Centro Hospitalar do Porto
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Diminishing surgeon’s radiation exposure in percutaneous forefoot deformity surgery –an alternative patient and c-armpositioning
Get PDFA exposição à radiação ionizante acarreta riscos para a saúde das equipas médicas. Este aspeto é particularmente relevante na cirurgia minimamente invasiva do pé devido ao posicionamento do doente e do cirurgião relativamente à fonte de radiação X. Durante o posicionamento “clássico” do doente, o C-arm e a equipa desconsideram alguns dos mais elementares princípios de segurança, particularmente nos centros com acesso mais limitado a aparelhos que utilizem baixas doses de radiação. A nossa técnica de posicionamento do doente permite uma redução da dispersão da radiação para o cirurgião e equipa médica, e os princípios de redução de exposição à radiação citados devem ser ponderados por todos aqueles que executam este tipo de técnicas na sua prática clínica regular.Exposure to ionizing radiation entails health risks to the medical staff. In minimally invasive orthopedic foot surgery, this can become a particularly important aspect, due to patient and surgeon positioning relative to the x-ray source. While using the ‘classical’ positioning of patient, C-arm and surgical team disregards some of the most basic principles of self-safety, particularly in those centres with limited access to smaller, lower radiation-producing devices. Our technique for patient positioning allows for a reduction in radiation scatter to the surgeon and operative team, and the principles of radiation exposure reduction cited should be considered by all colleagues performing this type of techniques in their daily practice.info:eu-repo/semantics/publishedVersio
Pica e perturbação de hiperatividade e défice de atenção: existe ligação?
Get PDFIntroduction: Pica is the persistent ingestion of non-nutritive substances. It is common during childhood and may be related to nutritional deficits, intellectual disability, stress, and psychosis. However, no causative biological condition is identified in most cases and there is limited evidence to support pharmacological intervention. As several authors describe pica as an impulse control disorder and impulsive symptoms are a core aspect of the diagnostic criteria of attention deficit hyperactivity disorder (ADHD), this study reviews literature data on pica, ADHD, and treatment response during childhood and adolescence and adds two case reports to this body of evidence.
Methods: Systematic literature review using the key terms “pica”, “attention deficit”, “hyperactivity”, “child”, and “adolescent”. A retrospective analysis of clinical data of two patients with pica and ADHD followed at the Child and Adolescent Psychiatry Department of Hospital Pediátrico was also conducted.
Results: As far as the authors are aware, only three cases are currently reported in the literature describing comorbid pica and ADHD in children. Of these, two reported complete pica symptom remission after methylphenidate treatment. Two other cases of children with pica and ADHD observed at the Child and Adolescent Psychiatry Department of our institution were reported in this study, one of which had complete symptom remission after psychostimulant treatment optimization.
Discussion: The suggested association between pica and ADHD may have underlying etiology in poor impulse control and dopaminergic system dysfunctions. Therefore, a pharmacological approach capable of improving dopaminergic functioning may be an alternative treatment for pica. Psychostimulants may improve pica by eliciting an increase in brain dopamine levels and a decrease in impulsivity.info:eu-repo/semantics/publishedVersio
Alterações ao exame físico do aparelho genital em idade pediátrica - o que é diferente nem sempre é patológico – Parte I (masculino)
Get PDFIntroduction: Findings in the physical examination of the external genitalia in children are often a source of concern for parents and caregivers, not only for the emotional significance that people unconsciously attribute to these structures (partly due to their reproductive function), but also for the physical and psychological impact in the child.
Due to the child’s close monitoring and periodic surveillance, the family physician has a key role in the identification and initial guidance of these cases.
Objectives: To review the evidence about main variations and anomalies of the external male genitalia in pediatric age regarding diagnosis and clinical approach in primary health care.
Results: In most cases, anomalies in the external male genitalia represent variants of normal and/or do not significantly affect function, thus only requiring clinical surveillance and no intervention. However, some cases − as epispadias, hypospadias, and urethral duplication − require surgical intervention and early action is crucial for the success of implemented measures.
Conclusion: Physical examination is a key aspect of child assessment. Although changes in physical examination of the external male genitalia mostly represent normality variants, clinicians should be able to recognize pathological changes and properly refer those cases without overloading health services or causing unnecessary anxiety to children and caregivers.info:eu-repo/semantics/publishedVersio
Caso clínico ginecológico
Get PDFHerein is reported the case of a child observed in the Emergency Department due to urinary retention, suprapubic pain, and dysuria. Urine culture was performed upon cystitis suspicion, which was positive for Escherichia Coli, and the patient was treated with amoxicillin and clavulanic acid. Three days later, the child was reevaluated for persistent urinary retention, fever, and vaginal bleeding. At gynecological examination, she had an imperforate hymen. Imaging evaluation was performed, revealing an abdominal mass, suggestive of piohematocolpos. The patient was submitted to surgical drainage, with complete condition resolution.info:eu-repo/semantics/publishedVersio
Caso clínico dermatológico
Get PDFLyme 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.info:eu-repo/semantics/publishedVersio
PBPK Modeling and Simulation of Antibiotics Amikacin, Gentamicin, Tobramycin, and Vancomycin Used in Hospital Practice
Get PDFThe importance of closely observing patients receiving antibiotic therapy, performing therapeutic drug monitoring (TDM), and regularly adjusting dosing regimens has been extensively demonstrated. Additionally, antibiotic resistance is a contemporary concerningly dangerous issue. Optimizing the use of antibiotics is crucial to ensure treatment efficacy and prevent toxicity caused by overdosing, as well as to combat the prevalence and wide spread of resistant strains. Some antibiotics have been selected and reserved for the treatment of severe infections, including amikacin, gentamicin, tobramycin, and vancomycin. Critically ill patients often require long treatments, hospitalization, and require particular attention regarding TDM and dosing adjustments. As these antibiotics are eliminated by the kidneys, critical deterioration of renal function and toxic effects must be prevented. In this work, clinical data from a Portuguese cohort of 82 inpatients was analyzed and physiologically based pharmacokinetic (PBPK) modeling and simulation was used to study the influence of different therapeutic regimens and parameters as biological sex, body weight, and renal function on the biodistribution and pharmacokinetic (PK) profile of these four antibiotics. Renal function demonstrated the greatest impact on plasma concentration of these antibiotics, and vancomycin had the most considerable accumulation in plasma over time, particularly in patients with impaired renal function. Thus, through a PBPK study, it is possible to understand which pharmacokinetic parameters will have the greatest variation in a given population receiving antibiotic administrations in hospital context.info:eu-repo/semantics/publishedVersio
Early life exposures and the risk of inflammatory bowel disease: Systematic review and meta-analyses
Get PDFBackground: Early life exposures impact immune system development and therefore the risk of immune-mediated diseases, including inflammatory bowel disease (IBD). We systematically reviewed the impact of pre-, peri‑, and postnatal exposures up to the age of five years on subsequent IBD diagnosis.
Methods: We identified case-control and cohort studies reporting on the association between early life environmental factors and Crohn's disease (CD), ulcerative colitis (UC), or IBD overall. Databases were search from their inception until May 24th, 2019 until July 14th, 2020. We conducted meta-analyses for quantitative review of relevant risk factors that were comparable across studies and qualitative synthesis of the literature for a wide range of early life exposures, including maternal health and exposures during pregnancy, perinatal factors, birth month and related-factors, breastfeeding, hygiene-related factors and social factors, immigration, antibiotics, offspring health, including infections, and passive smoking. PROSPERO registration: CRD42019134980.
Findings: Prenatal exposure to antibiotics (OR 1.8; 95% CI 1.2-2.5) and tobacco smoke (OR 1.5; 95% CI 1.2-1.9), and early life otitis media (OR 2.1; 95% CI 1.2-3.6) were associated with IBD. There was a trend towards an association between exposure to antibiotics in infancy and IBD (OR: 1.7, 95% CI 0.97, 2.9), supported by positive data on population-based data. Breastfeeding was protective against IBD. Other early life risk factors had no association with IBD, but data were limited and heterogenous.
Interpretation: Early life is an important period of susceptibility for IBD development later in life. Tobacco smoke, infections and antibiotics were associated positively, and breastfeeding was associated negatively with IBD. Our findings offer an opportunity to develop primary prevention strategies.info:eu-repo/semantics/publishedVersio
Congenital Diarrhea and Cholestatic Liver Disease: Phenotypic Spectrum Associated with MYO5B Mutations
Get PDFMyosin Vb (MYO5B) is a motor protein that facilitates protein trafficking and recycling in polarized cells by RAB11- and RAB8-dependent mechanisms. Biallelic MYO5B mutations are identified in the majority of patients with microvillus inclusion disease (MVID). MVID is an intractable diarrhea of infantile onset with characteristic histopathologic findings that requires life-long parenteral nutrition or intestinal transplantation. A large number of such patients eventually develop cholestatic liver disease. Bi-allelic MYO5B mutations are also identified in a subset of patients with predominant early-onset cholestatic liver disease. We present here the compilation of 114 patients with disease-causing MYO5B genotypes, including 44 novel patients as well as 35 novel MYO5B mutations, and an analysis of MYO5B mutations with regard to functional consequences. Our data support the concept that (1) a complete lack of MYO5B protein or early MYO5B truncation causes predominant intestinal disease (MYO5B-MVID), (2) the expression of full-length mutant MYO5B proteins with residual function causes predominant cholestatic liver disease (MYO5B-PFIC), and (3) the expression of mutant MYO5B proteins without residual function causes both intestinal and hepatic disease (MYO5B-MIXED). Genotype-phenotype data are deposited in the existing open MYO5B database in order to improve disease diagnosis, prognosis, and genetic counseling.This research was funded by Jubiläumsfonds der Österreichischen Nationalbank, grant no.16678 (to A.R.J.), grant no. 18019 (to G.-F.V.) and Tiroler Wissenschaftsfonds, grant No. 0404/2386 (toG.-F.V.).info:eu-repo/semantics/publishedVersio
Q Fever: An Emerging Reality in Portugal
Get PDFQ fever is a zoonosis caused by Coxiella burnetii with worldwide distribution at the increasing expression in Europe and endemic in Portugal. It is transmitted by inhalation of aerosols containing spores, main reservoir being cattle, goats and sheep as by ingesting cottage cheese or unpasteurized milk. The majority of patients are asymptomatic; however, they may present with fever, atypical pneumonia, acute hepatitis, cutaneous manifestations and rarely with cardiac or neurological involvement. Although most cases are self-limited, focal persistent or chronic Q fever can manifest years after the onset, wherefore follow-up is essential. The clinical heterogeneity may be so variable that the disease is often diagnosed only if it has been systematically considered. It should be especially taken into account in the presence of risk factors as valvular or joint prostheses, immunocompromised patients, pregnant women and epidemiological setting. The authors present a rare case of Coxiella burnetii pneumonia with cutaneous and hepatic manifestations without any risk factor. This case aims to emphasize the importance of Q fever in the differential diagnosis of fever or atypical pneumonia, even in the absence of known risk factors. The diagnosis is often challenging for clinicians and it is necessary to maintain a high index of suspicion. In Europe and specifically in Portugal is mandatory to report the cases to establish the real impact of this disease.info:eu-repo/semantics/publishedVersio
Recurrent neck swelling after iodinated contrast media administration
Get PDFA 74-year-old male with an abdominal aortic aneurism reported 2 episodes of neck swelling 16 hours after an abdominal CT with iodinated contrast media that reappeared in a subsequent CT, although the use of pre-medication. The tests used to exclude the hypersensitivity hypothesis where negative and once a new CT where needed we decided to do it with close monitoring. We performed a facial picture and cervical ultrasound exam before and 24 hours after the exam. The neck swelling and the ultrasound findings 24 hours after the CT made the diagnosis of contrast induced sialoadenitis possible. Contrast induced sialadentis is an uncommon adverse reaction to iodinated contrast media. As it presents with neck swelling it is important to exclude a hypersensitivity reaction because it's further limitations and make a differential diagnosis.info:eu-repo/semantics/publishedVersio