Browsing by Issue Date, starting with "2024-06-30"
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- The emerging landscape of SGLT2 inhibitors in pediatric populations with kidney diseases: A comprehensive literature reviewFreitas, Joana; Machado, Sara Nogueira; Vieira, Beatriz; Monteiro, Sara; Faria, Sameiro; Costa, Teresa; Mota, ConceiçãoSodium-glucose cotransporter 2 inhibitors (SGLT2i), originally developed as innovative antihyperglycemic agents, have demonstrated significant benefits in improving metabolic markers and protecting the kidneys and heart in patients with or without type 2 diabetes mellitus. The mechanisms behind these unexpected cardiorenal benefits cannot be attributed solely to improved glycemic control. Recent data suggest that metabolic reprogramming plays a role in the development of cardiorenal metabolic disease.Despite the effectiveness of SGLT2i in the management of chronic kidney disease (CKD)-related comorbidities in adults, their use in the pediatric population remains to be validated. The challenge in pediatric CKD lies in the imbalance between the metabolic needs of a growing child and the declining functional capacity of a failing kidney. Developing strategies to address modifiable factors in the progression of kidney disease is critical given the extended lifespan of the pediatric population. SGLT2i have emerged as innovative candidates for the treatment of CKD in children. By improving renal hemodynamic adaptation and mitigating overall CKD complications, these agents have the potential to be a novel therapeutic option for pediatric patients. This review will focus on the current understanding of how SGLT2i may provide cardiorenal protection.
- Sleep habits and screen use in an adolescent population during the COVID-19 pandemicVieira, Paula Manuel; Cascais, Inês; Alba, Diana; Bernardo, Ana; Faria, João; Feio, Ana; Coelho, Margarida Paiva; Ribeiro, Maria do Céu; Gomes, Lúcia; Fonseca, Paula; Rios, MartaIntroduction: Screen use among adolescents has increased, with excessive screen time associated with poor sleep. Isolation due to the COVID-19 pandemic may have exacerbated these problems. This study aimed to characterize adolescents’ sleep and screen use behaviors during the COVID-19 pandemic lockdown.Methods: This was a multicenter, cross-sectional, descriptive study of adolescents aged 10 to 18 years evaluated in an Adolescent Medicine outpatient visit of four hospitals in northern Portugal between January and March 2021. Adolescents completed a survey with questions about screen use and sleep and the Pediatric Daytime Sleepiness Scale (Portuguese version).Results: A total of 131 adolescents (66.4% female; median age 15 years) were enrolled during the study period. Participants reported a median sleep duration of nine hours on weekdays and 10 hours on weekends, with 25.9% sleeping less than eight hours on weekdays. Approximately 80% reported good or very good sleep quality. Onset insomnia was identified in 39.7% and excessive daytime sleepiness (EDS) in 13.7%. Most adolescents (74.0%) reported screen time of ≥6 hours/day. Screens were mainly used for attending classes and talking to friends. Smartphones were available in the bedroom at night for 83.2%, while 61.1% had televisions, 57.3% had computers, and 16.0% had gaming consoles in their bedrooms. Fifty-five percent used screens within an hour of bedtime every day. Screen time ≥6 hours/day and having a computer or smartphone in the bedroom at night were associated with shorter sleep duration on weekdays and EDS. Screen use within an hour of bedtime ≥4 times/week was associated with sleep-onset insomnia, shorter weekday sleep duration, and EDS. Discussion: Online classes during the COVID-19 lockdown may explain the use of devices ≥6 hours/day. Although most adolescents reported normal median sleep time and subjective good or very good sleep quality, screen use ≥6 hours/day and within one hour before bedtime was associated with sleep deprivation on weekdays and EDS.Conclusions: Excessive screen time during the pandemic appears to have had a negative impact on adolescents’ sleep. These findings underscore the importance of identifying and intervening in these issues when addressing adolescent global health.
- Anterior fontanelle closure time in 684 healthy Portuguese childrenCosta, Ricardo Craveiro; Salgado, Joana Rosmaninho; Oliveira, Daniela; Mendes, Francisca; Silva, Alexandre; Salgado, ManuelIntroduction and Aim: The timing of anterior fontanelle (AF) closure may be a useful marker for early disease detection. However, the few published studies on this topic have reported significant differences in the normal age ranges of AF closure between countries. The aim of this study was to report AF closure time in the Portuguese population during the last two decades.Methods: This was a 21-year retrospective observational study of healthy Portuguese children conducted from January 1999 to December 2019. Data on the age of AF closure were collected by a single pediatrician during outpatient child visits at specific ages (1, 2, 4, 6, 9, 12, 18, 24, 30, and 36 months) and during unscheduled visits due to appointment changes or illness. Clinically closed AF was defined as the absence of a depressible fontanelle on physical examination. AF closure time was calculated as the mean age between the age of the last palpable AF and the age of the first clinically closed AF. Results: A total of 684 children (gestational age ≥37 weeks, birth weight ≥2500 grams) were evaluated, of whom 364 (53.2%) were boys. The mean ± 1 standard deviation (SD) age of AF closure was 14.3 ± 4.9 months (range 2−33 months). The 2.5th and 97.5th percentiles, representing ± 2 SD of AF closure time, were 6 and 25 months, respectively. Other percentiles were P5 - 7 months, P25 - 11 months, P50 - 14 months, P75 - 16 months, and P95 - 22 months. Noteworthy, 0.6% and 3.1% of children had a closed AF at three and six months, respectively, while 2.9% still had an open AF at 24 months. AF closure occurred earlier in males than in females (13.6±4.7 vs. 15.1±5.0, p <0.001). A statistically significant difference was found in the mean ± 2 SD of the gender comparison (p=0.045).Conclusions: This study showed a normal distribution of AF closure age in Portuguese children. The acknowledgment of age-related variations in AF closure timing in different populations is important to raise clinicians’ awareness for timely suspicion and detection of pathologic cases and the need for clinical study.
- When vitamin supplementation would make all the differencePicão de Carvalho, Clara; Carmo, Filipa; Martins, Rosa; Matos, Eugénia; Torres, Erica; Rebelo, MónicaIntroduction: Dietary intake is insufficient to provide adequate levels of vitamin D during the first year of life and supplementation is required. The main function of calcitriol is to regulate calcium-phosphorus metabolism. Its deficiency can lead to hypocalcemia with severe clinical manifestations. Case Report: A six-month-old melanodermic female infant, exclusively breastfed until five months of age without cholecalciferol supplementation, was admitted for respiratory distress that progressed to severe bradycardia requiring resuscitation. Cardiac ultrasound was compatible with dilated cardiomyopathy, and the girl was admitted to the Intensive Care Unit. She later developed seizures, and neuroimaging was compatible with hypoxic-ischemic encephalopathy. Laboratory studies revealed hypovitaminosis D and hypocalcemia. Replacement therapy was initiated. Due to lack of improvement and poor prognosis, palliative care was provided, and the patient eventually died.Discussion/Conclusions: Vitamin D supplementation in the first year of life is essential to prevent calcium-phosphorus metabolism disorders and secondary cardiomyopathy, cardiogenic shock, and even death.
- From behavioral inhibition in toddlers to anxiety disorder: Influencing factorsMonteiro, Maria do Rosário; Rodrigues, Márcia; Martins, VâniaBehavioral inhibition (BI), a biologically driven temperamental trait defined by fearful, avoidant, and withdrawn reactions to novelty, is known to represent an early vulnerability in the development of anxiety disorders. Herein is reported the case of two 18-month-old twins whose parents exhibited high levels of anxiety, restricting the infants’ exposure to new stimuli and experiences. One of the twins exhibited inhibited behaviors with high physiological activation and met criteria for inhibition to novelty disorder. Several factors may predict the persistence of BI across the lifespan and moderate its association with later anxiety disorders, including cognitive or attentional biases, variations in neural functioning, attachment processes, parental psychopathology, and parenting practices. The COVID-19 pandemic exacerbated parental anxiety and pre-existing risk factors in particularly vulnerable children.
- An atypical presentation of pediatric malignant spinal cord compressionGaia, Maria João; Lopes, Vilma; Tenente, Joana; Coelho, Janine; Real, Marta Vila; Santos, FátimaBackground: Malignant spinal cord compression (MSCC) is a rare but serious complication of pediatric malignancies that can result in permanent neurologic deficits. The prognosis depends on neurological symptoms at diagnosis. Case report: A nine-year-old girl was evaluated for worsening pain in the left anterior iliac spine with one month of evolution. Over the next two days, she showed progressive gait instability and low back pain. During hospitalization, she developed decreased strength and sensitivity in the lower limbs, hyperreflexia with clonus, Babinski sign, and inability to walk. Magnetic resonance imaging showed a compressive intracanalicular lesion at D8-12, later identified as Ewing sarcoma. The patient was treated and had no sequelae. Conclusion: Clinicians should be aware that MSCC may have an atypical presentation, such as pain in an unusual location, and early recognition is essential to improve prognosis.
- Bronchial carcinoid tumor as a cause of recurrent pneumoniaGomes, Rita; Carvalho, Catarina; Silva, Gisela; Silva, Sílvia Ferreira; Paupério, Gonçalo S; Carvalho, Fátima; Barbosa, TelmaNeuroendocrine tumors (NETs) are the most common primary lung neoplasms. Clinical manifestations can be subtle, and chest radiograph usually shows non-specific findings, often leading to delayed or inaccurate diagnosis. Despite their indolent nature, NETs have metastatic potential and can cause significant morbidity. Early diagnosis is critical for optimal management, as surgical resection can be curative. The challenge is to correctly diagnose this rare entity while avoiding unnecessary testing. Patients with suspected NETs should be referred to a tertiary hospital for multidisciplinary evaluation, and bronchoscopy should not be delayed. Herein is reported the case of an adolescent with asthma who presented with nonspecific respiratory and constitutional symptoms. The persistence of symptoms and imaging alterations despite multiple treatments for recurrent pneumonia raised clinical suspicion of a more serious underlying condition, leading to the diagnosis of bronchial NET.
- Lymphadenopathy, weight loss, and anal lesion in a teenagerSousa, Jessica; Nisa, Madalena Meira; Coelho, Sónia; Antunes, JoaquinaSyphilis is a systemic disease with an increasing incidence in adolescents and young adults. Clinical manifestations can be variable and diagnosis requires a high index of suspicion, as syphilis can mimic other systemic diseases. Condylomata lata is a highly infectious manifestation of secondary syphilis, reported in 9-44% of cases. Here is reported the case of an adolescent girl who presented with inguinal lymphadenopathies, urinary and constitutional symptoms, and a history of unprotected sex with her boyfriend, who had been previously diagnosed with a genital ulcer. A complete physical examination was performed, and the detection of an anal lesion raised the hypothesis of perianal condylomata lata as a manifestation of secondary syphilis. All signs and symptoms of infection resolved with treatment. Early detection, appropriate treatment, and prevention of transmission are essential to reduce the burden of the disease.
- Sever’s disease: A diagnosis to rememberVieira, Daniela Costa; Pinto, Sara Martins; França, Ângela Santos; Silva, Margarida Trigo; Paniagua, ClaudiaSever’s disease, or calcaneal apophysitis, results from a local inflammatory process at the calcaneal growth plate and is one of the most common causes of disabling heel pain in physically active children.Herein is described the case of a ten-year-old child with chronic insidious pain in the left heel associated with physical activity. Physical examination led to the diagnosis of Sever’s disease. After appropriate treatment, a marked improvement in the child’s clinical status was noted.As a common cause of heel pain in children, this condition can be identified and diagnosed in primary care, with the family physician being responsible for its management and explaining its benign nature.
- A case of unexpected travelersSilva, Ana Castelbranco; Lança, Ana Ferreira; Nunes, Tómas; Martins, Rita; Ferreira, Maria GomesHuman myiasis is the infestation of humans with dipterous larvae. Cutaneous myiasis is the most common form and is one of the most common travel-associated skin diseases. The condition should be suspected when furuncle or boil-like skin lesions are observed in patients travelling from endemic regions. Herein is described the case of a toddler who had travelled from Guinea-Bissau seven days earlier and presented with a six-day history of painful furuncle-like swellings on the left thigh and scrotum. Two larvae were collected from one of the lesions, and entomological analysis confirmed the diagnosis of cutaneous myiasis. Complete larvae extraction is the primary treatment goal, and adequate preservation of the maggots is essential for public health analysis.