrease the growth hormone deficiency probability). DISCUSSION: Measurement of IGF-1 cannot be used in diagnosing growth hormone deficiency. CONCLUSION: Auxological criteria associated with a positive test seems to be a reliable diagnostic tool for growth hormone deficiency.