Reatividade cruzada entre penicilinas e cefalosporinas: mudança de paradigma

Allergic reactions to beta-lactam antibiotics are the most common cause of allergic drug reactions. The incorrect diagnosis prevents patients from receiving a highly effective therapy. The potential cross-reactivity between penicillin and cephalosporin has very significant therapeutic implications. Penicillins and cephalosporins share a common beta-lactam ring and side chains. A number of studies indicate that the R1 side chain, rather than the ring itself, is the determining factor for cross-reactivity. Herein is presented a review of the immunologic mechanisms implicated in penicillin and cephalosporin cross-reactivity and a practical approach to the use of cephalosporins in patients allergic to penicillin.info:eu-repo/semantics/publishedVersio

Radiographic control of medical devices in neonatology: a narrative review

Introdução: A gestão clínica dos recém-nascidos nas unidades de cuidados intensivos neonatais implica a colocação de diversos dispositivos médicos invasivos que necessitam de controlo radiográfico. O principal objetivo deste trabalho consistiu em realizar uma revisão narrativa sobre as boas práticas a adotar na aquisição de imagens radiográficas, em unidades de cuidados intensivos neonatais, para o controlo de dispositivos médicos de acordo com a literatura publicada e a experiência dos autores. Material e Métodos: Realizou-se uma revisão narrativa da literatura. Recorreu-se às bases de dados científicas PubMed; Science Direct; Google Scholar e Portal RCAAP, para a recolha de documentos de análise. Foram, ainda, consultados livros das coleções particulares dos autores. Resultados: A revisão narrativa incidiu sobre 39 documentos, dos quais 26 artigos científicos, quatro guidelines/consensos/recomendações e nove livros/capítulos de livro. Desenvolvimento: A colocação de cateteres intravasculares, sondas nasogástricas e tubos endotraqueais são procedimentos interventivos habitualmente utilizados na prestação de cuidados a recém-nascidos prematuros internados nas unidades de cuidados intensivos neonatais. O posicionamento preciso destes dispositivos é essencial e a radiografia do tórax e abdómen desempenha um papel de extrema relevância no controlo e monitorização da colocação destes dispositivos. Os desafios técnicos inerentes à realização destes exames radiográficos assumem uma exigência suplementar atendendo aos ajustes ao posicionamento e parâmetros de exposição em relação à população adulta. Os parâmetros de aquisição, bem como o pós-processamento da imagem, deverão ser otimizados de forma a permitirem visualizar o trajeto dos dispositivos médicos em toda a sua extensão e demonstrarem inequivocamente a posição da sua extremidade distal. Ao mesmo tempo a imagem terá de apresentar leitura anatómica suficiente para a monitorização de eventuais lesões iatrogénicas. Conclusão: O célere reconhecimento radiográfico de dispositivos incorretamente colocados, assim como, as complicações que podem originar, é essencial para uma rápida intervenção que permita a prevenção do agravamento do estado clínico do recém-nascido.info:eu-repo/semantics/publishedVersio

Caso clínico dermatológico

The case of a teenager with guttate psoriasis secondary to trauma and upper airway infection is reported. Guttate psoriasis is the second most common psoriasis variant in pediatric age. Infection and trauma (leading to Koebner phenomenon) seem to be major triggers of the condition. The diagnosis is clinical. Most cases with no previous history of psoriasis spontaneously remit. Topical corticosteroids and vitamin D analogs, as well as phototherapy, are the first-line treatments.info:eu-repo/semantics/publishedVersio

Efficacy and safety of vutrisiran for patients with hereditary transthyretin-mediated amyloidosis with polyneuropathy: a randomized clinical trial

Background: The study objective was to assess the effect of vutrisiran, an RNA interference therapeutic that reduces transthyretin (TTR) production, in patients with hereditary transthyretin (ATTRv) amyloidosis with polyneuropathy. Methods: HELIOS-A was a phase 3, global, open-label study comparing the efficacy and safety of vutrisiran with an external placebo group (APOLLO study). Patients were randomized 3:1 to subcutaneous vutrisiran 25 mg every 3 months (Q3M) or intravenous patisiran 0.3 mg/kg every 3 weeks (Q3W) for 18 months. Results: HELIOS-A enrolled 164 patients (vutrisiran, n = 122; patisiran reference group, n = 42); external placebo, n = 77. Vutrisiran met the primary endpoint of change from baseline in modified Neuropathy Impairment Score +7 (mNIS+7) at 9 months (p = 3.54 × 10-12), and all secondary efficacy endpoints; significant improvements versus external placebo were observed in Norfolk Quality of Life-Diabetic Neuropathy, 10-meter walk test (both at 9 and 18 months), mNIS+7, modified body-mass index, and Rasch-built Overall Disability Scale (all at 18 months). TTR reduction with vutrisiran Q3M was non-inferior to within-study patisiran Q3W. Most adverse events were mild or moderate in severity, and consistent with ATTRv amyloidosis natural history. There were no drug-related discontinuations or deaths. Conclusions: Vutrisiran significantly improved multiple disease-relevant outcomes for ATTRv amyloidosis versus external placebo, with an acceptable safety profile.This study was funded by Alnylam Pharmaceuticals Inc. The fundercollaborated with authors during study design, data collection, dataanalysis, data interpretation, and writing of the report. All authors hadfull access to all the data in the study and had final responsibility forthe decision to submit for publication.info:eu-repo/semantics/publishedVersio

Mastocitose cutânea maculopapular

Mastocytosis is a rare disorder caused by proliferation and accumulation of mast cells in various tissues, with characteristic symptoms associated with the release of their mediators. Its cutaneous form, usually benign, is the most frequent among children. The authors report the case of a two-month-old male infant who presented to the Emergency Department with small, tan-to-brown macules and papules distributed mainly on the trunk, which progressively became nodular and bullous, with one month of evolution. Darier´s sign was positive. The absence of systemic signs and analytic (including serum tryptase level) and echographic changes was consistent with the diagnosis of maculopapular cutaneous mastocytosis, or urticaria pigmentosa, subsequently confirmed by skin biopsy. Treatment with anti-histaminic therapy and topical immunosuppressant and avoidance of triggering factors led to a positive outcome.info:eu-repo/semantics/publishedVersio

Hemostatic spray as therapy for pancreatic stump bleeding after cephalic duodenopancreatectomy

A 70-year-old man with a cholangiocarcinoma underwent a cephalic duodenopancreatectomy. On the 2nd postoperative day, he had hematemesis without hemodynamic instability. Upper endoscopy (EGD) revealed a massive clot at the pancreatic stump, suspected as the source of hemorrhage. After partial clot removal, no active bleeding was found and no therapy was performed. Pancreaticogastric and gastrojejunal anastomoses, as well as the efferent-limb, showed no suspicious lesions. Octreotide was initiated and heparin prophylaxis was temporarily stopped. Bleeding from pancreatic stump following pancreatoduodenectomy is a rare but a life-threatening condition. Conventional endoscopic therapies, including clip placement and cautery, are mostly ineffective and with high risk of pancreatitis. We report the second case of hemostatic powder as a safe and successful therapy in this scenario.info:eu-repo/semantics/publishedVersio

Entre a Perturbação Obsessivo-Compulsiva e a Psicose

Introduction: Obsessive-compulsive disorder is an heterogeneous condition in which periods of altered perception or delusions may arise. Similarly, individuals with psychotic disorders may have obsessive-compulsive symptoms. Case report: A male adolescent presented to the Emergency Department (ED) with obsessive symptomatology with three months of evolution. Three weeks later, he returned to the ED showing symptom worsening and reporting delusions, being admitted to the inpatient unit to clarify the diagnosis. No positive symptoms were reported during hospitalization. During follow-up, the patient reported an episode of apparent delusional perception that he associated with the beginning of symptoms, again raising the question of whether a psychotic episode was present. Discussion/Conclusions: The distinction between obsessive-compulsive disorder and psychosis is not always clear, with obsessive-compulsive disorder being a significant comorbidity in patients with a first psychotic episode. Close patient assessment is required for early diagnosis and appropriate intervention.info:eu-repo/semantics/publishedVersio

Caso clínico pneumológico

Post-extubation acute pulmonary edema (PEAPE) is an uncommon complication of tracheal extubation, occurring in 0.1% of patients undergoing general anesthesia. It has rarely been described in pediatric age, but its incidence is thought to be underestimated, as many cases of post-operative respiratory distress may be misdiagnosed or unrecognized. A formerly healthy 15-year-old male diagnosed with acute appendicitis was submitted to a laparoscopic appendectomy under general anesthesia. Immediately after extubation, he developed signs and symptoms of respiratory distress, and chest radiograph was compatible with acute pulmonary edema. Due to suspicion of PEAPE, supplementary oxygen and intravenous furosemide were administered, with favorable outcome. PEAPE is a major anesthesia-related emergency, which may worsen the prognosis of low-risk surgical procedures. A high degree of suspicion should be maintained in children and adolescents presenting with signs of respiratory distress and hypoxia after general anesthesia, as prompt diagnosis and treatment are crucial for a favorable outcome.info:eu-repo/semantics/publishedVersio

Gastroenterite aguda por Campylobacter spp. no Serviço de Urgência Pediátrica de um hospital de nível II

Introduction: Campylobacter spp. is the main cause of pediatric acute bacterial gastroenteritis (ABG) in the European Union, with greater incidence in children under five years old. Most patients present complete recovery within days of infection, with no associated comorbidities. Antibiotic therapy should be reserved for severe cases. Objectives: The aim of this study was to investigate the epidemiology, symptoms, treatment, and complications of Campylobacter spp. infection in pediatric patients with ABG. Material and methods: Case-by-case review of the clinical records of patients evaluated in the Pediatric Emergency Department of a level II hospital with a diagnosis of ABG and Campylobacter spp. isolated from stool samples over a five-year period (2013-2017). Results: Of the 1990 stool tests performed, 637 (32%) were positive for the presence of bacteria. Campylobacter spp. was identified in the samples of 459 patients (72%). Eighteen patients were excluded for insufficient data, making up a final sample of 441 patients, with a mean age of three years old. Clinically, patients presented with aqueous diarrhea (59.6%), bloody diarrhea (43.8%), bloody and mucus diarrhea (15.4%), mucus diarrhea (3.9%), vomiting (36.3%), abdominal pain (24.3%), fever (63%), seizures (0.9%), and rash (0.2%). Eighty-nine patients were hospitalized. Eleven patients received antibiotic therapy. Discussion: This study represents the largest national case-by-case review of ABG by Campylobacter spp. in the pediatric population. Campylobacter was the main bacteria identified, mostly associated with self-limited disease. Conclusion: A judicious use of stool tests allows etiological identification in ABG. The growing number of cases of ABG by Campylobacter spp. reinforces the need for better hygiene procedures.info:eu-repo/semantics/publishedVersio

SARS-CoV-2 and hearing: An audiometric analysis of COVID-19 hospitalized patients

Purpose: COVID-19 associated hearing loss is still an ongoing matter of debate. No original studies exist on audiological effects of SARS-CoV-2 infection in hospitalized patients. The main objective was to determine whether SARS-CoV-2 may affect auditory function in clinically ill COVID-19 patients. Materials and methods: COVID-19 patients with moderate-severe disease and without prior history of hearing abnormalities were enrolled from a tertiary referral center, and matched with controls. Participants performed an audiometric evaluation, and thresholds were compared. Results: 120 ears from 60 patients were enrolled. Patients with COVID-19 showed worse mean auditory thresholds starting from 1000 Hz through higher frequencies, when compared to controls (1000 Hz: 18.52 ± 5.49 dB HL in controls vs 25.36 ± 6.79 dB HL in COVID-19, p < 0.001; 2000Hz: 17.50 ± 5.57 dB HL in controls vs 21.96 ± 7.05 dB HL in COVID-19, p = 0.010; 3000Hz: 17.97 ± 8.07 dB HL in controls vs 25 ± 9.38 dB HL in COVID-19, p = 0.003; 4000 Hz: 20.16 ± 10.12 dB HL in controls vs 29.55 ± 11.26 dB HL in COVID-19, p = 0.001; 8000 Hz: 31.09 ± 12.75 dB HL in controls vs 40.71 ± 19.40 dB HL in COVID-19, p = 0.030; Pure Tone Average: 20.42 ± 4.29 dB HL in controls vs 24.85 ± 5.62 dB HL in COVID-19, p = 0.001). Statistical significance persisted after adjusting for confounders such as age, gender and various comorbidities (p < 0.05). Conclusions: SARS-CoV-2 may affect hearing in COVID-19 patients with moderate-severe disease. Results are in line with the previous suggested effects of COVID-19 on auditory system. This study is expected to encourage further research on this topic.info:eu-repo/semantics/publishedVersio