RN&C: Ano de 2021
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- After pediatric stroke, it’s time to enable!Publication . Jorge, Ines Santos; Vouga, Luis Afonso; Castro, João Paulo; Amorim, Rosa; Palhau, LurdesIntroduction: Although rare, pediatric stroke is more common than one may think. Deficits may not be evident in the short term but emerge months or years later, when psychomotor development, educational, and social requirements increase. Aims: To characterize the pediatric population with stroke followed at the Physical and Rehabilitation Medicine (PRM) consultation in a tertiary center and compare it with data in the literature and review the evidence on pediatric stroke rehabilitation care. Material and Methods: This was a retrospective study focusing on the first observation of stroke patients followed at a pediatric PRM consultation over 12 months. Gender, age, type of stroke, vascular territory, risk factors, functionality, event recurrence, and mortality were assessed. A bibliographic search was conducted on PubMed and Medline using the keywords ‘stroke’, ‘pediatric’, ‘perinatal’, ‘neuroplasticity’, ‘functionality’, and ‘rehabilitation’. Inclusion criteria comprised meta-analysis, systematic review, and review type of studies, written in Portuguese and English languages, and focusing human studies. Results: The study included 42 patients, 25 of whom were male (60%). Perinatal stroke was reported in 33 patients (13 in the prenatal period and 20 up to 28 days of life). Ischemic stroke was reported in 35 cases (83%), with the middle cerebral artery being the most affected vascular territory in 29 cases (69%). Fifty percent of patients had known risk factors, specifically prematurity in 21%. Fifty to 75% of patients had high functionality levels. No stroke recurrence or deaths were reported during the study period. Rehabilitation care should be implemented as soon as possible. Evidence-based guidance is still lacking for this population. Conclusions: Stroke, although uncommon in the pediatric population, is a major cause of morbidity and mortality. Diagnosis is challenging, as symptoms are often subtle and mimic other more frequent diseases in this age group. Timely referral to the physiatrist allows integration of the child into a rehabilitation program, optimizing neuroplasticity and improving participation in several activities.
- Biochemical clinical casePublication . Silva, Joana Vanessa; Ferreira, Joana; Silva, Mariana; Costa, MiguelBisalbuminemia is a qualitative albumin variation defined by coexistence of two types of serum albumin with different electrophoretic mobilities in the same individual. It can be of two different types: hereditary (or permanent) and acquired (or transient). Herein is described a rare case of hereditary bisalbuminemia in a healthy infant, incidentally found during elevated aminotransferase study. Despite not having pathological significance, acknowledgement of this analytical alteration is key for adequate management of these patients.
- Castleman disease. A rare diagnosis in childhoodPublication . Monteiro-Cunha, Sara; Vasconcelos, Sofia; Neto, Cláudia; Oliva, Tereza; Salgado, MiguelIntroduction: Castleman Disease (CD) is a rare polyclonal lymphoproliferative disorder characterized by massive growth of lymphoid tissue. The most common sites of disease are the chest, abdomen, neck, and axilla. Excisional biopsy is mandatory for diagnosis, and complete surgical resection the gold-standard treatment in unicentric CD. Case report: A ten-year-old girl was observed at the Emergency Department with sore throat and fever. Oropharynx examination revealed inflamed tonsils, with no exudates. Enlarged lymphadenopathy was palpable in the right supraclavicular fossa. Ultrasound revealed right supraclavicular lymphadenopathy with loss of adipose hilum and histopathologic assessment established CD diagnosis. Discussion/Conclusion: Lymphadenopathy is a common presentation in children, usually benign and self-limited. But it may also be a sign of underlying malignancy. Any lymphadenopathy in the supraclavicular fossa is worrisome and requires prompt investigation. CD diagnosis may be challenging, due its rare nature in childhood and nonspecific symptoms.
- Children and teens moving towards mental healthPublication . Pires, Sara; Vieira, Diana; Castello-Branco, MariaChildhood and adolescence are periods of rapid growth when several structural and behavioral transformations take place. It is important to identify positive environmental exposures during these years and establish behavioral patterns that may have a positive effect on the development of these populations. There is an increasing body of evidence showing that regular exercise has unquestionable physical, social, and psychological benefits, contributing to general health and wellbeing. The aim of this study was to review the available literature regarding the impact of regular physical activity on the mental health of children and adolescents and to highlight possible mechanisms involved in this association. Study findings suggest that there is a global positive impact of physical activity on mental health, with the strongest effect related to the decrease of depressive symptoms. Other benefits include improvement in self-esteem, cognitive function, and sleep quality and a reduction of externalizing behaviors and anxiety symptoms. Competitive and esthetical sports were an exception. Overall, the current evidence allows recommending regular physical activity in children and adolescents, not only for its organic but also mental health benefits.
- Chronic tenosynovitis of the hand – An unusual presentation of tuberculosis in children tenossinovitePublication . Vieira-Martins, Miguel; Santos, Constança; Teixeira, Ana Luísa; Costa, Ricardo; Pon, Jorge; Rodrigues, CarlosTuberculosis remains the most common cause of death from infectious diseases worldwide. Extrapulmonary tuberculosis with musculoskeletal involvement occurs in about 10-15% of cases, mainly affecting joints and bones. Of these, only 1-5% are reported as synovitis of the hand. However, prompt diagnosis and treatment are often delayed and, if left untreated, bone and tendon destruction soon ensue and may lead to chronic synovitis. A 15-year-old girl presented with recurrent pain of the hand following trauma. Imaging showed tenosynovitis and tendon rupture. Surgical treatment was performed. Pathological assessment revealed necrotic caseous granulomas. Chest radiography showed no abnormal findings, but both Tuberculin Skin Test and Interferon Gamma-Release Assay were positive. Tuberculous tenosynovitis was diagnosed, and 12-month anti-tuberculous chemotherapy was instated. Five years after surgery, the patient maintained chronic pain and functional hand limitation. Tuberculous tenosynovitis of the hand is a rare and insidious condition that should be considered in the differential diagnosis of chronic hand pain. Delayed diagnosis and treatment can lead to residual functional limitation, making disease recognition critical.
- Congenital candidiasis – a diagnostic challengePublication . Rolim, Sara; Figueirinha, Joana; Miguel, Cristina; Lopes, Susana; Rocha, Felisbela; Martins, Cecília; Carvalho, SóniaIntroduction: Congenital candidiasis is a rare intrauterine infection characterized by vesicular and pustular skin lesions appearing in the first six days of life. Clinical case: The authors describe the case of a full-term infant presenting erythematous macules, vesicles and pustules involving the trunk and extremities and cervical burn-like dermatitis at birth. Mycological skin lesion culture was positive for Candida albicans. Blood culture was positive for methicillin-sensitive Staphylococcus aureus. After systemic antifungal and antibiotic therapy was started, the newborn remained asymptomatic with lesion improvement. Discussion/ Conclusion: Herein is reported a case of congenital candidiasis in a full-term infant, with a successful recovery. The rarity of congenital candidiasis can lead to delayed diagnosis and unnecessary treatment. This case shows that fungal infection should be considered in the differential diagnosis of vesiculopustular skin lesions in neonates. Systemic therapy should be initiated if invasive candidiasis is suspected.
- Covid-19 - What changed in the pediatric emergency room of a district hospital during the state of emergency?Publication . Pessoa, Tânia; Parente, Rita; São-Pedro, Maria; Simões, Mariana; Vale, Gonçalo; Lacerda, Catarina; Santos, Sandra; Correia, Susana; Didelet, CristinaIntroduction: The COVID-19 pandemic led to the adoption of a state of emergency in Portugal, during which hospital emergency admissions declined. The aim of this study was to analyze the differences in Pediatric Emergency Room admissions during the state of emergency compared to the pre-pandemic setting. Material and methods: Retrospective analytical observational study of patients admitted to the Pediatric Emergency Room of a group I hospital from March 19 to May 2 of 2020 and homologous 2019 period. Data regarding age, gender, admission origin and cause, recurrences, diagnosis, and discharge destination were collected. Results: During the state of emergency, a 78.7% reduction in Pediatric Emergency Room admissions occurred compared to the pre-pandemic state (956 in 2020 vs 4481 in 2019). The main differences between both periods were an increase in admission of patients with <1 year old; a decrease in admissions by own initiative together with an increase of external referrals; less infectious diseases diagnoses; a higher number of accidental intoxications or ingestions, foreign bodies, and burns; a decrease in recurrences; a relative increase of hospital transfers; and higher hospitalization rates despite their shorter duration. No increase was found in Observation Room admissions, referrals for hospital consultations, or deaths. Discussion: Most study findings may be due to a reduction in common reasons for attending the Pediatric Emergency Room, due to social distancing/quarantine and transport/circulation limitations imposed by the pandemic. Conclusions: There was no significant increase in patients’ disease severity and those with criteria for visiting the Pediatric Emergency Room continued to do so. Compliance with isolation measures and recommendations of the Directorate-General of Health (DGS) seem to have been met.
- Dermatology clinical casePublication . Leitão, Cátia; Pereira, Isabel; Tenente, Joana; Vila-Real, Marta; Oliveira, Ana; Leite, Ana LuísaIncontinentia pigmenti is an X-linked neuroectodermal dysplasia. It is a rare genetic disease with multiorgan involvement, and hence a multidisciplinary approach is of paramount importance. Although diagnosis is based on clinical findings, genetic molecular testing can be performed to confirm diagnosis and allow future genetic counselling. The authors describe the case of a 4-month-old girl accidentally diagnosed with incontinentia pigmenti following routine physical examination in the Emergency Department. Timely diagnosis enabled appropriate multidisciplinary approach and follow-up.
- Dermatology clinical casePublication . Costa Azevedo, André; Camilo Marinhas, Andreia; Costa e Silva, André; Costa, Mariana; Martinho, IsabelHerein are reported two cases of a previously healthy fourteen-year-old girl and a nine-year-old boy who presented to the Pediatric Emergency Department with a cutaneous reaction after applying a temporary black henna tattoo. Diagnosis of delayed hypersensitivity to black henna was established. Black henna tattoos are known for their temporary and harmless nature, but henna usually contains paraphenylendamine (PPD), originating black henna. PPD induces skin sensitization and causes allergic contact dermatitis.
- 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.