NASCER E CRESCER - BIRTH AND GROWTH MEDICAL JOURNAL

Dermatology clinical case

Bárbara Leal, Daniela Ribeiro, Catarina Matos, Sónia Coelho — Fri, 05 Apr 2024 00:00:00 +0100

A previously healthy nine-month-old boy presented to the Emergency Department with a two-week history of rash that started in the diaper area and later extended to the trunk, limbs and face. The mother reported a family history of psoriasis. The child had multiple erythematous papules and plaques on the face, trunk, diaper area, and limbs. He was diagnosed with guttate and napkin psoriasis and started on topical treatment, with good response. Psoriasis is a chronic condition that can manifest clinically at any stage of life. In pediatric age, the presence of a positive family history is common and guttate or napkin psoriasis are typical clinical presentations. Sometimes, napkin psoriasis rapidly progresses to a more widespread form, typically involving the face. The diagnosis is clinical and must be differentiated from other common causes of exanthema and diaper rash in infants.

Involuntary movements in an adolescent

Mafalda Moreira, Diana Alba, Inês Paiva Ferreira, Cláudia Monteiro — Fri, 05 Apr 2024 00:00:00 +0100

Extrapyramidal symptoms (EPS), such as dystonia, akathisia, and parkinsonism, are movement disorders that have been described as a side effect of antipsychotic medications in adults. In children, their use has expanded, as have this type of symptoms, especially those caused by first-generation antipsychotics. Paliperidone is a second-generation drug approved for schizophrenia in adolescents. The authors describe the case of a 12-year-old boy with a chronic disruptive behavior disorder who was admitted to the Emergency Department with tongue protrusion, inability to speak, eye rolling, and body tremors since that day. He was treated with paliperidone, the dose of which had been doubled in the previous month. Examination revealed dystonia of the eyes, mouth, and tongue, and increased neck tone. Biperiden was administered with complete resolution of symptoms after five minutes, and paliperidone was discontinued. This case suggests that caution should be exercised when prescribing antipsychotics (even second-generation agents). As the use of antipsychotics in children is increasing, pediatricians should be familiar with the acute presentation of side effects of these drugs.

Ear pain − Not always otitis

Fri, 05 Apr 2024 00:00:00 +0100

Acute auricular perichondritis is an infection of the external ear that can lead to potentially serious complications if not promptly diagnosed and treated. The authors present the case of a five-year-old boy who was diagnosed with acute perichondritis after presenting to the Pediatric Emergency Department with acute ear redness, swelling, and pain. The diagnosis of acute perichondritis was established based on the classic physical examination findings of erythema and edema with sparing of the earlobe.

One bacteria, multiple foci

Fri, 05 Apr 2024 00:00:00 +0100

A previously healthy 16-year-old male with a ten-day history of proptosis and pain in the left upper eyelid and inflammatory signs of the left lower limb, without fever, was admitted to the Emergency Department. Computed tomography (CT) scan revealed an extensive intraorbital lesion and a multiloculated collection in the muscle planes of the thigh. The boy underwent surgical drainage and was started on empiric antibiotics. Methicillin-susceptible Staphylococcus aureus was isolated from blood and exudate cultures. Because the boy remained febrile, a chest CT scan was performed, which revealed bilateral cavitary lung lesions. He completed a long course of antibiotherapy. The study for potential immunodeficiency disorders was unremarkable.
Most pediatric cases of community-associated Staphylococcus aureus bacteremia are associated with a localized source of infection. Diagnosis depends on isolation from blood and fluid aspirates. Treatment usually requires surgical drainage and intravenous antibiotherapy. Staphylococcus aureus bacteremia may be associated with multiple foci of infection, which should be recognized promptly.

Pediatric Alport Syndrome: From Diagnosis to Transitioning Care

Ana Marta Gomes, Idalina Beirão — Fri, 05 Apr 2024 00:00:00 +0100

Management of low systemic blood flow in extremely preterm infants

Catarina Couto, Elisa Proença — Fri, 05 Apr 2024 00:00:00 +0100

Extremely preterm infants are at significant risk for low systemic blood flow and inadequate organ perfusion. A comprehensive evaluation of clinical, laboratory, echocardiographic, and end-organ perfusion markers allows for a pathophysiology-based and individualized approach to low blood flow states. The aim of this article was to review the diagnosis and management of low systemic blood flow in extremely preterm infants.

Oral iron therapy for pediatric restless legs syndrome: An evidence-based review

Ana Lucas, Gisela Leite, João Correia — Fri, 05 Apr 2024 00:00:00 +0100

Restless legs syndrome (RLS) is a sensorimotor neurological disorder that affects sleep and has a significant impact on mood, behavior, cognition, and function. Genetics, the brain dopamine system, and iron deficiency are known to play important roles in its pathophysiology. The aim of this study was to review the current evidence on the effectiveness of oral iron supplementation in the treatment of pediatric RLS. A total of six publications were included: one guideline and five observational studies. Although there is limited evidence to draw definitive conclusions about the effectiveness of oral iron in the treatment of pediatric RLS, initiation of oral iron at a dose of 3−8.5 mg/kg/day for 12 weeks when ferritin levels are below 50 ng/dL appears to be beneficial. Given the small number of studies on this topic and their limitations, B-level SORT strength of recommendation was assigned.

Deliberate self-harm in adolescence: a cross-sectional study

Fri, 05 Apr 2024 00:00:00 +0100

Introduction: The high prevalence of deliberate self-harm (DSH) and its strong association with suicide make the condition a natural target for intervention to prevent harmful consequences for adolescents. The aim of this study was to determine the prevalence of DSH and to characterize DSH patterns and associated risk factors in a sample of adolescents.
Methods: A cross-sectional study was conducted by applying a questionnaire based on the “Lifestyle and Coping Questionnaire” adapted to the Portuguese language. Adolescents aged between 12 and 17 years attending the outpatient clinic of a secondary-care hospital were invited to participate. Data were analyzed by descriptive, bivariate, and regression analysis using SPSS v.25 software.
Results: A total of 159 eligible responses were obtained from adolescents with a mean age of 15 years. Of the 25.8% who reported having engaged in DSH, the majority (61%) did so more than once, and the same percentage did not seek help. A statistically significant association was found between DSH and befriending less easily, having a history of bullying, and seeking online information on how to self-harm. A significantly higher risk of self-harm was found among adolescents who had experienced a variety of negative life events (adjusted odds ratio [aOR] 1.47, confidence interval [CI] 1.231-1.1763; p<0.01), whereas having no health problems (aOR 0.356, CI 0.13-0.969; p=0.04) and not using drugs (aOR 0.087, CI 0.012-0.633; p=0.016) were protective factors.
Conclusions: DSH is a common but often overshadowed problem in adolescents. The findings of this study highlight the need for careful assessment of adolescents with better screening for DSH and associated risk factors.

Impact of the COVID-19 pandemic on pediatric hospital admissions: Retrospective study in a Portuguese level II hospital

Fri, 05 Apr 2024 00:00:00 +0100

Introduction: Since the emergence of SARS-CoV-2, pediatric admissions from all causes have decreased. This was mainly due to a decrease in all common respiratory diseases, such as bronchiolitis and pneumonia. The aim of this study was to evaluate the impact of the pandemic on pediatric admissions and diagnoses in a level II hospital.
Methods: A retrospective analysis was conducted, including all children admitted to a Portuguese level II hospital between March 2020 and December 2021 and the homologous period 2018-2019. The number of admissions, most common diagnoses, and demographic data were analyzed.
Results: A total of 2956 admissions were included. A 44.1% decrease in pediatric hospital admissions was observed with the onset of the COVID-19 pandemic. Admissions for common communicable diseases such as acute bronchiolitis, acute gastroenteritis, varicella, and stomatitis decreased. An increase in respiratory illnesses, mainly due to respiratory syncytial virus, was observed when the pandemic restrictions ended.
Conclusion: The COVID-19 pandemic had a major impact on pediatric hospital admissions. Social distancing measures and the use of masks limited the transmission of common infectious diseases previously responsible for hospital admissions. Future studies are needed to understand whether the changes in respiratory virus epidemiology were transient.

TRAP sequence – A case of successful conservative management

Fri, 05 Apr 2024 00:00:00 +0100

Twin reversed arterial perfusion (TRAP) is a rare sequence that complicates monochorionic multiple pregnancies. This condition affects both fetuses - the acardiac twin and the pump twin. This report presents the case of a monochorionic multiple pregnancy complicated by TRAP diagnosed in the first trimester. After clarifying the couple and multidisciplinary discussion, conservative management was chosen because no genetic abnormalities or complications were identified in the normal twin development throughout pregnancy, and the acardiac twin stopped growing at 16 weeks, resulting in a vaginal term delivery of a healthy baby. In utero intervention is currently the first-line treatment option in these cases, but several studies have reported the benefits of an expectant approach. The optimal approach has not yet been established.

Successful off-label use of omalizumab in a child with chronic spontaneous urticaria

Tânia Gonçalves, Iolanda Alen Coutinho, Joana Sofia Pita, Paula Leiria Pinto — Fri, 05 Apr 2024 00:00:00 +0100

Omalizumab is approved as third-line therapy for patients older than 12 years with antihistamine-refractory chronic spontaneous urticaria.
The authors present the case of an eight-year-old boy with a history of migratory maculopapular skin lesions, arthralgias, and conjunctival hyperemia. Laboratory findings were unremarkable. Skin biopsy was consistent with urticaria. Treatment with oral betamethasone and quadruple dose of bilastine was initiated, with clinical resolution of arthralgias and conjunctival hyperemia, but no improvement in skin lesions. After five months of illness, the patient developed several side effects of corticosteroids and was started on cyclosporine, with no clinical response after four weeks of treatment. At this point, he was started on off-label omalizumab 300 mg every four weeks, and corticosteroid therapy was discontinued after one month of treatment. After the third administration of omalizumab, the boy achieved complete clinical resolution.
Omalizumab may be an effective and safe treatment for antihistamine-refractory chronic spontaneous urticaria in pediatric age.

Rumination in eating disorders – A case report

Fri, 05 Apr 2024 00:00:00 +0100

Rumination syndrome is characterized by both voluntary and involuntary postprandial regurgitation. Although some physiological and psychological factors have been studied, the underlying mechanism is not yet understood.
The aim of this study was to review the comorbid association between rumination and eating disorders based on the clinical case of a 13-year-old adolescent girl with purging anorexia nervosa who presented with ruminative episodes.
Rumination syndrome in adolescents is often associated with comorbid mental health disorders. In eating disorders, the diagnosis has some additional challenges due to the secrecy surrounding this behavior and its heterogeneous presentation. Although still largely unknown to most clinicians, rumination syndrome in adolescents may be partly responsible for emotional and organic deterioration and should therefore be addressed.