Browsing by resource type "text"
Now showing 1 - 10 of 18
Results Per Page
Sort Options
- Um achado incomum no exame da fontanela anteriorPublication . Pinho, Catarina Marques; Teixeira, Joana Vidal; Nogueira, Antony; da Silva, Ana Ribeiro; Martins, AlexandraIntrodução: A palpação da fontanela anterior permite avaliar o volume e pressão intracranianos. Uma fontanela tensa numa criança tranquila e observada em posição vertical sugere hipertensão intracraniana, que pode ter várias etiologias, nomeadamente processos neoformativos. Caso clínico: Uma lactente do sexo feminino, de dois meses de idade, recorreu a consulta na sua Unidade de Saúde Familiar por tumefação na fontanela anterior. Objetivou-se a presença de tumefação nodular, de consistência mole, com cerca de 1 cm de maior diâmetro. A ecografia transfontanelar revelou um provável quisto epidermoide. A lactente foi referenciada para Cirurgia Pediátrica, tendo realizado ecografia de controlo após dois meses, que revelou crescimento da lesão, motivo pelo qual foi referenciada para Neurocirurgia. Efetuou ressonância magnética encefálica, que confirmou o diagnóstico ecográfico e excluiu comunicação da lesão com estruturas endocranianas. A lactente manteve seguimento por Neurocirurgia e foi decidido manter vigilância até a fontanela encerrar para realização da cirurgia de exérese. O exame histológico confirmou o diagnóstico de quisto dermoide. Discussão:A vigilância clínica e os achados dos exames imagiológicos demonstraram o carácter benigno da lesão, permitindo adiar a intervenção cirúrgica.
- Arthrogryposis multiplex congenita affecting a monochorionic diamniotic twin pregnancyPublication . Brás, Rafael; Veloso, Helena; Moleiro, Maria; Rodrigues, Sofia; Inocencio, Gonçalo; Mota, Céu; Soares, Gabriela; Rodrigues, Maria Céu; Braga, JorgeArthrogryposis multiplex congenita is a clinically and etiologically heterogeneous group of diseases characterized by presence of contractures involving at least two different body areas. It is observed in one in every 3000−5000 live births. A case of singleton arthrogryposis in a spontaneous monochorionic diamniotic twin pregnancy is reported. Diagnosis was established after morphological ultrasound. There were no further complications during pregnancy. After cesarean delivery, diagnosis of amyoplasia involving the four limbs was confirmed. Newborn is currently undergoing motor rehabilitation. The higher risk of singleton arthrogryposis in monochorionic twin pregnancies is documented and appears to be related with vascular changes early in the course of pregnancy. In amyoplasia, some degree of disability and dependency is expected, even with postnatal rehabilitation.
- Breastfeeding for Better Health – A Community-Based InterventionPadilha, Sofia; Arantes, Pedro; Sarmento de Beires, Teresa; Ribeiro, Joana; Eiras, AndreiaIntroduction: Breastfeeding provides multiple health benefits for both mother and child. Several studies suggest that community interventions enhance breastfeeding literacy, practice and duration. The authors developed an intervention to improve parents’ knowledge of the benefits of breastfeeding in the prenatal period as a means of promoting this practice. Methods: An informative session on breastfeeding was organized for pregnant women registered at USF Rainha D. Amélia and their partners. Questionnaires were implemented before, immediately after, and one month post-session to assess knowledge at these intervals. Statistical analysis included descriptive analysis, comparison between questionnaires and analysis of the effect of several variables on knowledge progression. Results: The study included 33 participants, 78.8% of whom were women. Initial questionnaire results showed 67.3% correct answers, which increased to 91.5% immediately post-session, representing a 36% improvement (p < 0.001). Level of education was the sole predictor of higher initial knowledge (p = 0.023). Age and level of education significantly impacted knowledge progression (p = 0.034), but after adjusting for confounders, only previous attendance of a breastfeeding course predicted greater knowledge progression (p = 0.023). Discussion: The project effectively met its goals, confirming the efficacy of community interventions on breastfeeding conducted by healthcare professionals. Age, level of education, and prior breastfeeding knowledge positively influenced the decision to breastfeed. Father’s involvement and increased understanding of breastfeeding will likely enhance their ability to support the mothers. Conclusion: This community intervention positively impacted breastfeeding literacy.
- Cyberbullying in pre-adolescence - reality of a city in northern PortugalMelo, Vanda; Pacheco, Pedro; Portela, Mariana; Costa, Sandra; Ribeiro, HelenaIntroduction: The rapid evolution of communication technologies has enabled easy and premature access for children and young people to social networks, the internet, and smartphones. The indiscriminate use of these technologies has led to the emergence of cyberbullying. The objective was to analyse the prevalence of cyberbullying and the most frequent forms involved in this age group. Methods: A cross-sectional observational study was conducted through anonymous questionnaires distributed in primary schools (2nd and 3rd cycles) in the municipality. Results: The study included 482 students, with a median age of 12 years (9-15 years), and a similar gender distribution (55% female, 45% male). Regarding the daily screen time, 20.5% reported spending less than 1 hour, 47.7% between 1 to 3 hours, while 31.1% spent more than 3 hours per day. The prevalence of cyberbullying in the studied sample was 30.9%, with 34.9% of them admitting to being victims in the last 3 months, with only 50% requesting help. The most reported type of cyberbullying was being excluded from a chat or social network. In the subsample of children who experienced cyberbullying, a statistically significant relationship was found between victimization and being female (p-value 0.046) and between victimization and being an aggressor (p-value <0.001). Conclusion: According to this study, the exposure to digital technology in this age group is practically universal, with a cyberbullying prevalence of around 31%. This alarming victimization rate occurs during a crucial phase of the child’s social and emotional development.
- Dermatology clinical casePublication . Brandão, Pedro; Falcão-Reis, Inês; Rodrigues, Cátia; Ferreira, Vânia; Sá, IsabelUlcus Vulvae Acutum or Lipschütz ulcer is a rare cause of acute vulvar ulcer that usually affects young, non-sexually active women and consists on the sudden emergence of vulvar ulcers some days after an influenza-like syndrome, usually caused by Epstein-Barr virus. Despite its exuberant presentation, such ulcers are benign and self-limited. Diagnosis is clinical and treatment, symptomatic. Lesions typical resolve within a few weeks, leaving no scars. The authors describe the case of a 17-year-old, sexually active female adolescent with Lipschütz ulcers.
- Feeding difficulties in the offspring of mothers with an eating disorder - a case reportCarvalho e Marques, Pedro; Sá, Teresa; Martins, VâniaBackground: One of the main risk factors for eating disorders (ED) in early childhood is maternal ED. Mothers with a history of ED have difficulties in their approach to feeding their children, with mealtimes being perceived as stressful, with controlling behavior and intrusiveness. Case presentation: An 11-month-old female infant was evaluated at a Child Psychiatry Consultation for feeding difficulties. Her mother had a history of Restrictive Anorexia Nervosa. Mother-child psychotherapy was performed due to a pattern of insecure attachment and an ongoing conflict over control and autonomy between the caregiver-child. After the intervention, mealtimes became more natural and less conflictual. Discussion and conclusion: The authors aim to shed light on the transgenerational transmission of ED. Feeding interactions between mothers with ED and their offspring are less harmonious, with greater conflict, controlling behaviors, negative affect and decreased emotional availability to the child. Clinicians must be aware of a potential parental history of ED when dealing with children with feeding problems.
- Fever from Primary Tooth Eruption – What is the evidence?Publication . Matos, Sara; Silva, PatríciaIntroduction: There is no consensus on the causal relationship between primary dental eruption and both systemic and local signs and symptoms. Fever, an important sign, is often reported. Such lack of evidence hampers clinical reasoning and may contribute to delayed diagnosis of important conditions. Objective: To review existing evidence underlying the association between primary tooth eruption and fever. Methods: A review of the evidence on English, Portuguese and Spanish scientific publications over the last ten years was performed in the main international databases using the query “tooth eruption” and “fever” [MeSH], and in the index of Portuguese medical journals using the query “erupção dentária” and “febre” [DeCS]. SORT system of the American Family Physician was used for rating the strength of evidence. Results: A total of 53 articles were retrieved, from which two meta-analyses and two original studies were selected, comprising a total of 5317 children. Massignan et al. (2016) meta-analysis and Memarpour et al. (2015) clinical trial found a slight temperature increase on the day of primary tooth eruption, but no fever. In Nemezio et al. (2017) meta-analysis, this association was observed in the subgroup that used the rectal method for temperature assessment. Un Lam et al. (2016) observational study reported a fever prevalence of 49.9%. Discussion and conclusions: The present analysis had several limitations, including a significant heterogeneity amongst studies in the definition of fever, interpersonal variability during fever measurements, different fever assessment methods or absence of that information, and no exclusion of confounding factors. Given available evidence, it is not possible to establish a clear association between primary dental eruption and the occurrence of fever. A higher number of robust studies is required to confirm this hypothesis (SORT B).
- Fluid administration − Which direction?Publication . Vaz, Sara; Sousa, Sofia Cochito; Abecasis, Francisco; Boto, Leonor; Rios, Leonor; Camilo, Cristina; Vieira, MarisaIntroduction: Although fluid administration for intravenous hydration is a common practice in pediatric age, it is not devoid of risks. Methods: This was a retrospective cohort study including all children admitted to surgical recovery and receiving intravenous hydration at a Pediatric Intensive Care Unit between January and December 2015. Sodium, chloride, and base excess values were registered on two occasions: after surgery and during Unit’s hospitalization. Results: Two hundred and seven children were included in the study, 66% of which, male, with a median age of 6.7 years. Fluids used consisted of 0.9% saline solution, 0.45% saline solution, and polyelectrolyte solution. The most frequently used fluids were polyelectrolyte (62%) and 0.9% saline solution (48%) at the operating room, and 0.9% saline (63%) and 0.45% saline (44%) solutions at the Pediatric Intensive Care Unit. At the operating room, 0.9% saline solution led to higher chloride median values and more negative base excess (metabolic acidosis) values compared with polyelectrolyte solution. At the Pediatric Intensive Care Unit, 0.9% saline solution administration resulted in hyperchloremia (p=0.002) and more metabolic acidosis (p=0.019) compared with 0.45% saline solution. There was no statistically significant association between type of solution used and sodium values. Discussion: This study shows that the use of 0.9% saline solution is associated with development of hyperchloremic acidosis. This suggests that replacement of 0.9% saline solution with a plasma-like electrolyte solution may improve patient outcomes.
- Hypotonia and feeding problems in the newborn: a congenital myotonic dystrophy type 1 clinical casePublication . Silva, Cláudia Teles; Madureira, Cristina; Melo, Cláudia; Martins, Cecília; Cardoso, Raquel; Miguel, CristinaIntroduction: Congenital myotonic dystrophy type 1 (DM1) is characterized by hypotonia and severe general weakness at birth, often with respiratory distress and even death. Clinical report:A newborn male with prenatal diagnosis of ventriculomegaly and polyhydramnios was born at 39 weeks of gestation with no immediate occurrences and a maternal family history of two cases with unspecified neuromuscular conditions. The newborn was admitted in the second day of life due to feeding problems and desaturation episodes, presenting with hypotonia, non-vigorous crying, facial diplegia, and arthrogryposis of the lower limbs. A genetic study for myotonic dystrophy was requested, which revealed cytosine thiamine and guanine (CTG) expansion in the DMPK gene (1100−1400 repeats), confirming diagnosis of congenital DM1. Discussion and conclusions: Despite the presence of congenital DM1, this newborn presents with a milder phenotype than expected for the condition. Symptom recognition, combined with family history, allowed an early diagnosis and adequate follow-up.
- Imaging clinical casePublication . Martins, Cristiana; Ferreira, Jorge; Pereira, GabrielaIntroduction: Acute hemorrhagic edema of infancy (AHEI) is a rare and benign leukocytoclastic vasculitis, frequently misdiagnosed. Case report: A twelve-month-old boy presented with a seven-day history of coryza and cough associated with lowgrade fever and the sudden appearance of a purpuric rash over the left lower limb. It progressed to an annular purpuric rash, with well-defined edges, on the face, limbs, ears, buttocks, and scrotum, with right tibiotarsal joint edema. Mild thrombocytosis was detected on laboratorial investigation. Patient was treated with a two-day course of oral betamethasone, with clinical improvement. No complications were reported within three weeks of follow-up. Discussion: AHEI has a sudden onset and a benign, self-limiting course. This report may be a helpful reminder to discriminate AHEI from other, more serious diseases, avoiding exhaustive and unnecessary investigation.