Browsing by Author "Antunes, H"
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- Acute Alithiasic Cholecystitis and Human Herpes Virus Type-6 Infection: First CasePublication . Gomes, MM; Antunes, H; Lobo, AL; Branca, F; Correia-Pinto, J; Moreira-Pinto, JA three-year-old male child presented with erythematous maculopapular nonpruritic generalized rash, poor feeding, vomiting, and cramping generalized abdominal pain. He was previously healthy and there was no family history of immunologic or other diseases. On examination he was afebrile, hemodynamically stable, with painful palpation of the right upper quadrant and positive Murphy's sign. Laboratory tests revealed elevated inflammatory markers, elevated aminotransferase activity, and features of cholestasis. Abdominal ultrasound showed gallbladder wall thickening of 8 mm with a positive sonographic Murphy's sign, without gallstones or pericholecystic fluid. Acute Alithiasic Cholecystitis (AAC) was diagnosed. Tests for underlying infectious causes were negative except positive blood specimen for Human Herpes Virus Type-6 (HHV-6) by polymerase chain reaction. With supportive therapy the child became progressively less symptomatic with gradual improvement. The child was discharged on the sixth day, asymptomatic and with improved analytic values. Two months later he had IgM negative and IgG positive antibodies (1/160) for HHV-6, which confirmed the diagnosis of previous infection. In a six-month follow-up period he remains asymptomatic. To the best of our knowledge, this represents the first case of AAC associated with HHV-6 infection.
- Acute pancreatitis in children : a tertiary hospital reportPublication . Antunes, H; Nascimento, J; Mesquita, A; Correia-Pinto, JINTRODUCTION: The incidence of acute pancreatitis (AP) in children has increased significantly in the past two decades. OBJECTIVE: All cases of AP, acute recurrent pancreatitis (ARP), and chronic pancreatitis examined between May 2002 and May 2012 at Hospital de Braga, Portugal, were reviewed. MATERIAL AND METHODS: Patients were identified by searching the hospital's electronic discharge records for the International Classification of Disease, Ninth Revision (ICD-9) code 577.0 (acute pancreatitis). ARP was considered as two or more episodes of AP per year or more than three episodes over a lifetime with intervening return to baseline. The following data were analyzed: demographic information, clinical, laboratory and imaging test results, etiology of pancreatitis, medical and surgical management, length of hospitalization, and outcome. The clinical and laboratory factors used in the pediatric acute pancreatitis severity score system and computed tomography severity index (CTSI) score were compared between patients with mild and severe disease. RESULTS: A total of 37 patients, 31 episodes of AP and 6 patients with ARP, were documented. The most prevalent etiologies were biliary stones/sludge (24.3%) and trauma (16.2%). Admission elevated white blood cell count (p=0.011), 48-h trough calcium (p=0.007), and 48-h rise in blood urea nitrogen (p=0.025) correlated significantly with disease severity. CTSI on admission had a score below 4 in three patients with severe disease. CONCLUSION: This Portuguese pediatric pancreatitis report highlights the multiple and complex etiology of this disease. Better pediatric scoring systems and management algorithms are needed.
- Alimentação e nutrição do lactentePublication . Guerra, A; Rêgo, C; Silva, D; Ferreira, GC; Mansilha, H; Antunes, H; Ferreira, R
- O atraso de desenvolvimento nas crianças com anemia por deficiência de ferro. Poderá ser revertido pela terapêutica com ferro?Publication . Antunes, H; Gonçalves, S; Teixeira-Pinto, A; Costa-Pereira, AOBJECTIVE: To compare development of 17 children aged 12 months with iron deficiency anaemia (IDA) and 18 controls without IDA after a 3-months follow-up period and iron therapy in the IDA group. SUBJECTS AND METHODS: Development of all children was evaluated using the Griffith's Scale. Data was collected on parent's social class and education, breast-feeding, number of siblings and clinical nutritional status. RESULTS: At 12 months children with IDA had significantly lower development scores--mean (sd)--than those without IDA: 112(5) vs. 121(7). At 15 months, after iron therapy, there were no significant differences between cases and controls. Non-IDA children showed significantly lower development scores at 15 months when compared with 12 months (121 vs 115). CONCLUSIONS: The study shows that iron therapy can revert some of the adverse effects in the development of children with IDA and therefore both IDA prevention and treatment can be justified.
- Avaliação do desempenho de três câmaras de expansãoPublication . Abreu, S; Silva, LF; Teixeira, S; Marques, HC; Ramalhete, N; Antunes, HIntroduction: Several aspects are known to influence the drug distribution within the low respiratory tract, with particular emphasis on those related to the inhalation device. The aim of this work was to assess the performance of three spacers in the drug release, and also the quantity of active agent deposited inside these devices. Materials and Methods: In order to evaluate the behaviour of particles in suspension delivered through the Ventilan®HFA inhaler coupled to three different spacers (Volumatic®, AeroChamber MAX® and NebuChamber®) the Multistage Liquid Impinger (MSLI) was used, according to the Portuguese Pharmacopoeia. The mass of salbutamol sulphate deposited on the different impinger compartments and inside the spacer was determined by spectrophotometry, with the purpose of determining the percentage of cumulative mass for each spacer, and then the fine particle fraction. The results were compared statistically using a one-way analysis of variance (one-way ANOVA) with a Bonferroni post-hoc test. Results: About 40 to 50% of salbutamol sulphate was found deposited in the body of the three spacers. This deposition was slightly lower for NebuChamber® (average ± standard deviation of 43.8 % ± 11.6 %), in relation to Volumatic® (p=0.351) or AeroChamber MAX® (p=0.115). The fine particle fraction reached values of 28.2 ± 4.1%, 29.6 ± 2.4% and 30.9 ± 6.7% for Volumatic®, AeroChamber MAX® and NebuChamber®, respectively. Conclusion: The spacers showed to have similar efficiencies in the delivery of salbutamol sulphate in the last stages, and there was no relation between the results and the spacers characteristics such as volume, shape and material. Therefore, Volumatic® appears to be perfect for hospital use, since its big volume does not constitute a disadvantage, and its lower cost, when compared to the remaining two spacers, represents an advantage of utmost importance for public hospitals.
- A case of pediatric paraparesis secondary to an idiopathic acute transverse myelitisPublication . Teixeira, J; Carvalho, S; Martins, S; Pontes, T; Machado, A; Antunes, HIntroduction: Acute transverse myelitis (ATM) refers to a frequently idiopathic, segmental spinal cord inflammation. It is a rare condition, in particular in children, and not previously reported in a family retinitis pigmentosa (RP) clinical setting. Case Report: An 11-year-old previously healthy girl, with a family history of RP, presented with a subacute flaccid paraparesis, with bilateral, up to the fourth dorsal level, mixed sensory hypoesthesia and autonomic dysfunction. Brain and spinal cord magnetic resonance imaging (MRI) showed an extensive, T2-hyperintense, non-contrast enhancing lesion from the second to fifth dorsal levels. Cerebrospinal fluid (CSF) and lab studies were normal, as the ophthalmologic observation. Treated with high-dose corticosteroids and intensive physical therapy,a significant recovery could be seen. Conclusion:Early pharmacological and physical treatment is fundamental and may indeed change the prognosis of this disease ATM. The family history of RP, although probably incidental, brings nevertheless the issue of a possible etiological contribution, or pathologic common pathways.
- Chediak-Higashi syndrome: pathognomonic featurePublication . Antunes, H; Pereira, A; Cunha, I
- Children's exposure to second hand smoke at home: A cross-sectional study in Portugal.Publication . Vitória, PD; Machado, JC; Araújo, AC; Ravara, SB; Samorinha, C; Antunes, H; Rosas, M; Becoña, E; Precioso, JSecond-hand tobacco smoke (SHS) is a major indoor pollutant that causes serious health problems for all exposed, especially children. Children are often exposed to SHS at home, due to parental or other households' or guests' smoking. This study describes Portuguese children's exposure to SHS at home (total and by Portuguese main regions). In 2010/2011, a questionnaire was applied to a sample of Portuguese children in the 4th grade (N=3187, mean age 9.05±0.7 years, 51.1% male). Descriptive analysis, chi-square tests and crude odds ratios were performed. Of the participants, 62.9% of those with smoking parents and 19.2% of those with non-smoking parents were exposed to SHS at their home. Parental smoking varied significantly among regions and was significantly associated with children's exposure to SHS at home. Children's exposure to SHS at home was high, especially if their parents smoke. Children living in Lisbon Region presented the highest SHS exposure rate. The association of SHS exposure with geographic regions suggests the influence of social and contextual factors on smoking behaviour and on tobacco control effectiveness. Our findings highlight the need to effectively prevent children's SHS exposure at their home and to develop tailored tobacco control measures by region.
- Choque tóxico por streptococcus B hemoliticus do grupo APublication . Pontes, T; Antunes, HIn the last years has been observed an increased incidence of invasive group A beta-hemolytic streptococcal infections, including the toxic shock syndrome. The most common portal of entry is the skin and mucous membranes. The toxic shock syndrome can occurred as a rare complication of pharyngitis. The association between varicella and the use of nonsteroidal antiinflammatory drugs with necrotizing fasciitis by Streptococcus pyogenes has been discussed without reach at consensus, but some authors disapproved the use of nonsteroidal antiinflammatory drugs in this viral infection. The authors reported the clinical case of a 12 year old adolescent, that 15 days after the diagnosis of mononucleosis infectious confirmed by serology and treated with ibuprofen, was internment by streptococcal toxic shock syndrome with rhabdomyolysis, hepatitis, cellulitis of the leg, arthritis of the knee and pleural effusion. Therapeutics was made with penicillin G and clindamycin. We present this case for the severity of the clinical situation and for the questions that rise.
- Comportamentos de risco e excesso de peso na adolescência: revisão da literaturaPublication . Rosa, MF; Gonçalves, S; Antunes, HA adolescência é uma fase de maior vulnerabilidade para o envolvimento em comportamentos de risco. Paralelamente, o excesso de peso pode ter implicações pessoais e inter-pessoais que podem pôr em causa o bem-estar psicológico dos adolescentes e potenciar o envolvimento em comportamentos de risco. Objectivo: Analisar estudos sobre comportamentos de risco (ferimentos auto-infligidos e consumo de substâncias) num contexto de obesidade ou sobrepeso na adolescência, observando o papel que certas variáveis psico-sociais podem ter na sua moderação. Métodos: Pesquisa de livros e em bases de dados de artigos científicos sobre o tema. Resultados: Os resultados das investigações que procuram associações entre o excesso de peso na adolescência e o cometimento de ferimentos auto-infligidos e/ou consumo de substâncias são pouco consistentes. Alguns estudos mostram que os adolescentes obesos apresentam mais comportamentos de risco, ao passo que outros mostram que o excesso de peso e a obesidade nos jovens parecem estar associados a uma frequência menor ou idêntica deste tipo de comportamentos nos seus pares de peso saudável. Existem evidências de que a regulação emocional, a participação em actividades sociais e o suporte social proporcionado pelos pares e família podem moderar estes comportamentos de risco nos adolescentes com excesso de peso. Conclusão: O excesso de peso não é necessariamente um factor de risco para que os adolescentes cometam ferimentos auto-infligidos ou enveredem por padrões de consumo de álcool e tabaco mais problemáticos, podendo no entanto existir factores psico-sociais que tornem os adolescentes com excesso de peso mais vulneráveis a este tipo de comportamentos. (Discussão) A investigação sobre a associação entre o excesso de peso e o desenvolvimento de comportamentos de risco é reduzida. O número de estudos torna-se ainda mais escasso se reduzirmos os estudos existentes à população adolescente. Relativamente aos ferimentos auto-infligidos, a investigação tem vindo a estudar a relação entre suicídio e obesidade, mas pouco se sabe sobre a prevalência dos vários tipos de comportamentos auto-infligidos e dos perfis de auto-regulação mais frequentes na população jovem obesa. Apesar disso a presença de ferimentos auto-infligidos na adolescência demonstra que é independente da condição de excesso de peso. No entanto outros estudos mostram que o excesso de peso pode traduzir-se em maior vulnerabilidade para cometer ferimentos auto-infligidos. A ausência de resultados consensuais a este nível alerta para o facto de ser urgente explorar esta relação ao mesmo nível do que já foi efectuado no âmbito das perturbações alimentares como a bulimia e a anorexia nervosa. Diversos autores têm encontrado níveis elevados de co-ocorrência da bulimia nervosa e de ferimentos auto-infligidos, tendo ambos sido conceptualizados como estratégias mal-adaptativas de regulação emocional ou de lidar com a insatisfação com a imagem corporal. Nesta linha comprova-se que as dificuldades de auto-regulação também podem ser comuns à obesidade, tornando-se fundamental aprofundar a sua ligação aos ferimentos auto-infligidos. Reflectindo sobre o impacto do sobrepeso no consumo de álcool, surge uma grande diversidade de resultados. Se por um lado encontramos estudos que reforçaram uma relação directa entre o IMC dos adolescentes e o consumo de substâncias, por outro outras investigações mais recentes apontam na direcção contrária. Esta incongruência pode dever-se a aspectos sócio-demográficos específicos da amostra seleccionada para cada estudo (como o sexo e a idade), ou a outros factores de ordem psico-social. Quanto ao consumo de tabaco as investigações mais recentes indicam um aumento do seu consumo nos jovens com excesso de peso em relação aos jovens de peso saudável. A ideia partilhada pelos adolescentes de que o uso de tabaco faz perder peso pode explicar a maior prevalência do uso de tabaco nos adolescentes com excesso de peso em relação a adolescentes com peso normal. A literatura refere ainda que as dificuldades de integração no grupo de pares, sentidas por vezes pelos adolescentes obesos, podem levar a um maior envolvimento nestes comportamentos. Factores como o estado emocional, o suporte familiar, o grau de participação em actividades sociais e a relação com os pares podem assim exercer uma influência negativa ou positiva na prevalência dos comportamentos de risco nos adolescentes com excesso de peso. Também aqui os resultados dos estudos empíricos não permitem dados conclusivos. (...) (Conclusão) O excesso de peso por si só não é necessariamente um factor de risco para o cometimento de ferimentos auto-infligidos e para o consumo de substâncias. No entanto existem factores demográficos e psico-sociais que podem interferir nesta relação, podendo tornar os adolescentes com excesso de peso mais ou menos vulneráveis à adopção destes comportamentos. Os profissionais de saúde desempenham aqui um papel importante na educação para a saúde, podendo alertar os adolescentes para as consequências deste tipo de comportamentos, principalmente os associados ao excesso de peso.