Acute pancreatitis in children : a tertiary hospital report

INTRODUCTION: 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

Drug Allergy with Cutaneous Manifestations. Diagnostic Approach

As reacções adversas a fármacos (RAF) representam um problema frequente na prática clínica. A alergia a fármacos resulta de mecanismos de hipersensibilidade imunológica e representa 6-10% do total de RAF. Clinicamente, as reacções alérgicas a fármacos podem ser classificadas como imediatas (tipo I) ou não-imediatas (com manifestações clínicas diversas e associadas sobretudo a reacções de tipo IV). Neste artigo são abordados aspectos gerais, nomeadamente os mecanismos imunopatogénicos implicados na alergia a fármacos e reactividade cruzada mas também as manifestações cutâneas mais relevantes, nomeadamente exantemas máculo-papulares, eritema fixo a fármacos (EFF), pustulose exantemática aguda generalizada (PEAG), síndrome de hipersensibilidade a fármacos (DRESS – drug rash with eosinophilia and systemic symptoms), síndrome de Stevens-Johnson/necrólise epidérmica tóxica (SSJ/NET). O papel dos testes cutâneos (epicutâneos ou intradérmicos de leitura tardia) na abordagem de reacções não-imediatas é também revisto. Os beta-lactâmicos (BL) são o grupo farmacológico mais frequentemente envolvido em reacções de hipersensibilidade imunológica e que mais dificuldades coloca na prática clínica diária, nomeadamente devido aos riscos de reactividade cruzada, pelo que é analisado em maior detalhe ao longo da revisão. A indução de tolerância a fármacos poderá ser considerada em casos selecionados, sobretudo quando na ausência de alternativas terapêuticas igualmente eficazes ou seguras

Mais do que uma causa rara de hipertensão arterial pulmonar no idoso

© 2020 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).An 80-year-old woman with a history of systemic hypertension and dual-chamber pacemaker implantation for sick sinus syndrome presented to the hospital with worsening dyspnea and fatigue for several months. The chest X-ray (Figure 1A) showed a markedly enlarged cardiac silhouette along with a tubular opacity (dotted lines) paralleling the right heart border. Echocardiographic examination depicted dilated right heart chambers, right ventricular dysfunction and a high probability of pulmonary hypertension.info:eu-repo/semantics/publishedVersio

Diagnosis of Eosinophilic Esophagitis in an Infant Undergoing Milk Oral Immunotherapy - A Case Report

Although the standard of care for cow’s milk (CM) allergy is strict food avoidance, oral immunotherapy (OIT) is being widely investigated as an alternative management option in certain cases. Immediate adverse reactions to OIT have been described, but its long-term effects are much less often reported. We present the case of a girl diagnosed with IgE-mediated CM allergy that was proposed for our CM OIT protocol at the age of 3 years. The first sessions (dose escalation up to 5 ml) were well tolerated, however eight hours after her daily morning dose of 5ml CM the child developed late episodes of vomiting. No other symptoms, particularly immediately after CM ingestion, were reported. These episodes became progressively worse and on the third day she presented mild dehydration and blood eosinophilia. After OIT interruption, a progressive clinical improvement was observed. An esophageal endoscopy was performed, showing signs of eosinophilic esophagitis (EoE) with peak 20 eosinophils/hpf. After treatment with topical swallowed fluticasone (500 mcg bid) and a CM-free diet for 4 months, the child was asymptomatic and endoscopy and biopsy findings were normal. The long-term effects of milk OIT are still in part unknown. We hypothesize that eosinophilic esophagitis may have been a consequence of OIT in this case. The findings seem to indicate that food allergy may play a role in the pathogenesis of esophageal eosinophilia and stress the importance of a well programmed long-term follow-up of patients that have undergone milk OIT

Relevância do VANT no processo de representação e produção de Arquitetura

The emergence of the airplane as an influential element for architects of the twentieth century’s modern movement, has transformed the knowledge and modes of interpreting the landscape, which has a reflection in planning and interacting with the territory. In the 21st Century, the relevance of the aircraft is perpetuated with the emergence of the Unmanned Aerial Vehicles (UAV) - commonly designated as drones - in the airspace of the city. The democratization of this technology transforms the urban airspace, promoting a paradigm shift from contemporary reality and influencing aspects such as privacy, security, urban planning and regulations of airspace utilization. On the professional scope, the relevance of the UAV in the process of representing and producing Architecture becomes one of its most influential points by enabling new forms of action by the architect and expanding his autonomy, technical capacity and awareness of the scenarios where he intervenes. With the aim of framing the relevance of these vehicles in the process of representation and production of architecture, this work exposes the main valences of UAVs in architecture, by investigating their specifications and applications in different areas. The development of a case study with a UAV and aerial digital photogrammetry made it possible to test the developed premises

Sistema óptico de baixo custo para monitorização dinâmica de estruturas

Neste trabalho descreve-se a implementação de um sistema baseado em tecnologia óptica, sendo o elemento sensor uma rede de Bragg (FBG). Pretende-se um sistema de baixo custo que permita a monitorização dinâmica de estruturas, nomeadamente para determinação das suas frequências naturais, com elevada capacidade de multiplexagem, sendo esta uma propriedade intrínseca a dispositivos baseados em FBG’s. O sistema implementado apresenta uma sensibilidade de 0.985 V/G

Accidental Exposures in Food Allergy

Introdução: A recomendação habitual no tratamento da alergia alimentar é a evicção completa, até à aquisição de tolerância. É importante perceber em que situações ocorrem falhas na evicção, de forma a orientar o melhor possível o doente com alergia alimentar. Objectivo: Conhecer a frequência e caracterizar as exposições acidentais, num grupo de doentes com alergia alimentar. Material e métodos: A partir dos registos do Serviço de Imunoalergologia do Hospital Dona Estefânia, foram seleccionados doentes com idade ≤ 10 anos com alergia às proteínas do leite de vaca, ovo, peixe, amendoim ou frutos secos. Os pais/prestadores de cuidados responderam a um inquérito telefónico referente ao alimento implicado, falhas na dieta e sintomas. Resultados: Contactou -se um grupo de 65 doentes com idade média de 4,3 anos (63% do sexo masculino), totalizando 69 casos de alergia alimentar – cerca de 42 casos de alergia ao leite, 11 casos de alergia ao peixe, 10 de alergia ao ovo, 5 de alergia aos frutos secos e 1 de alergia ao amendoim. Na maioria dos casos a primeira reacção foi desencadeada por ingestão (95,6%) e foi imediata (78,3%), manifestando -se por sintomas mucocutâneos (MC) em 75,4%, gastrintestinais em 33,3% e respiratórios em 23,2%. Ocorreu anafilaxia em 17%. Houve falhas na dieta em 68,1% dos casos, que contabilizaram um total de 68 eventos de exposição acidental, na maioria (87,1%) com sintomas. Destes 68 eventos de exposição acidental, em 69,1% (n=47) o leite foi o alimento implicado, em 14,7% (n=10) foi o ovo, em 13,2% (n=9) o peixe e em 2,9% (n=2) os frutos secos. As manifestações clínicas mais frequentes foram MC (55,9,9%), seguindo -se as do tracto respiratório (25%) e as do tracto gastrointestinal (23,5%). Em 20,5% dos eventos de exposição acidental, ocorreu reacção anafiláctica. A maior parte das ingestões/exposições acidentais ocorreram em casa (36,8%) e na escola (29,4%). Perante a reacção foi administrada terapêutica em 41,2%, aguardaram resolução espontânea 38,2% e recorreram ao serviço de urgência 20,6% dos casos. Conclusões: As falhas na dieta de evicção foram frequentes, a maioria com sintomas. Aconteceram maioritariamente em casa e na escola, o que pode sugerir lacunas no conhecimento dos pais/prestadores de cuidados. A caracterização das exposições acidentais nos doentes com alergia alimentar poderá ajudar a optimizar a transmissão de informação, a estes e aos seus responsáveis, relativamente à prevenção de situações de risco

The Portuguese observatory on occupational psychosocial factors: contribution for public health

To achieve the goal of sustainable employment, considering the profile of the Portuguese working population (PWP), is needed a range of strategies to ensure long, productive, and sustainable careers allied with a better quality of working life, health, and wellbeing, but also with public health policies grounded on scientifically validated and reliable data. This is possible through a comprehensive working system approach that ensures workers will be mentally and physically able to remain at work by the balance between work demands and individual resources allied with public health policies transfer into the workplaces by organizations’ leadership and policy makers. The Portuguese Observatory on Occupational Factors (Popsy@Work) aims at addressing this global challenge by: i) digitally collecting psychosocial data on the PWP; ii) implementing and strengthening of a psychosocial occupational health surveillance digital system; iii) providing reference values for the PWP concerning Psychosocial Health; iv) Transferring to society knowledge and best practices; v) Raising awareness on the importance of psychosocial management in occupational settings based on science. Popsy@work is a digital platform that collects and aggregates psychosocial data analytically and creates a visualization hub adding value to data on the PWP and giving science back to society in a usable way, empowering workers, strengthening organizations and grounding public policies. Pospy@Work considers the development of strategic intelligence on levels and inequalities of psychosocial health and well-being in occupational settings by robust metrics and reference data. Creating opportunities for national policy dialogue on inequalities, including the psychosocial health of the PWP through collaboration with diverse sectors identifying and mapping subgroups of populations whose unmet needs require specific outreach measures

Nuevos datos petrográficos, geoquímicos y geocronológicos del plutón de Reguengos de Monsaraz (Zona de Ossa Morena, SO del Macizo Ibérico, Portugal)

The Reguengos de Monsaraz pluton is a late to post-tectonic Variscan intrusion occurring in the Ossa Morena Zone (Iberian Variscan Chain). The dominant lithological types are tonalites and granodiorites, but the internal area of the massif is composed of gabbro-dioritic rocks. Field evidence shows that the intrusion is heterogeneous at mesoscopic scale suggesting that the emplacement of mafic and felsic magmas was contemporaneous. Petrographic and geochemical studies reveal that the different lithologic types define a continuous sequence with compositions varying from metaluminous to slightly peraluminous and a typical calc-alkaline signature. In Harker variation diagrams, it is possible to observe systematic rectilinear correlations pointing to the involvement of magma mingling/mixing processes in the petrogenesis of this sequence. Rb-Sr isotopic data, using a mineral-mineral pair from a granodiorite sample, yielded an age of 298 Ma, interpreted as a cooling age after igneous crystallization.El plutón de Reguengos de Monsaraz es una intrusión varisca tardi- a post- tectónica localizada en la Zona de Ossa Morena (Cadena Varisca Ibérica). Los tipos litológicos dominantes son las tonalitas y las granodioritas aunque la zona mas interna del macizo está formada por rocas gabro-dioríticas. Las evidencias de campo muestran que todos los tipos litológicos son heterogéneos a escala mesoscópica y sugeren que el emplazamiento de los magmas máficos y félsicos fue contemporáneo. Los estudios petrográficos y geoquímicos muestran que los diferentes litotipos definen una secuencia continua con una afinidad calcoalcalina típica y composiciones variando desde metaluminosas a peraluminosas. En los diagramas de Harker se observan correlaciones rectilíneas sistemáticas, lo que sugiere que la mezcla de magmas tuvo un papel decisivo en su petrogénesis. Los datos isotopicos de Rb-Sr, usando un par mineral-mineral de una granodiorita, da una edad de 298 Ma, que se interpreta como la edad del enfriamiento posterior a la cristalización ígnea