Browsing by Issue Date, starting with "2023-12-31"
Now showing 1 - 10 of 12
Results Per Page
Sort Options
- Urinary tract infections in a Pediatric Emergency Department – Etiology and antibiotic susceptibility patternsSantos, Paula; Nascimento, Ana Sofia; Santos, Filomena; Ribeiro, Catarina; Morais, JulietaIntroduction: Urinary tract infections are common in children. The decision to start empiric antibiotic therapy before isolation of the causative agent must be made based on the clinical presentation and antimicrobial resistance profile of each population. The aim of the present study was to identify the most common etiological agents in urinary tract infections in children and adolescents attending the Pediatric Emergency Department of a level II hospital and the antimicrobial susceptibility pattern, in order to optimize the use of empiric and prophylactic therapy.Material and Methods: A retrospective analysis of urine cultures with a positive result between January 2019 and December 2021 was performed.Results: A total of 774 urine cultures were evaluated. The most frequently isolated etiological agents were Escherichia coli (68.5%), Proteus mirabilis (18.1%), and Staphylococcus saprophyticus (4.7%). Escherichia coli showed 4.9% resistance to cefuroxime and 26.2% resistance to amoxicillin-clavulanic acid. Proteus mirabilis showed an adequate susceptibility profile to all empirically used antibiotics. In adolescents, 26.8% of urinary tract infections were caused by Staphylococcus saprophyticus. Ten cases (1.3%) of extended-spectrum beta-lactamase-producing Enterobacteriaceae were identified.Discussion: Cefuroxime showed an adequate susceptibility profile for all microorganisms. Escherichia coli showed a high resistance rate to amoxicillin-clavulanic acid, exceeding the acceptable resistance threshold for empirical antibiotic therapy. The results suggest an increase in the incidence of urinary tract infections caused by Staphylococcus saprophyticus, which means that the prescription of fosfomycin as first-line empirical therapy for female adolescents should be discouraged.
- The impact of the COVID-19 pandemic on adolescent Emergency Department visitsMartins, Inês Aires; Queirós, Joana Carvalho; Lira, Sónia; Ribeiro, Maria do CéuIntroduction: Adolescence is a unique period of physical and emotional growth. During the COVID-19 pandemic, several countries decided to close schools, with yet unclear consequences for mental health. Stressful life events may affect adolescents’ quality of life and precipitate psychiatric emergencies. This study aimed to compare the reasons for Emergency Department (ED) visits among adolescents before the COVID-19 pandemic and after the relief of social distancing measures. Methods: A retrospective cohort study was conducted, including individuals aged 13-18 years admitted to the ED of a Portuguese level II hospital between January and June 2019 (Group 1) and January and June 2022 (Group 2). Data were collected from electronic medical records. Descriptive and inferential statistical analyses were performed.Results: A total of 5135 adolescents were included in the two groups, with no demographic differences between them. Infectious diseases were the most common diagnosis overall. Group 2 showed a significant increase in mental health conditions such as anxiety (odds ratio [OR] 1.354) and feeding or eating disorders (OR 12.380), and its population was generally younger, especially in the feeding or eating disorders and intentional self-harm subgroups. No differences were found between groups regarding preexisting mental health conditions, except for intentional self-harm due to exposure to harmful substance effects, which were significantly more common in Group 2 (OR 4.267).Conclusions: Although acute infectious diseases remain the most common cause of ED admissions, this study showed a significant increase in ED visits for mental health disorders, reflecting the impact of the COVID-19 pandemic. Protecting adolescents from adversity, promoting psychological well-being, and ensuring access to mental health care are critical to adolescent health.
- Anaphylaxis in the Pediatric Emergency Department of a central hospitalCoelho, Cristina; Pereira, Liliana Patrícia; Santa, Cátia; Pedrosa, CláudiaAnaphylaxis is a potentially life-threatening medical emergency. Early diagnosis and treatment are crucial. In children, the diagnosis is complicated by some unique features of the pediatric population. Food is the most common etiology in pediatric patients.The aim of this study was to characterize the episodes of anaphylaxis identified in the Pediatric Emergency Department (ED) of a central hospital between 2012 and 2021 according to the 2014 EAACI guidelines. Seventy-eight anaphylaxis episodes were included, 44 of which were first episodes. Children’s median age was 9.5 years (range 6 months-17 years) and 62.8% were male. A history of atopy was present in 52.6% of cases and asthma and/or allergic rhinitis in 50.9%.The most common trigger was food (74.4%) and the most common food was milk (27.6%).Mucocutaneous manifestations occurred in 94.9%, respiratory manifestations in 80.8%, gastrointestinal manifestations in 38.5%, and cardiovascular manifestations in 21.8%.Epinephrine treatment was administered in 83.3% of episodes. Patients with an epinephrine autoinjector (EAI) used it in 52.9% of episodes. The median (range) monitoring time was 13 (3-26) hours.At discharge, EAI was prescribed in 84.1% of first episodes, and 95.5% were referred for specialty consultation.As reported in the literature, food etiology prevailed in the described anaphylaxis cases. Epinephrine was the first-line treatment in most cases. EAI was used in approximately half of patients. Despite growing awareness, it is essential to alert patients and health professionals to the importance of epinephrine in the management of these cases.
- Growing through grief. Bereavement after parental suicide in a child with autism spectrum disorder: A clinical casede LIz, Mariana Ferraz; Lopes, Ana Filipa; Antunes, Marta Pereira; Falcão, Mariana Lima; Araújo, Sara; Santos, Maria do CarmoThe impact of suicide on children remains unclear. Herein is reported the case of a seven-year-old boy who was referred for consultation for behavioral changes after witnessing his mother’s suicide. The main complaints were constant questions about death, emotional lability, and motor agitation. During bereavement-focused psychotherapy, some particularities in social functioning were noted, leading to the diagnosis of autism spectrum disorder (ASD). The bereavement process following parental suicide is modulated by several factors. Understanding these factors in the context of the particularities of the ASD population has allowed for a better understanding of the individual challenges of children that warrant specific interventions.Much remains to be understood about suicide imprinting in surviving offspring, particularly in children with ASD for whom the bereave-ment process may be overlooked.
- Dent disease: A cause of proteinuria against all oddsRosinha, Inês; Machado, Marta; Cordinhã, Carolina; do Carmo, Carmen; Gomes, ClaraDent disease is a rare X-linked progressive renal disease characterized by hypercalciuria and low molecular weight proteinuria. In early childhood, patients may manifest only proteinuria and/or hypercalciuria, both of which are generally asymptomatic. The authors report three cases of male patients with asymptomatic, non-orthostatic nephrotic proteinuria first detected during screening for an acute condition. All had intermittent hypercalciuria, one had nephrocalcinosis, and one had mild hypotonia and some learning difficulties. Genetic testing identified pathogenic variants in all patients, two in the OCRL gene and one in the CLCN5 gene. To date, none have developed chronic kidney disease.The diagnosis of Dent disease can be challenging, but it should be considered in all men with unexplained proteinuria. This approach may not only allow for earlier diagnosis, but also avoid unnecessary testing and potentially harmful treatments.
- Dermatology clinical caseGonçalves, Vera; Costa e Silva, André; Azevedo, André; Martinho, Isabel; Martins, Sandrina; Teixeira, VeraThe authors report the case of an eight-year-old boy who presented o the Pediatric Emergency Department for severe oral mucositis, fever, purulent conjunctivitis, and skin rash. The diagnosis of Mycoplasma pneumoniae-induced rash and mucositis (MIRM) was established. Extrapulmonary complications of Mycoplasma pneumoniae infections are increasingly recognized. Over the years, patients with mucocutaneous manifestations have been misdiagnosed with erythema multiforme spectrum disease. In 2015, MIRM was proposed as a distinct clinical entity with unique pathophysiology, clinical manifestations, and prognosis.
- Vaping: A Pediatric problem?Monteiro, Sara; Almeida, RuiElectronic cigarettes were developed almost two decades ago. Their use, colloquially known as vaping, has gradually increased among young people.Although initially marketed as an alternative to traditional cigarettes, electronic cigarettes expose users to substances associated with adverse health effects and are not recognized by the World Health Organization as a smoking cessation method. The use of new flavors, esthetically appealing devices, and low perceived risk appear to be contributing to increased use among adolescents worldwide, a trend also observed in Portugal. However, their health risks are not fully understood. Recently, a new entity - e-cigarette or vaping-associated lung injury (EVALI) – has been described, with increasing incidence and significant morbimortality. The treatment of nicotine dependence in adolescents who smoke electronic cigarettes is challenging.Electronic cigarettes are addicting a new generation and posing associated health risks. Their increasing use should alert physicians and encourage the development of strategies to address this issue among adolescents.
- Childhood neglect: Another perspective on childhood obesityAzevedo, Inês Alexandra; Aguiar, Benedita Bianchi; Silva, Joana; Marques, Elizabeth; Silva, Maria José; Monteiro, Virgínia; Gomes, Lúcia; Costa, MiguelChildhood obesity is a multifactorial condition. Extreme cases are often associated with the inability of caregivers to follow the recommended diet plan, despite prior warnings of the potential risks associated of non-compliance.A seven-year-old girl with a body mass index (BMI) of 38.6 kg/m2 (z-score +7.3) and multiple comorbidities was seen in a Pediatric Nutrition outpatient consultation. After several attempts to educate her guardians about the potential risks of obesity, the girl was referred for a multidisciplinary evaluation and placed in a children’s home. With adequate nutrition and regular exercise, significant improvements were achieved in BMI (23.5 kg/m2; z-score +2.06). After three years, the girl was returned to her family home by court order, with subsequent worsening of her BMI (maximum 40.7 kg/m2; z-score +4.07), despite information provided by the medical team to social services and the court. Given that caregivers play an essential role in the prevention of childhood obesity, persistent refusal to follow therapeutic recommendations coupled with indifference in the face of red flags meets the criteria for abuse.
- Classic pertussis infection in a two-year-old child with complete primary immunizationGaspar, Mariana; Sutre, Filipe; Couto, Celina; Gavino, Alexandra; Vilarinho, Filipa; Lopes, AldinaPertussis infection, or "whooping cough," is a highly contagious but vaccine-preventable respiratory disease caused by Bordetella pertus-sis. It can affect people of all ages, but is usually more severe in young infants. Despite high vaccination coverage worldwide, this infection remains a problem. Pertussis infection is spread by aerosolized droplets and the clinical presentation can vary with age and immunity. The classic presentation includes cough paroxysms, inspiratory whoop, and post-tussive vomiting. Laboratory confirmation is not necessary for diagnosis and should not delay treatment.The authors present the case of a healthy two-year-old girl with a one-month history of dry paroxysmal cough with inspiratory whoop who was admitted to the Emergency Department for loss of consciousness during a coughing episode.This case is intended to raise awareness of severe, life-threatening pertussis infection in children with complete primary immunization who present with respiratory symptoms consistent with this infection.
- Two adolescents with unilateral cutaneous lesionsMarinho, Pedro; Teixeira, Susana Cláudia; Nogueira, Miguel; Machado, SusanaThe authors report two cases of previously healthy male adolescents who presented with multiple unilateral telangiectatic macules without other associated cutaneous lesions. In one case, the telangiectasias had appeared 12 months earlier; in the other, they had been present since birth. The morphology and distribution pattern were consistent with unilateral nevoid telangiectasia, which is characterized by multiple unilateral telangiectasias arranged linearly by dermatome. The congenital form is rare, persists into adulthood, and is not associated with other vascular malformations. The acquired form resolves spontaneously after exclusion of the precipitating factor. Laser therapy is effective for unesthetic and/or persistent lesions.