Browsing by Issue Date, starting with "2020-03-15"
Now showing 1 - 5 of 5
Results Per Page
Sort Options
- What role for the pacifier in acute otitis media risk?Publication . Silva Peixoto, Joana; França, Cíntia Cardal; Barge, Sílvio; Branco, MarianaIntroduction: Sucking reflex is acknowledged as a comforting mechanism for infants. When used for short periods of time, it is considered a healthy habit. Acute otitis media is one of the most frequent infections in pediatric age and has been associated with pacifier misuse.Objectives: To review available evidence regarding the association between pacifier use in the first years of life and otitis media risk.Methods: A literature search was conducted on several databases using MeSH terms “otitis” and “pacifiers” for guidelines, systematic reviews, randomized controlled trials, and observational studies over the last 20 years. SORT scale of the American Family Physician was used to evaluate evidence levels.Results: A total of 56 articles were retrieved, of which four guidelines, one systematic review, and one original article were selected. According to guidelines, there is no reason to discourage pacifier use, as it can be particularly beneficial in the first six months of life. Afterwards, pacifier use should be limited to moments of falling asleep. Its use should also be avoided in infants with chronic or recurrent otitis media. The systematic review stablished pacifier use as a risk factor for recurrent acute otitis media (RAOM) which is susceptible to intervention. In the observational study, a statistically significant association was found between pacifier use and RAOM risk.Conclusions: Pacifier use should not be actively discouraged in the first semester of life, as it can have beneficial effects for children (SORT A). Afterwards, its use should be discontinued due to increased otitis risk (SORT A).
- Psychotic symptoms during stimulant treatment for attention-deficit/hyperactivity disorderPublication . Sá, Teresa; Silva, Filipa Martins; Magalhães, Patrícia; Martins, Vânia; Barrias, PaulaIntroduction: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. Pharmacological treatment, either alone or in combination with psychosocial interventions, is important in the therapeutic strategy. Psychostimulants remain the most effective medication and are generally well tolerated. However, one of its rare but significant side effects is development of psychotic symptoms. Objectives: To perform a literature review about the risk of psychotic symptoms during ADHD treatment with stimulants and discuss possible pharmacological treatment implications.Methods: A literature search was conducted on PubMed database using the terms “ADHD”, “central nervous system stimulants”, and “psychosis”. The search was supplemented with data retrieved from published guidelines.Results and discussion: ADHD diagnosis has been increasing, as well the use of stimulants for its treatment. However, using these drugs is not without controversy. ADHD pharmacological treatment is rarely associated with psychotic symptoms. Reported symptoms include hallucinations and paranoid delusions, and occasionally also euphoria, grandiosity, and other mania and hypomania features. These symptoms are generally short-lived and self-limited within days after stimulant discontinuation. One study comparing amphetamines and methylphenidate suggested that the former was more likely to cause psychosis compared with the latter. Additionally, study authors agreed that stimulant-induced psychosis seems to be associated to susceptibility factors.Conclusion: Psychostimulants are highly beneficial for ADHD patients. However, small studies and case reports suggest an association with new-onset psychotic symptoms. Physicians should be aware that psychotic symptoms may arise during stimulant ADHD treatment. Further investigation is required to identify patients who are most at risk of experiencing such adverse events.
- Disease modelling and drug development with iPSC-derived cells: a brave new world?Publication . Oliva-Teles, Natália
- Immune neonatal thrombocytopenia - reviewPublication . Sequeira, Ana Isabel; Rocha, Dalila; Dias, Carla João; Carreira, Luísa; Cleto, EsmeraldaIntroduction: Thrombocytopenia is the most frequent hematological change in the neonatal period, with immune thrombocytopenia as the main cause of moderate-to-severe thrombocytopenia in apparently healthy newborns. Immune thrombocytopenia in the fetus or newborn may result from platelet alloantibodies against paternal antigens inherited by the fetus (alloimmune thrombocytopenia) or platelet autoantibodies due to maternal autoimmune disease (autoimmune thrombocytopenia).Objetives: To review published literature about immune thrombocytopenia in newborns, including the latest advances in pathogenesis, diagnosis, treatment, and prevention.Results: Neonatal alloimmune thrombocytopenia is the most common cause of severe thrombocytopenia and intracranial hemorrhage in term neonates. Clinical presentation varies from mild thrombocytopenia to life-threatening bleeding and death. As maternal screening is not routinely performed, most cases are diagnosed in the first child. Despite intensive research, a consensus strategy for prevention and treatment of the condition is lacking. Diagnosis of neonatal autoimmune thrombocytopenia is usually apparent from maternal medical history and thrombocytopenia. Although maternal immune thrombocytopenic purpura does not carry a high risk of perinatal hemorrhage, it may lead to thrombocytopenia in the newborn, mostly mild-to-moderate. Clinical presentation varies from no symptoms to mucocutaneous signs of thrombocytopenia and may persist for weeks to months requiring long-term monitoring. Conclusions: Fetal and Neonatal alloimmune thrombocytopenia can cause severe disease in the affected fetus or newborn. Facing the lack of routine antenatal screening, the strategies currently proposed for pregnancies at risk. We also discussed the latest research and therapies in development, aiming at potential improvements in diagnosis, treatment, and prevention of this disease. Neonatal autoimmune thrombocytopenia may cause long-lasting low platelet count, that need regular checking.
- Behavioral insomnia in a pediatric sleep clinic: retrospective studyPublication . Martins, Rosa Araújo; Oliveira, Lia; Ferreira, RosárioBackground/Objective: Behavioral insomnia is a common sleep disorder among children, with potentially negative impact on health, behavior, and cognition. This study aimed to characterize a pediatric population referred to a Sleep Disorder Clinic of a tertiary hospital due to behavioral insomnia. Methods: Retrospective and descriptive study based on the review of medical records of patients with insomnia over an eight-year period (2008−2016). Results are presented as median (minimum-maximum), mean (standard deviation), and percentage. Results: A total of 964 children attended the Sleep Disorder Clinic in the considered time period, 162 (16.8%) of which due to insomnia and 137 (14.2%) to behavioral insomnia. Most children (58.4%) were male and the median age at referral was 45 months (5 months–18 years). The median bedtime was 10 pm (8 pm−4 am) and nocturnal awakenings were frequent, particularly in pre-school aged children. Regarding bedtime routines, 62% of children were not able to fall asleep alone, 48.9% had television in the bedroom, 43.1% (11.9% of which, teenagers) required an object to fall asleep, and 42.3% required lights on. Most patients (62%) had a routine to fall asleep, which was dependent on the caregiver in younger children and on television and reading in teenagers. The most frequent daytime symptoms were sleepiness in older children and irritability in younger children. Regarding treatment, 29.9% were taking drugs before referral. Conclusions: Most children in this study were preschoolers, an important age window. Later sleep time, TV in the bedroom, and parental dependence to fall asleep were frequent, revealing a broad area for intervention. The authors propose greater investment in training health professionals and caregivers working in the area, in order to promote the adoption of adequate sleep hygiene as a form of prevention.