Browsing by Issue Date, starting with "2021-06"
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- Intense Pulsed Plus Low-Level Light Therapy in Meibomian Gland DysfunctionPublication . Marta, Ana; Baptista, Pedro Manuel; Marques, Joao Heitor; Almeida, Daniel; José, Diana; Sousa, Paulo; Barbosa, IrenePurpose: To analyse the clinical outcome in patients with meibomian gland dysfunction (MGD) who underwent intense pulsed light (IPL) plus low-level light therapy (LLL). Materials and methods: The prospective non-comparative study included identified by MGD patients with altered interferometry and lower loss area of the meibomian glands (LAMG), who underwent IPL plus LLL, between July 2020 and August 2020. A multimodal assessment was performed before, 2-3 weeks, and 6 months after treatment. The main outcome was lipid layer thickness (LLT) and the secondary outcomes were the ocular surface disease index (OSDI) score, presence of corneal fluorescein staining (CFS), blink rate (BR), Schirmer test (ST), tear meniscus height (TMH), tear osmolarity (OSM), non-invasive break-up time (NIBUT) and LAMG. Results: This study included 62 eyes of 31 patients, 61.3% female, with a mean age of 66.94±9.08 years at the time of IPL plus LLL treatment. LLT (<0.001) grades improved 6 months after treatment. The mean OSDI score improved (p<0.001) from 45.02±21.17 (severe symptoms) to 22.35±17.68 (moderate symptoms) at 2-3 weeks and 8.24±17.9.91 (normal) at 6 months after treatment. CFS was identified in 51.6% (32/62) before and in 45.2% (28/62) 6 months (p=0.293) after treatment. ST (p=0.014) grades improved; OSM grades mild worsened (p<0.001); TMH, NIBUT and LAMG grades did not modify 6 months after treatment. No patient suffered any adverse effects. Conclusion: IPL combined with LLL was effective and safe, improving the lipid layer thickness in MGD and decreasing the level of symptoms.
- Parental support and perceived self-efficacy − a study of parental perceptions in an early childhood child psychiatry unitPublication . Garcia Ribeiro, Catarina; Dias, Pedro; Peixoto, Ivo; Ganhoto, Rita; Silva, Salomé; Caldeira da Silva, PedroIntroduction: Perceived parental self-efficacy (PSE) has shown an association with positive parental behavior, highlighting its benefit in promoting child well-being and healthy development. The identification of its potential determinants remains a focus of attention in mental health when assessing parental perceptions and cognitions or planning parental interventions. Material/Methods: This was a cross-sectional study in an Early Childhood Child Psychiatry Unit. All parents of babies and toddlers assessed for the first time were included and completed a Parenting Sense of Competence (PSOC) scale (portuguese translation, α= 0.75-0.83) and two additional questions concerning perceptions of support from the other parent and family of origin. Average PSOC was compared between both parents and correlations with perceptions of support were tested. Statistical analysis was conducted in SPSS® version 21 through descriptive analysis and variable correlation (t-test and Pearson r). Results: A total of thirty-four questionnaires were completed. Average PSOC was similar between father and mothers (73.44 vs 72.24, p=0.533). Fathers perceived themselves as more supported than mothers, either from the family of origin (5.09 vs 4.21, p=0.001), as from the other parent (4.91 vs 4.09, p=0.011). A positive correlation was found between father’s PSOC and perception of support from the family of origin (r=0.639, p <0.01). Conclusions: Among mothers of children followed in this Child Psychiatry Unit, support perceptions did not correlate with perceived parental self-efficacy. However, father’s perceived self-efficacy could relate to perceptions of support, raising clinical attention on how fathers and their family of origin can influence the relational triad. Perceptions of parental support should be explored when considering within-family horizontal relations as a potential mechanism influencing vertical relations through its association with perceived self-efficacy.
- Dermatology clinical case Caso clínico dermatológicoPublication . Ferreira, Adriana; Sousa, Eulália; Soares, Joana; Lira, Susana; Machado, ÂngelaLyme disease is a spirochaetal infection caused by Borrelia Burgdorferi sensu lato, which is transmitted by infected ticks of the genus Ixodes. It has a broad spectrum of clinical manifestations which, associated with its low incidence in Portugal, requires a high level of clinical suspicion for diagnosis. However, it is considered endemic in certain geographic areas, like Central Europe. The authors report the case of a child, living in Switzerland, who developed multiple erythema migrans lesions. Although parents did not recall a history of tick bite, Lyme disease diagnosis was established on clinical grounds, based on erythema and epidemiologic findings. When properly treated with oral antibiotic therapy, Lyme disease has an excellent prognosis. This case highlights the importance of epidemiologic history as a diagnostic clue.
- Immunotherapy with hymenoptera venom in a child with anaphylaxisPublication . Falcão, Inês; Cunha, LeonorSystemic reactions to hymenoptera venom in childhood are uncommon, comprising less than 1% of cases. The prevalence proves higher in adults, encompassing 0.3−8.9%. Anaphylaxis forms the most severe of all allergic reactions and can be fatal. Specific immunotherapy based on hymenoptera venom is the only treatment that prevents moderate-to-severe systemic reactions. Due to immunotherapy safety and effectiveness, this treatment is indicated during childhood in cases of grade II and III systemic reactions. The authors describe the clinical case of a fourteen-year-old male patient, son of a beekeeper, who was followed in the Allergy and Clinical Immunology Department due to anaphylaxis to hymenoptera venom and was under immunotherapy to Apis mellifera venom since the age of nine, besides complying with measures to evade hymenoptera.
- Extensive skin necrosis after periprosthetic knee infection: a case that highlights the possibility of complications induced by low-molecular-weight heparinPublication . Fonte, Hélder; Dias Carvalho, Andre; Rosa, João; Pereira, Cláudia; Pereira, Alexandre; Sousa, RicardoWe describe a case of a patient with atrial fibrillation, anticoagulated with dabigatran, that developed severe knee skin necrosis in the setting of an acute periprosthetic knee infection, after initiating low-molecular-weight heparin. A wide range of etiology hypotheses was discussed within a multidisciplinary team. The complex approach consisted of treating the underlying infection, multiple types of soft-tissue management, and stopping enoxaparin.
- Protocolo de Prevenção e Tratamento de Infeções Associadas à Terapêutica Imunossupressora de Doenças AutoimunesPublication . Valdoleiros, Sofia R.; Furtado, Isabel; Silva, Carolina; Correia Gonçalves, Inês; Santos Silva, André; Vasconcelos, Olga; Horta, Ana; Vasconcelos, A. Ludgero; Xará, Sandra; Gonçalves, Maria João; Abreu, Miguel; Sarmento-Castro, RuiWe propose a guideline about the risk, prevention and treatment of infection in the patient under immunomodulatory or immunosuppressive therapy in the context of autoimmune or autoinflammatory disease. It is divided into three sections: drugs and associated risk of infection; immunizations; risk, prevention, and treatment of specific infections. The treatment of autoimmune diseases involves the use of immunosuppressive or immunomodulatory therapies, with an increasing number of new drugs being used. It is associated with an increased risk of infection, which may be present globally or only for specific agents, varying widely depending on the pharmacological class and even within the same class. The prevention strategy and clinical management need to be individually tailored and there are several key factors: characterization of the disease that prompts the immunosuppression, understanding of the mechanism of action of the immunosuppressive drug, knowledge of previous infections, recognition of risk factors, laboratory test results, vaccine administration, monitoring of clinical signs and symptoms and patient education.
- Misaligned shouldersPublication . Santos Silva, Íris; Correia, Aníbal; Santos, Rita; Aleixo, Catarina; Santos, MafaldaSprengel deformity is a congenital elevation of the scapula. Herein is reported the case of a child with the right scapula at a higher level compared to the left and limited abduction of the right shoulder. Other pathoanatomical anomalies can be associated. Treatment is usually conservative, since surgery is only considered in patients with severe scapular function limitation, neck pain, or to improve cosmesis.
- Folic acid, vitamin B12, and psychotic symptoms among young psychiatric inpatientsPublication . Pedro dos Reis, Filipa; Duarte, Luísa; Cartaxo, Teresa; Santos, VítorIntroduction: Folic acid and/or vitamin B12 deficiency are known to be associated with neuropsychiatric disorders. However, the association between serum levels of these molecules and psychotic symptoms is not established. The aim of this study was to investigate the association between folic acid and vitamin B12 serum levels and the presence of psychotic symptoms among child and young adult psychiatric inpatients. Material and Methods: This was a retrospective cohort study of 165 patients under 25 years of age admitted due to psychiatric disorders between 2005 and 2018 and with folic acid and vitamin B12 serum levels assessed during hospitalization. Two groups of patients were defined according to presence or absence of psychotic symptoms. Rehospitalization was also assessed. Results: Folic acid serum levels were significantly lower (p=0.01) in children and young adults hospitalized for psychiatric disorders with psychotic symptoms compared to patients of the same age with acute psychiatric illness without psychotic symptoms. A similar non-significant trend was found for vitamin B12. Rehospitalization rates were also higher in the first group. Conclusion: Results from this study suggest that low folic acid serum levels are associated with psychotic symptoms regardless of the baseline diagnosis.
- Kawasaki disease in a five-month-old infantPublication . Maciel, Juliana; Meireles, Daniel; Magalhães, Mariana; Gonçalves, Sara; Ribeiro Fernandes, Sofia; Fernandes, Paula CristinaIntroduction: Kawasaki disease, an acute self-limited vasculitis of small and medium arteries of unknown etiology, is the leading cause of heart disease in children in most developed countries. If untreated, it can lead to coronary artery dilatation and aneurysm, placing patients at risk for coronary thrombosis, myocardial infarction, or sudden death. Case Report: A previously healthy five-month-old boy presented with a history of respiratory symptoms and fever, being admitted for respiratory syncytial virus bronchiolitis. He maintained fever for five days associated with progressive clinical worsening and sequential development of conjunctival injection, cracked lips, swelling of hands and feet, and polymorphous rash of the limbs. Diagnostic procedures showed increased levels of inflammatory markers, hyponatremia, hypoalbuminemia, sterile pyuria, and aseptic meningitis. Despite an initial normal echocardiogram, Kawasaki disease was suspected and the boy started intravenous immunoglobulin on the fifth day. On the seventh day, echocardiogram showed signs of pancarditis and mild coronary artery ectasia and acetylsalicylic acid was started. The boy was discharged, but eight days later echocardiogram revealed major and diffuse coronary artery ectasia in a follow-up consultation and he was readmitted to start corticosteroid therapy. After five months, the boy displayed normalization of cardiac changes, without further complications. Comments: Kawasaki disease below six months of age is rare and associated with a high risk of coronary artery aneurysm. It is important to recognize the clinical and laboratory criteria associated with this entity and start early treatment, avoiding cardiac complications.
- Association Between Iron-Related Protein Lipocalin 2 and Cognitive Impairment in Cerebrospinal Fluid and SerumPublication . das Neves, Sofia Pereira; Taipa, Ricardo; Marques, Fernanda; Soares Costa, Patrício; Monárrez-Espino, Joel; Palha, Joana A.; Kivipelto, MiiaA worldwide increase in longevity is bringing novel challenges to public health and health care professionals. Cognitive impairment in the elderly may compromise living conditions and precede Alzheimer's disease (AD), the most prevalent form of dementia. Therefore, finding molecular markers associated with cognitive impairment is of crucial importance. Lipocalin 2 (LCN2), an iron-related protein, has been suggested as a potential marker for mild cognitive impairment (MCI) and AD. This study aimed at investigating the association between LCN2 measured in serum and cerebrospinal fluid (CSF) with cognitive impairment. A cross-sectional design based on two aging cohorts was used: individuals diagnosed with subjective cognitive complaints (SCC), MCI, and AD from a Swedish memory clinic-based cohort, and individuals diagnosed with SCC and AD from a Portuguese cohort. Binary logistic [for the outcome cognitive impairment (MCI + AD) in the Swedish cohort and AD in the Portuguese cohort] and multinomial logistic (for the outcomes MCI and AD) regression analyses were used. No associations were found in both cohorts when controlling for sex, education, and age. This explanatory study suggests that the association between serum and CSF LCN2 concentrations with cognitive impairment reported in the literature must be further analyzed for confounders.