RN&C: Ano de 2022
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- Acute pancreatitis in children: Ten-year experience of a level II hospitalPublication . Manuel, Ana Rute; Vieira, Rita Gabriela; Torre, Maria De Lurdes; Lemos, Piedade SandeIntroduction: The incidence of acute pancreatitis (AP) in children is increasing, together with the awareness of the need for pediatric-specific management recommendations. This study aimed to assess the epidemiology, etiology, management, and clinical course of pediatric AP cases followed at a secondary hospital. Methods: Retrospective analysis of all pediatric AP cases admitted to a level II hospital in the metropolitan area of Lisbon, Portugal, between January 2009 and December 2018. Results: Eight cases of pediatric AP were identified, with an average age of 12 years (minimum 4 years, maximum 16 years) and classified according to etiology as drug-induced (n=3), biliary (n=1), infectious (n=1), and idiopathic (n=3). Recurrent AP was identified in one patient. The median hospital stay was 6.5 days. The main symptoms at presentation were abdominal pain (100.0%) and vomiting (75.0%). All patients had increased levels of amylase activity in serum (>3 times the upper limit of normal). Pancreatic image abnormalities were observed in five patients (62.5%), four in the abdominal ultrasound and one in computed tomography scan. One patient underwent endoscopic retrograde cholangiopancreatography. Two patients received a course of antibiotics. All cases were classified as mild, according to the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition classification. Discussion: This series showed a predominance of secondary over idiopathic AP, in agreement with recently published studies reporting a reduction in the incidence of idiopathic AP due to increased efforts to identify the underlying causes of the disease. Since the incidence of AP is increasing in pediatric age, physicians should be aware of recent recommendations for the optimal management of the condition in this age group.
- Positive blood culture and neonatal sepsis – A five-year studyPublication . Ferreira, Adriana; Sousa, Eulália; Freitas, Joaquim; Vieira, Mariana; Miranda, Filipa; Silva, FranciscoIntroduction: Neonatal sepsis remains a major cause of morbidity and mortality in pediatric age. Since the predominant causative microorganisms vary between regions and over time, it is crucial to know the local epidemiology. The aim of this study was to characterize patients with positive blood culture and clinical presentation of sepsis admitted to a Neonatology Unit and identify possible risk factors and implicated microorganisms and respective antimicrobial susceptibility patterns. Methods: This was a retrospective descriptive study of clinical data of patients admitted to the Neonatology Unit of a level II hospital with positive blood culture and clinical presentation of sepsis over five years (2014-2018). Results: Seventy-three culture-proven sepsis cases were identified, 51 (69.9%) of which corresponded to low-birth-weight neonates and 52 (71.2%) to preterm newborns. Most cases (60; 82.2%) concerned late-onset sepsis. The most frequent microorganisms identified were coagulase-negative Staphylococcus (55; 75.3%), mainly associated with late-onset sepsis. Group B Streptococcus and Escherichia coli were the most common microorganisms isolated in early-onset sepsis. No cases of methicillin-resistant Staphylococcus aureus were identified. Coagulase-negative Staphylococcus presented high resistance rates to beta-lactam antibiotics. Conclusions: The results retrieved from this study document the local epidemiology of neonatal sepsis and show a high frequency of late-onset sepsis associated with nosocomial pathogens. Coagulase-negative Staphylococcus spp. are resistant to the most commonly used antibiotics, with these cases requiring the use of vancomycin. It is crucial to implement effective guidelines to control and prevent nosocomial infections and reduce the incidence, morbidity, and mortality of neonatal sepsis, as well as the need for broad-spectrum antibiotics.
- Spontaneous air leak in a Pediatric Emergency Department: An 11-year experiencePublication . Luís, Telma; Lomba, Andreia; Abreu Almiro, Maria Miguel; Almeida, Sílvia; Valente, CarlaIntroduction: Due to lack of data, the management of air leaks in children and adolescents is based on protocols for adults. In this study, the authors review and report their institutional experience in the area. Methods: Retrospective and descriptive study of spontaneous air leak cases diagnosed in a Portuguese Pediatric Emergency Department (PED) between January 2007 and December 2018. Results: Twenty-one episodes of spontaneous air leak were diagnosed in 16 patients (87.5% male), with a mean (± standard deviation) age of 14.3 (± 5.1) years. Eighteen cases of spontaneous pneumothorax were reported, fifteen of which primary (eleven first-time episodes and four recurrences) and three secondary (two first-time episodes and one recurrence) to asthma. Three cases of pneumomediastinum with subcutaneous emphysema were identified, two of which related to infection. Smoking habits and/or recent physical activity were major triggers. Pleuritic chest pain was the most frequent symptom on admission. Conservative treatment was the only approach used in six cases. Most cases required thoracic drainage, five of which required surgical intervention. Discussion: This study shows similar demographic features, triggers, and clinical presentation to those reported in the literature for these cases. The management of the condition was based on recommendations established for adults. Conclusion: Although spontaneous air leak is an uncommon condition, it is a reality in PED. Prospective studies in pediatric age are required to develop adequate recommendations for children and adolescents.
- Persistent fever and hemoptoic sputum – clinical casePublication . Mosca, Sara; Magalhães, Adriana; Couto Guerra, Isabel; Azevedo, InêsForeign body aspiration (FBA) is a common and serious problem in children. Considering that signs and symptoms can be non-specific and subtle, it is of utmost importance to recognize vulnerable patient groups, combine an accurate history with complete physical examination, and follow a structured diagnostic approach towards correct diagnosis. In the present case, a high index of suspicion was essential to prevent a delay in FBA diagnosis, discuss the appropriate management strategy and improve patient outcomes.
- Dermatology clinical casePublication . Luís, Telma; Clemêncio, Tatiana; Santos, André L.; Loureiro, FernandaThe case of a teenager with guttate psoriasis secondary to trauma and upper airway infection is reported. Guttate psoriasis is the second most common psoriasis variant in pediatric age. Infection and trauma (leading to Koebner phenomenon) seem to be major triggers of the condition. The diagnosis is clinical. Most cases with no previous history of psoriasis spontaneously remit. Topical corticosteroids and vitamin D analogs, as well as phototherapy, are the first-line treatments.
- Pulmonary clinical casePublication . Amaro, C.M.; Protasio, Pedro; Rodrigues, Carlos; Ferreira, AnaPost-extubation acute pulmonary edema (PEAPE) is an uncommon complication of tracheal extubation, occurring in 0.1% of patients undergoing general anesthesia. It has rarely been described in pediatric age, but its incidence is thought to be underestimated, as many cases of post-operative respiratory distress may be misdiagnosed or unrecognized. A formerly healthy 15-year-old male diagnosed with acute appendicitis was submitted to a laparoscopic appendectomy under general anesthesia. Immediately after extubation, he developed signs and symptoms of respiratory distress, and chest radiograph was compatible with acute pulmonary edema. Due to suspicion of PEAPE, supplementary oxygen and intravenous furosemide were administered, with favorable outcome. PEAPE is a major anesthesia-related emergency, which may worsen the prognosis of low-risk surgical procedures. A high degree of suspicion should be maintained in children and adolescents presenting with signs of respiratory distress and hypoxia after general anesthesia, as prompt diagnosis and treatment are crucial for a favorable outcome.
- Maculopapular cutaneous MastocytosisPublication . Soares Pinho, Crisbety; Barreto, Inês; Rebimbas, Sandra; Coelho, SóniaMastocytosis is a rare disorder caused by proliferation and accumulation of mast cells in various tissues, with characteristic symptoms associated with the release of their mediators. Its cutaneous form, usually benign, is the most frequent among children. The authors report the case of a two-month-old male infant who presented to the Emergency Department with small, tan-to-brown macules and papules distributed mainly on the trunk, which progressively became nodular and bullous, with one month of evolution. Darier´s sign was positive. The absence of systemic signs and analytic (including serum tryptase level) and echographic changes was consistent with the diagnosis of maculopapular cutaneous mastocytosis, or urticaria pigmentosa, subsequently confirmed by skin biopsy. Treatment with anti-histaminic therapy and topical immunosuppressant and avoidance of triggering factors led to a positive outcome.
- A rare cause of axillary swellingPublication . Moreira, Mafalda; Pereira, Olívia R.; Malheiro, Ana Sofia; Bonet, Berta; Teixeira, SandraAxillary swelling is a common condition in pediatric age. The most common diagnosis is lymph node swelling, but it can also be caused by soft tissue tumors, vascular lesions, or inflammation of sweat glands. In rare cases, it can be due to ectopic breast tissue (EBT). A 14-year-old female presented with right axillary pain with one year of evolution and swelling for the past two months, gradually increasing in size, especially during menstruation. Sonography revealed EBT in both axillae, and further study showed duplication of the excretory system in both kidneys. The tissue on the right axilla was excised. EBT should be considered in the differential diagnosis of axillary swelling in adolescents and young females. When the diagnosis is established, the presence of associated urologic anomalies should be investigated. Clinicians should be aware that EBT can undergo the same pathological changes as normally located breast tissue. Surgical removal should be considered for cosmetic and prophylactic treatment.
- Between Obsessive-Compulsive Disorder and PsychosisPublication . Videira, Mafalda; Santos, Pedro; Santos, VeraIntroduction: Obsessive-compulsive disorder is an heterogeneous condition in which periods of altered perception or delusions may arise. Similarly, individuals with psychotic disorders may have obsessive-compulsive symptoms. Case report: A male adolescent presented to the Emergency Department (ED) with obsessive symptomatology with three months of evolution. Three weeks later, he returned to the ED showing symptom worsening and reporting delusions, being admitted to the inpatient unit to clarify the diagnosis. No positive symptoms were reported during hospitalization. During follow-up, the patient reported an episode of apparent delusional perception that he associated with the beginning of symptoms, again raising the question of whether a psychotic episode was present. Discussion/Conclusions: The distinction between obsessive-compulsive disorder and psychosis is not always clear, with obsessive-compulsive disorder being a significant comorbidity in patients with a first psychotic episode. Close patient assessment is required for early diagnosis and appropriate intervention.
- Progressive back pain due to epidural cerebrospinal fluid collection: a rare complication of lumbar puncture in adolescentsPublication . Simões, Ana Sofia; Penteado, Raquel; Carvalho, Leonor; Dias, AndreaLumbar puncture is commonly performed in Pediatrics. Common complications include headache and mild pain at the puncture site. Uncommon complications after the procedure, such as epidural cerebrospinal fluid collection, have rarely been described in children and adolescents. The authors present the clinical report of an adolescent with symptomatic epidural cerebrospinal fluid collection following a non-traumatic lumbar puncture. Diagnosis (including magnetic resonance imaging findings), treatment, clinical course, and prognosis associated with epidural cerebrospinal fluid collection are reported.