CT volumetry performs better than nuclear renography in predicting estimated renal function one year after living donation

The evaluation of split renal function (SRF) is a critical issue in living kidney donations and can be evaluated using nuclear renography (NR) or computerized tomography (CT), with unclear comparative advantages. We conducted this retrospective study in 193 donors to examine the correlation of SRF assessed by NR and CT volumetry and compared their ability to predict remaining donor renal function at 1 year, through multiple approaches. A weak correlation between imaging techniques for evaluating the percentage of the remaining kidney volume was found in the global cohort, with an R2 = 0.15. However, the Bland-Altman plot showed an acceptable agreement (95% of the difference between techniques falling within - 8.51 to 6.11%). The predicted and observed eGFR one year after donation were calculated using the CKD-EPI, and CG/BSA equations. CT volume showed a better correlation than NR for both formulas (adjusted R2 of 0.42. and 0.61 vs 0.37 and 0.61 for CKD-EPI and CG/ BSA equations, respectively). In non-nested modeling tests, CT volumetry was significantly superior to NR for both equations. CT volumetry performed better than NR in predicting the estimated renal function of living donors at 1-year, independently from the eGFR equation.info:eu-repo/semantics/publishedVersio

Anuário Científico do CHUP 2021

O Anuário Científico de 2021 é um documento integrador da produção científica do Centro Hospitalar Universitário do Porto (CHUP). O Serviço de Investigação Clínica do Departamento de Ensino, Formação e Investigação (DEFI), com a edição deste anuário, pretende partilhar a atividade científica hospitalar com a comunidade e os seus profissionaisinfo:eu-repo/semantics/publishedVersio

Geriatric otorhinolaryngology: reasons for outpatient referrals from generalists to ENT specialists

Purpose: To determine the main symptoms leading to referral of geriatric patients from primary care to otorhinolaryngology. Methods: Retrospective, observational study performed on patients aged 65 and older, referred from Primary Care to the Otorhinolaryngology and Head and Neck Surgery department of a tertiary centre during 2019 and 2020. Symptoms leading to otorhinolaryngological referral were categorized as "Oto-neurological symptoms", "Nasal symptoms", "Pharyngolaryngeal symptoms", "Other Head and Neck symptoms" and "Other Reasons". Data regarding age, gender and whether patients maintain follow-up or have been discharged was also collected. Results: The study population included a total of 1304 patients (697 female; 607 male). Oto-neurological symptoms were found to be the most prevalent symptoms, with 65% of patients reporting oto-neurological symptoms as at least one of the reasons for referral. Hearing loss was the most commonly reported symptom, with an association found between this symptom and age (p < 0.001). Results also showed an association between the female gender and vertigo/dizziness (p < 0.001) and tinnitus (p = 0.007). An association between the male gender and nasal symptoms was also found (p = 0.018), particularly nasal obstruction (p = 0.003) and epistaxis (p = 0.028). No statistically significant associations were found among the pharyngolaryngeal group. Conclusions: This retrospective observational study allowed for a better understanding of the type of otorhinolaryngological symptoms affecting elderly patients and driving otorhinolaryngology evaluation, cementing hearing loss as one of the major complaints among older adults and allowing for a better preparation by otorhinolaryngologists for the changing needs of this subset of the population.info:eu-repo/semantics/publishedVersio

Síndrome de fuga de ar espontâneo num Departamento de Emergência Pediátrica: Experiência de 11 anos

Introduction: Due to lack of data, the management of air leaks in children and adolescents is based on protocols for adults. In this study, the authors review and report their institutional experience in the area. Methods: Retrospective and descriptive study of spontaneous air leak cases diagnosed in a Portuguese Pediatric Emergency Department (PED) between January 2007 and December 2018. Results: Twenty-one episodes of spontaneous air leak were diagnosed in 16 patients (87.5% male), with a mean (± standard deviation) age of 14.3 (± 5.1) years. Eighteen cases of spontaneous pneumothorax were reported, fifteen of which primary (eleven first-time episodes and four recurrences) and three secondary (two first-time episodes and one recurrence) to asthma. Three cases of pneumomediastinum with subcutaneous emphysema were identified, two of which related to infection. Smoking habits and/or recent physical activity were major triggers. Pleuritic chest pain was the most frequent symptom on admission. Conservative treatment was the only approach used in six cases. Most cases required thoracic drainage, five of which required surgical intervention. Discussion: This study shows similar demographic features, triggers, and clinical presentation to those reported in the literature for these cases. The management of the condition was based on recommendations established for adults. Conclusion: Although spontaneous air leak is an uncommon condition, it is a reality in PED. Prospective studies in pediatric age are required to develop adequate recommendations for children and adolescents.info:eu-repo/semantics/publishedVersio

Pancreatite Aguda na Idade Pediátrica: casuística de 10 anos de um hospital nível II

Introduction: The incidence of acute pancreatitis (AP) in children is increasing, together with the awareness of the need for pediatric-specific management recommendations. This study aimed to assess the epidemiology, etiology, management, and clinical course of pediatric AP cases followed at a secondary hospital. Methods: Retrospective analysis of all pediatric AP cases admitted to a level II hospital in the metropolitan area of Lisbon, Portugal, between January 2009 and December 2018. Results: Eight cases of pediatric AP were identified, with an average age of 12 years (minimum 4 years, maximum 16 years) and classified according to etiology as drug-induced (n=3), biliary (n=1), infectious (n=1), and idiopathic (n=3). Recurrent AP was identified in one patient. The median hospital stay was 6.5 days. The main symptoms at presentation were abdominal pain (100.0%) and vomiting (75.0%). All patients had increased levels of amylase activity in serum (>3 times the upper limit of normal). Pancreatic image abnormalities were observed in five patients (62.5%), four in the abdominal ultrasound and one in computed tomography scan. One patient underwent endoscopic retrograde cholangiopancreatography. Two patients received a course of antibiotics. All cases were classified as mild, according to the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition classification. Discussion: This series showed a predominance of secondary over idiopathic AP, in agreement with recently published studies reporting a reduction in the incidence of idiopathic AP due to increased efforts to identify the underlying causes of the disease. Since the incidence of AP is increasing in pediatric age, physicians should be aware of recent recommendations for the optimal management of the condition in this age group.info:eu-repo/semantics/publishedVersio

Caracterização dos hábitos de brincar, sono e comportamento em crianças em idade pré-escolar

Introduction: Playing is a fundamental activity of childhood. The primary goal of this study was to characterize the playing habits of Portuguese children aged between three and five years old. The secondary goals were to investigate children’s sleeping habits, audiovisual media exposure, and behavior, as well as caregivers ́ perception of these.Material and methods: Observational study based on the application of an online questionnaire to parents and caregivers about children’s sociodemographic features, playing habits, exposure to screens, sleep, and behavior.Results: A total of 240 questionnaires were retrieved, 58.3% (n=140) of which regarding male children. Overall, 93.9% (n=225) of children attended or had previously attended kindergarten, 56.9% (n=137) practiced at least one extracurricular activity, 64.4% (n=155) played outdoors in most days, and 80.9% (n=194) played with their peers. Most caregivers (68.3%, n=164) daily played with their children, but 95% (n=228) would like to do it more often. Free play was preferred among children (64%, n=154). Most children (77.4%, n=186) had contacted with audiovisual media before the age of 18 months. Most caregivers (89.6%, n=215) considered that their children slept well, with 27.4% (n=66) acknowledging that they threw frequent tantrums and 21.3% (n=51) that they were impulsive or aggressive. Most caregivers recognized the importance of playing for children. Regarding sleep habits and behavior, lower focus in quiet activities (odds ratio [OR] 4.638, 95% confidence interval [CI] 1.902-11.314) and more regular tantrums (OR 2.317, 95% CI 1.022-5.250) were independent predictors of sleeping problems. Conclusion: Free playing, frequent outdoor playing, and playing with other children stood out as protective factors of children’s physical and mental health. However, inadequate screen exposure and schedule overload with structured activities represent concerns that should be addressed in Pediatric appointments. Family-centered playful learning should be encouraged.info:eu-repo/semantics/publishedVersio

Vacinação Anti-Sarampo, Parotidite e Rubéola na criança com alergia ao ovo

Introduction: Egg allergy is one of the most common food allergies in childhood. Administration of the measles, mumps, and rubella (MMR) vaccine is recommended in pediatric age. Despite the presence of traces of egg protein in its composition, the literature recommends MMR vaccine administration regardless of the patient’s past egg allergy history, identifying cases in which the administration should occur in hospital setting. Purpose: To characterize the pediatric population referred to the Allergy and Clinical Immunology Department of Centro Hospitalar Universitário do Porto for MMR vaccine administration and investigate vaccination safety in children with egg allergy or sensitization. Methods: This was a retrospective observational study of clinical records of children with confirmed or suspected egg allergy referred to the Allergy and Clinical Immunology Department for administration of the MMR vaccine between January 1, 2013 and December 31, 2019. Results: Among 60 children studied, 90% presented symptoms upon egg intake, with cutaneous reactions being the most prevalent (67%) and four reported cases of anaphylaxis. Allergy to cow’s milk protein (55%), followed by allergy to other foods (45%) were the most frequent personal histories of allergic diseases. Asthma was identified in 10% of patients and was controlled in all cases. Among children referred for vaccination booster dose, one had had a reaction to the previous MMR vaccine dose. Three children developed late local skin reactions, and one had a late systemic reaction after vaccination. All children had negative oral food challenge. Conclusion: MMR vaccine administration is safe and recommended in pediatric age, regardless of egg allergy history. However, immunization should be performed in hospital setting in children with a history of anaphylaxis due to egg allergy, previous anaphylactic reaction to MMR vaccine or one of its constituents, uncontrolled asthma with documented egg allergy, and uncontrolled asthma with allergy to a previous MMR vaccine dose.info:eu-repo/semantics/publishedVersio

Defeitos congénitos da glicosilação

Congenital disorders of glycosylation are a highly variable, rapidly expanding family of genetic diseases that result from defects in the synthesis of glycans. The vast majority of these monogenic diseases are inherited in an autosomal recessive way, but some types follow an autosomal dominant or X-linked inheritance. The present work aimed to review the state of the art of congenital disorders of glycosylation, including available therapeutic options, and present a simplified diagnostic approach to this group of diseases. Congenital disorders of glycosylation can be classified into four categories: N-linked glycosylation defects, O-linked glycosylation defects, combined glycosylation defects, and glycosphingolipid and glycosylphosphatidylinositol anchor synthesis defects. The phenotype may range from mild to severe, depending on disease severity. Clinical features include dysmorphic features, neurologic, dermatologic, cardiac, endocrine, immunologic, hematologic, gastrointestinal and liver involvement, and skeletal muscle abnormalities. As there is no universal or pathognomonic sign or symptom and no sensitive diagnostic test, it is of foremost importance to keep a high index of suspicion of these diseases. When a congenital disorder of glycosylation is suspected, the first step in screening is to perform serum transferrin isoelectric focusing. Molecular genetic testing is the most specific diagnostic test. Treatment is usually symptomatic, with specific treatment only available for some of these disorders. Since congenital defects of glycosylation may affect any organ at any age and have variable clinical presentation, they should be considered in the differential diagnosis of any patient with multiorgan involvement.info:eu-repo/semantics/publishedVersio

Febre persistente e expectoração hemoptóica – caso clínico

Foreign body aspiration (FBA) is a common and serious problem in children. Considering that signs and symptoms can be non-specific and subtle, it is of utmost importance to recognize vulnerable patient groups, combine an accurate history with complete physical examination, and follow a structured diagnostic approach towards correct diagnosis. In the present case, a high index of suspicion was essential to prevent a delay in FBA diagnosis, discuss the appropriate management strategy and improve patient outcomes.info:eu-repo/semantics/publishedVersio

Uma causa rara de tumefação axilar

Axillary swelling is a common condition in pediatric age. The most common diagnosis is lymph node swelling, but it can also be caused by soft tissue tumors, vascular lesions, or inflammation of sweat glands. In rare cases, it can be due to ectopic breast tissue (EBT). A 14-year-old female presented with right axillary pain with one year of evolution and swelling for the past two months, gradually increasing in size, especially during menstruation. Sonography revealed EBT in both axillae, and further study showed duplication of the excretory system in both kidneys. The tissue on the right axilla was excised. EBT should be considered in the differential diagnosis of axillary swelling in adolescents and young females. When the diagnosis is established, the presence of associated urologic anomalies should be investigated. Clinicians should be aware that EBT can undergo the same pathological changes as normally located breast tissue. Surgical removal should be considered for cosmetic and prophylactic treatment.info:eu-repo/semantics/publishedVersio