Percorrer por autor "Costa, E."
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- Adenopatia supraclavicular no lactente: um desafio diagnósticoPublication . Silva, H.; Barbosa, T.; Costa, E.; Morais, L.; Ramos, A.RESUMO Introdução: As adenopatias na criança são um motivo frequente de consulta e representam um desafio diagnóstico. O diagnóstico diferencial inclui principalmente a patologia infecciosa, a congénita e a neoplásica. Caso Clínico: Descrevemos o caso de um lactente de sete meses de idade com uma adenopatia supraclavicular unilateral, indolor, com três meses de evolução. O estudo analítico não demonstrou alterações e na radiografia pulmonar observou-se um infiltrado hilar bilateral. A prova tuberculínica foi positiva com uma induração de 20mm. O exame anatomo-patológico evidenciou alterações compatíveis com linfadenite tuberculosa. Conclusão: Salientamos que a tuberculose deverá ser incluída no diagnóstico diferencial de uma adenopatia supra-clavicular, especialmente nos países de alta prevalência.
- Anemia ferripriva refractária à terapêutica com ferro oral – que etiologias?Publication . Martins, S.; Costa, E.; Ribeiro, L.; Salgado, M.; Couto, C.; Pereira, F.; Barbot, J.Introdução: Uma anemia ferripriva refractária (AFR) à terapêutica com ferro oral pode colocar questões delicadas em termos de diagnóstico etiológico. O não cumprimento da terapêutica ou a deficiente correcção de eventuais erros alimentares são as causas mais frequentes. No entanto, é importante ponderar outras etiologias como défice de absorção, hemorragia oculta assim como erros de metabolismo do ferro. Objectivos: Os autores pretendem discutir os diagnósticos diferenciais de AFR bem como a pertinência dos exames auxiliares de diagnóstico. Material e Métodos: Foi efectuado um estudo retrospectivo dos processos clínicos de seis doentes em idade pediátrica com anemia ferripriva refractária ao ferro oral. Resultados: Três doentes apresentavam patologia gastrointestinal com má absorção de ferro, um apresentava hemorragia oculta e duas crianças tinham anemia ferripriva provocada por erros do metabolismo do ferro. Discussão/Conclusões: Discute-se a pertinência e oportunidade das seguintes investigações etiológicas: parâmetros hematológicos, padrão dos parâmetros bioquímicos de ferro, prova terapêutica de absorção, rastreio de patologia de absorção, resposta terapêutica ao ferro endovenoso e/ou ferro de absorção não dependente da secreção gástrica e investigação endoscópica e histológica do tracto digestivo. Conclui-se ser importante no estudo destes doentes a elaboração de uma metodologia de investigação que tenha em conta elementos de ordem epidemiológica, semiológica e analítica assim como a utilização criteriosa de exames auxiliares de diagnóstico invasivos. ABSTRACT Background: A refractory iron deficiency anaemia may have some issues considering its aetiology. Non-compliance to drug therapies and persistent dietary errors are the most common causes. However, it is important to consider other possibilities such as malabsorption, occult bleeding and errors on iron metabolism. Purpose: The authors aim to demonstrate the need of a diagnostic investigation strategy in a refractory iron deficiency anaemia study. Material and Methods: We performed a retrospective study of medical records of six patients with refractory iron deficiency anaemia. Results: Three patients had gastrointestinal pathology with impaired absorption of iron, one had occult gastrointestinal bleeding, and two children had iron deficiency caused by iron metabolism disorders. Discussion / Conclusion: The relevance of the following investigations are discussed: hematologic indices, iron-status indicators, screening of malabsorption, response to intravenous iron and/or oral iron formulation independent of gastric acid secretion and endoscopic and histological investigation of the digestive tract. The development of a research methodology that considers epidemiologic, clinical and analytical factors is necessary in such patients.
- Caso hematológico: Anemia de FanconiPublication . Nascimento, P.; Costa, E.; Porto, B.; Barbot, J.The authors present the case of a child with complex congenital heart defect, bilateral malformation of the thumbs, hearing loss, failure to thrive and delayed psychomotor development, oriented to the hematology consultation at the age of 9 years for the presence of thrombocytopenia and macrocytosis.
- Caso hematológico: hemorragia tardia pós adeno-amigdalectomiaPublication . Salgado, M.; Costa, E.; Campos, F.; Leite, L.; Freitas, I.; Barbot, J.The authors present the clinical case of a six years old child followed by Pediatric Hematology because of anemia detected after a late hemorrhage following adenotonsillectomy, debating the differential diagnosis and management.
- Caso hematológico: Púrpura Trombocitopénica IdiopáticaPublication . São Simão, T.; Salgado, M.; Costa, E.; Barbot, J.The immune thrombocytopenic purpura (ITP) is a controversial disease. The generality of the literature argues that a historical objective clinical examination and a blood count with careful observation of the peripheral blood smear is sufficient for diagnosis. Some cases contradict this belief.
- Caso hematológico: trombocitemia essencialPublication . Lopes, R.; Araújo, L.; Costa, E.; Soares, S.; Barbot, J.Essential Thrombocythemia (ET) is a rare disease in pediatric age. The dominant clinical manifestations are thrombotic (arterial or venous) and/or hemorrhagic, but most of the cases are asymptomatic, and diagnosis made by routine hemogram. A previously healthy adolescent, federated football player, was oriented to the paediatric haematology consultation, at the age of 15 years, because of the presence of sustained thrombocytosis. It was established the diagnosis of Essential Thrombocythemia based on the criteria of the World Health Organization (WHO) 2008. The authors highlight the importance of establishing this diagnosis, even in pediatric age, to set the earliest possible a strategy of clinical surveillance, prevention of associated complications and the most adequate therapeutic approach.
- Como transporta os seus filhos?Publication . Borges, A.; Costa, E.; Pinto, M.; Costa, M.RESUMO Os acidentes rodoviários são a principal causa de morte e incapacidade temporária e definitiva em crianças e jovens em Portugal. Objectivo: Caracterizar a forma como os pais transportam os seus filhos em veículos motorizados ao Serviço de Urgência (SU), bem como o grau de informação sobre o transporte, relacionando-o com o perfil sócio-cultural e demográfico da amostra. Material e Métodos: Estudo analítico e aleatório, com base em questionário aplicado aos pais das crianças atendidas no SU do Hospital de São Miguel, sem motivo de urgência/emergência, no período de Novembro de 2003 a Abril de 2004. Para a análise dos resultados foram considerados 4 grupos etários, tendo em conta a forma de transporte seguro (< 18 meses, 18 meses aos 3 anos, 4 aos 6 anos, 7 aos 13 anos). Resultados: Foram obtidos 254 questionários. A média de idades foi de 3 anos e 1 mês (mínima 1 mês e máxima 13 anos), com um predomínio das crianças com idade ≤ 18 meses (39%). A maioria das famílias era de nível social médio baixo (Graffar IV – 51%) ou médio (Graffar III – 33%). O tipo de transporte mais utilizado foi o automóvel (99%). Apenas 35% da amostra estudada transportava as suas crianças de forma correcta, com base nas normas e dispositivos de segurança adequados, actualmente em vigor. A protecção correcta foi mais frequente nas crianças entre os 18 meses e os 3 anos – 54% contra 31% do resto da amostra. Uma maior protecção correcta foi associada aos níveis de escolaridade mais elevados dos progenitores. Apesar de 53 pais terem sofrido algum acidente de viação, apenas 38% consideraram que o acidente teve alguma repercussão na forma como os seus filhos são transportados. É de salientar que 63% dos inquiridos desconhecia qualquer tipo de campanha de prevenção / ensino da forma correcta de transporte das crianças. Comentários e Conclusões: Verificámos que, na amostra estudada, a utilização dos sistemas de retenção de forma correcta e segura para o transporte de crianças é altamente insuficiente, sendo emergente implementar medidas que alterem estes comportamentos. ABSTRACT Road accidents are the main cause of death and of temporary and definitive incapacity in children and youths in Portugal. Objective: To characterize the way parents transport their children in motorized vehicles to the Emergency Department (ED), their knowledge about child passenger safety and the influence of the socio-cultural and demographic profile on their attitude. Material and Methods: Analytical and random study based on a questionnaire applied to the parents of the children that were evaluated in the ED of the Hospital of Sao Miguel, with no urgency or emergency cause of attendance, from November/ 2003 to April/2004. We considered four groups according to the age and the different ways of safe transport (bellow 18 months, 18 months to 3 years, 4 to 6 years, 7 to 13 years). Results: We obtained 254 questionnaires. The average age was 3 years and 1 month (minimum 1 month, maximum 13 years), with a predominance of children aged less than 18 months (39%). The majority of families belonged to low (Graffar IV - 51%) or medium (Graffar III - 33%) social level. The automobile was the most common way of transportation (99%). Only 35% of the studied sample transported their children based on the right legal norms and adequate safety devices. Right protection was more frequent in children between 18 months and 3 years - 54%, versus 31% in the rest of the sample. Better safety procedures were associated with high educational levels of the parents. Fifty-three parents suffered a road accident, however only 38% considered that the accident had some repercussion in the form their children were transported. It is import to point out that 63% of the inquired parents were unaware of any type of campaign of prevention about child passenger safety. Commentaries and Conclusions: In this study, we verified that the use of child restraints in the right and safe way is highly insufficient and it is emergent to implement measures to change these behaviours and prevent children’s death and incapacity.
- Effect of Aging in the Perception of Health-Related Quality of Life in End-Stage Renal Disease Patients under Online-HemodiafiltrationPublication . Moura, A.; Madureira, J.; Alija, P.; Fernandes, J.; Oliveira, .; Lopez, M.; Filgueiras, M.; Amado, L.; Sameiro-Faria, M.; Miranda, V.; Santos-Silva, A.; Costa, E.This work aimed to evaluate how aging could influence patients' perception of health quality of life (HRQOL), as well as, the effect of aging on dialysis adequacy and in hematological, iron status, inflammatory and nutritional markers. In this transversal study were enrolled 305 ESRD patients under online-hemodiafiltration (OL-HDF) (59.67% males; 64.9 ± 14.3 years old). Data about comorbidities, hematological data, iron status, dialysis adequacy, nutritional and inflammatory markers were collected from patient's records. Moreover, HRQOL score, by using the Kidney Disease Quality of Life-Short Form (KDQOL-SF), was assessed. Analyzing the results according to quartiles of age, significant differences were found for some parameters evaluated by the KDQOL-SF instrument, namely for work status, physical functioning and role-physical, which decreased with increasing age. We also found a higher proportion of diabetic patients, a decrease in creatinine, iron, albumin serum levels, transferrin saturation and nPCR, with increasing age. Moreover, significant negative correlations were found between age and mean cell hemoglobin concentration, iron, transferrin saturation, albumin, nPCR, work status, physical functioning and role-physical. In conclusion, our results showed that aging is associated with a decreased work status, physical functioning and role-physical, with a decreased dialysis adequacy, iron availability and nutritional status, and with an increased proportion of diabetic patients and of patients using central venous catheter, as the vascular access. The knowledge of these changes associated with aging, which have impact in the quality of life of the patients, could be useful in their management.
- Effect of Aging in the Perception of Health-Related Quality of Life in End-Stage Renal Disease Patients under Online-HemodiafiltrationPublication . Moura, A.; Madureira, J.; Alija, P.; Fernandes, J.; Oliveira, J.; Lopez, M.; Filgueiras, M.; Amado, L.; Sameiro-Faria, M.; Miranda, V.; Santos-Silva, A.; Costa, E.This work aimed to evaluate how aging could influence patients’ perception of health quality of life (HRQOL), as well as, the effect of aging on dialysis adequacy and in hematological, iron status, inflammatory and nutritional markers. In this transversal study were enrolled 305 ESRD patients under Online-hemodiafiltration (OL-HDF) (59.67% males; 64.9 ± 14.3 years old). Data about comorbidities, hematological data, iron status, dialysis adequacy, nutritional and inflammatory markers were collected from patient’s records. Moreover, HRQOL score, by using the Kidney Disease Quality of Life-Short Form (KDQOL-SF), was assessed. Analyzing the results according to quartiles of age, significant differences were found for some parameters evaluated by the KDQOL-SF instrument, namely for work status, physical functioning and role-physical, which decreased with increasing age. We also found a higher proportion of diabetic patients, a decrease in creatinine, iron, albumin serum levels, transferrin saturation and nPCR, with increasing age. Moreover, significant negative correlations were found between age and mean cell hemoglobin concentration, iron, transferrin saturation, albumin, nPCR, work status, physical functioning and role-physical. In conclusion, our results showed that aging is associated with a decreased work status, physical functioning and role-physical, with a decreased dialysis adequacy, iron availability and nutritional status, and with an increased proportion of diabetic patients and of patients using central venous catheter, as the vascular access. The knowledge of these changes associated with aging, which have impact in the quality of life of the patients, could be useful in their management.
- Eritroblastopenia transitória da infância: atitude expectante face a uma anemia gravePublication . Pereira, M.; Bergantim, R.; Costa, E.; Morais, L.; Lavrador, V.; Barbot, J.Introdução: A eritroblastopenia transitória da infância (ETI) é uma condição aguda caracterizada por anemia moderada a grave e reticulocitopenia, secundárias a uma supressão temporária da eritropoiese. A etiologia é desconhecida, embora ocorra associação com uma infecção vírica em cerca de metade dos casos. Tipicamente, apresenta um curso benigno e auto-limitado, necessitando apenas de vigilância da evolução clínica. Caso clínico: Descreve-se o caso clínico de uma menina com três anos de idade, internada por infecção respiratória alta e ETI. O seu quadro hematológico era caracterizado por anemia com hemoglobina de 7.1 g/dl e reticulocitopenia, sem alterações nas outras linhas celulares. A evolução foi favorável, com recuperação espontânea ao fim de três semanas. Conclusão: O reconhecimento desta entidade hematológica benigna, distinguindo-a de outras formas de anemia arregenerativa, pode evitar o recurso a procedimentos diagnósticos e terapêuticos desnecessários. ABSTRACT Introduction: Transient erythroblastopenia of childhood (TEC) is an acquired, acute disorder, characterized by moderate to severe anemia and reticulocytopenia, secondary to a temporary suppression of red blood cell production. The etiology of TEC remains unknown, although an association with viral infections has been proposed. It is self-resolving and careful observation is the only medical support needed in most cases. Case report: The authors describe the case of a three-year-old girl who was admitted with an upper respiratory tract infection and TEC. Initial signs were anemia, with a 7.1 g/dl hemoglobin level and reticulocytopenia, without another hematologic abnormality. Spontaneous recovery occurred after three weeks. Conclusion: A better knowledge of this benign hematologic disorder of childhood, distinguishing TEC from other causes of non-regenerative anemia, can prevent unnecessary diagnostic procedures and treatment.