Centro Hospitalar do Porto
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Perspectiva do GRUPUGE: drenagem de coleções peripancreáticas guiada por ecoendoscopia
Get PDFPancreatic and peripancreatic collections (PPC) are a known complication of acute pancreatitis. They are categorized into four types of collection: (1) acute peripancreatic fluid collection, (2) pseudocyst, (3) acute necrotic collection and (4) walled-off necrosis. Most PPC resolve spontaneously or are persistent but asymptomatic. Intervention is needed in a minority of patients with infected or symptomatic collection. Endoscopic ultrasound-guided transmural drainage is currently the first-line treatment option for PPC management. It has shown great technical and clinical success, similar to percutaneous or surgical approaches, but with lower morbidity and costs and better quality of life. In this review article, the GRUPUGE presents an updated perspective on the potential role of endoscopic ultrasound-guided drainage of peripancreatic collections, addressing the selection criteria and the technical issues of different techniques and analysing emerging data on their efficacy and safety.As coleções pancreáticas e peripancreáticas constituem uma complicação conhecida de pancreatite aguda. As coleções são classificadas em quatro tipos: (1) coleção líquida peripancreática aguda, (2) pseudoquisto, (3) coleção necrótica aguda e (4) coleção necrótica encapsulada (walled-off necrosis). A maioria das coleções peripancreáticas resolvem espontaneamente ou mantém-se assintomáticas. A drenagem está indicada numa minoria de doentes em que a coleção infecta ou se torna sintomática. A drenagem de coleções peripancreáticas guiada por ecoendoscopia é atualmente considerada a primeira linha de tratamento. Os procedimentos guiados por ecoendoscopia têm mostrado uma elevada taxa de sucesso técnico e clínico, semelhante às abordagens cirúrgica e percutânea, mas está associada a menor morbilidade e custos e a melhor qualidade de vida. Neste artigo de revisão, o GRUPUGE apresenta uma perspetiva atualizada do papel da ecoendoscopia na drenagem de coleções peripancreáticas, abordando critérios de seleção e questões técnicas relativas aos diferentes procedimentos, e analisando os dados disponíveis sobre a sua eficácia e segurança.info:eu-repo/semantics/publishedVersio
Association Between Iron-Related Protein Lipocalin 2 and Cognitive Impairment in Cerebrospinal Fluid and Serum
Get PDFA 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.info:eu-repo/semantics/publishedVersio
Hypoglycemic episodes in hospitalized people with diabetes in Portugal: the HIPOS-WARD study
Get PDFBackground: We intended to estimate the proportion hypoglycemic/hyperglycemic emergency episodes in treated diabetes mellitus (DM) patients admitted to a hospital ward, and calculate the prevalence of risk factors for hypoglycemia and diabetic complications.
Methods: In this cross-sectional, multicentered study, the observational data was collected by physicians from patient's hospitalization to discharge/death. Statistical tests were 2-tailed considering 5% significance level.
Results: There were 646 ward admissions due to hyperglycemic emergencies and 176 hypoglycemic episodes with a ratio hypoglycemia/hyperglycemia 0.27 for all DM patients. In T2DM patients the ratio was 0.38. These were mainly female (55.1%), functionally dependent (61.4%) and retired/disabled (73.1%). Median age was 75 years and median duration of disease 11 years. Half the patients were on insulin-based therapy and 30.1% on secretagogue-based therapy. Approximately 57% of patients needed occasional/full assistance to manage the disease. The most frequent risk factor for hypoglycemia was polypharmacy (85.0%). Hypoglycemia in the 12 months before admission was higher in insulin-based therapy patients (66.1%; p = 0.001).
Conclusions: Hyperglycemic emergencies are the most frequent cause of hospitalization in Portugal, although severe hypoglycemic events represent a health and social problem in elderly/frail patients. There is still the need to optimize therapy in terms of the potential for hypoglycemia in this patient group and a review of anti-hyperglycemic agents to add on to insulin.This work was supported by Merck Sharp & Dohme (MSD) Portugal [MK0431–854]. The study was scientifically promoted by the Portuguese Society of Diabetology (Sociedade Portuguesa de Diabetologia), Portuguese Society of Endocrinology, Diabetes and Metabolism (Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo) and Portuguese Society of Internal Medicine (Sociedade Portuguesa de Medicina Interna).info:eu-repo/semantics/publishedVersio
Alterações ao exame físico do aparelho genital em idade pediátrica - o que é diferente nem sempre é patológico – Parte II (feminino)
Get PDFIntroduction: Findings in the physical examination of the external genitalia in children are often a source of concern and anxiety for parents and caregivers. Due to the proximity and role in child’s periodic surveillance, the family physician is in a privileged position to identify and initially provide guidance on these situations, key for the success of future interventions.
Objectives: To review available evidence on the main variations and anomalies of the external female genitalia in pediatric age, focusing on diagnosis and clinical approach in primary health care.
Results: In most cases, anomalies of the prepubertal female external genitalia are only variants of normal and/or do not significantly affect function, hence not requiring intervention other than clinical surveillance – e.g., fusion of labia minora. However, others require referral to secondary health care − like congenital vaginal obstruction or clitoral hypertrophy –, with early intervention being crucial for the success of implemented measures in some cases.
Conclusion: Genital pathology in prepubertal children is most often diagnosed by systematic and careful physical examination and usually has a favorable outcome. It is important to distinguish variants of normal from situations requiring more specialized assessment, in order to optimize health care system resources without overloading it and decrease parental anxiety.info:eu-repo/semantics/publishedVersio
Covid-19 - O que mudou num serviço de urgência pediátrico de um hospital distrital durante o estado de emergência?
Get PDFIntroduction: 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.info:eu-repo/semantics/publishedVersio
Crianças e adolescentes caminhando na direção da saúde mental
Get PDFChildhood 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.info:eu-repo/semantics/publishedVersio
Depressão óssea craniana neonatal
Get PDFA female preterm was admitted to the Neonatal Intensive Care Unit for late prematurity and very low weight. The physical examination was normal. On the third day of life, a hard left, non-painful parietal depression was noted, with no evidence of neurological impairment. Head computed tomography (CT) showed focal sinking of the left parietal bone posteriorly to the coronal suture. A watchful attitude was adopted and the patient was discharged on day 28. The diagnosis was a “ping-pong fracture”, which can occur iatrogenically or spontaneously in uterus. This diagnosis can be confirmed by x-ray or CT scan and the prognosis is usually good, with complete deformity regression. At two months, the parietal fracture was barely perceptible, and neurological examination was normal.info:eu-repo/semantics/publishedVersio
Ombros desalinhados
Get PDFSprengel 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.info:eu-repo/semantics/publishedVersio
Cisto nasolabial em idade pediátrica
Get PDFHerein is described the case of a 26-month-old male observed in the Emergency Department for edema of the upper lip and left malar region with less than 24 hours of evolution and progressive worsening. No other associated complaints, previous history of trauma, or insect sting were reported. Computed tomography revealed a “left premaxillary abscess associated with ipsilateral nasogenian phlegm”. Intravenous antibiotic therapy with clarithromycin and clindamycin and systemic corticosteroid therapy with dexamethasone were started, and the boy was admitted to the Pediatric Department. He presented favorable clinical evolution, with complete resolution of inflammatory signs. At discharge, the patient remained asymptomatic and was referred to Otorhinolaryngology consultation for follow-up.
Although nasolabial cysts are rare in pediatric age, this case intends to raise awareness of the condition, enabling its recognition by clinicians, and increase knowledge about its course and treatment.info:eu-repo/semantics/publishedVersio
Face grosseira, hipotonia e regressão do neurodesenvolvimento
Get PDFInborn errors of metabolism are a heterogeneous class of multisystemic diseases which, although individually rare, are collectively quite common. Central nervous system is usually affected.
The authors report the case of a five-month-old girl, daughter of non-consanguineous parents, born after an unremarkable full-term pregnancy and delivery. Hypotonia and neurodevelopmental regression were noted from the age of five months, along with progressive onset of facial dysmorphism, hepatomegaly, seizures, and dilated cardiomyopathy. Gangliosidosis type 1 diagnosis was confirmed by biochemical, enzymatic, and genetic findings.
This report enhances the relevance of multidisciplinary approach and follow-up.info:eu-repo/semantics/publishedVersio