‘TB OR NOT TB?’: A Importância de um Rastreio Adequado

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Rifampicin-Resistant Serotype B Neisseria meningitidis: First Case in Portugal

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Lemierre Syndrome in a Teenager Presenting as Pulmonary Septic Embolism

Lemierre syndrome is easily missed and may be more common than generally believed. Usually a complication of a deep neck abscess, it can present suddenly with shortness of breath and hypoxemia. Accurate diagnosis and orientation are mandatory for the treatment of an otherwise potentially life-threatening disease. We describe a case of an adolescent with Lemierre syndrome and septic pulmonary embolism.info:eu-repo/semantics/publishedVersio

Persistent Hypothermia and Excessive Sweating Following Intrathecal Morphine Administration in a Teenage Boy: A Case Report

INTRODUCTION: Opioids are used intrathecally to manage surgical pain. There are few reports of hypothermia after spinal morphine injection, none in the pediatric population. We present a teenager's case of mild hypothermia. CASE PRESENTATION: A 15-year-old boy was scheduled for elective abdominal laparotomy. General anesthesia was combined with spinal anesthesia, using levobupivacaine and morphine. In the recovery room, he presented a decreased tympanic temperature (34.4°C) associated with excessive sweating, hyperglycemia, and complained of feeling hot. All other vital signs were normal. It was decided to maintain clinical vigilance and hourly monitoring of temperature and glycaemia values. Despite active warming, he remained hypothermic for 16 hours, with gradual remission of symptoms and normalization of glycemic values. It is unknown how intrathecal morphine causes hypothermia. The most viable hypothesis is its effect on the hypothalamus. In our case the most probable causes of post anesthesia hypothermia were excluded; therefore, we can admit that the cause of hypothermia was the spinal administration of morphine. Some reports used naloxone and lorazepam successfully. In our report, they disappeared spontaneously 16 hours later, which corroborates our diagnosis. CONCLUSIONS: Children undergoing subarachnoid block with with intrathecal morphine may develop a disruption on thermoregulation, leading to a resistant postoperative hypothermia associated with excessive sweating.info:eu-repo/semantics/publishedVersio

COVID-19 in a Tertiary Paediatric Centre in Portugal: a Single-Centre Retrospective Study

Objective: To describe the demographic, clinical, laboratory and imaging features of the first 300 SARS-CoV-2-infected children presenting to a tertiary paediatric centre in Portugal. Design: Single-centre, retrospective, descriptive study of paediatric patients who had a confirmed SARS-CoV-2 infection from 7 March to 20 September 2020. Setting: Tertiary paediatric referral centre (Hospital Dona Estefânia, Lisbon, Portugal). Patients: 18 years or younger. Main outcome measures: Incidence, mortality, age of infection, clinical characteristics, treatment prescribed and outcome. Results: Three hundred patients with confirmed COVID-19 presented to the centre. One hundred and seventeen (39%) patients were admitted to the hospital: 69 with COVID-19 and 48 for other reasons. The most common symptoms in children admitted with COVID-19 were fever (49) and cough (38). Six patients required intensive care. Two children died and seven reported short-term sequelae. Conclusions: COVID-19 is usually a mild disease in children, but a small proportion of patients develop severe and critical disease. Fatal outcomes were rare and only occurred in children with severe previous medical conditions.info:eu-repo/semantics/publishedVersio

Hepatic mitochondrial content in malondialdehyde may be a marker of sea lamprey contact with atrazine

The atrazine attracts special attention as pollutant because of itspersistence in the aquatic environment. Although this herbicide has been studied in teleost, its toxicity in the sea lamprey, Petromyzon marinus is still poorly understood. Oxidative stress may occur if chemical pollutants contribute to block the capacity of mitochondria to generate ATP with continuous production of reactive oxygen species (ROS), disturbing the success of P. marinus seawater acclimation. So, the aim of this study was to evaluate how atrazine influences the malondialdehyde (MDA), glutathione (GSH) and glutathione disulfide (GSSG) contents of gills and liver mitochondria of juveniles from Lima river basin, Portugal during salt acclimation. Sampling occurred at the beginning of the P. marinus downstream migration. The sampled juveniles were transported alive to the laboratory and maintained in 200 l tanks with LSS 8 life support system. Two groups of 40 specimens were hold in tanks with 50 or 100 lg/l atrazine, during 30 days. The salinity was gradually increased from 0 to 35 psu,following a three step procedure during a 30 days period. The control group was maintained in freshwater without atrazine. Mitochondria obtained by centrifugation at 15000 g, 30 min, 4°C, of tissues homogenates prepared in 50 mM Tris-HCl pH 7.5 buffer were used in determination of ROS, MDA, GSH and GSSG by fluorescence. The statistical analysis were performed by ANOVA I and Duncan (p < 0.05), using SPSS 22 for Windows.The results showed that in P. marinus juveniles, no significant changes in the markers of oxidative stress and cell damages were detected in the mitochondrial gills. Nevertheless, in the animals exposed to 50 lg/l atrazine the content in glutathione and GSSG increased. A similar pattern of stress markers was detected in hepatic mitochondria. However, in the presence of atrazine, the MDA level of the mitochondria of liver increased threefold in the animals during salt acclimation. The high level of mitochondrial damages, detected in the hepatic mitochondria of macrophthalmia treated with atrazine, suggests that herbicide exposure caused metabolic failures which can disturb the adaptation of these specimens to the oceanic feeding phase. The hepatic mitochondrial MDA levels of P. marinus, may eventually detect sea lamprey contact with chlorine herbicides

Can the mitochondrial malondialdehyde content be an useful tool to distinguish ecological quality of Petromyzon marinus habitat?

The sea lamprey is an anadromous species that migrates twice during its life cycle between freshwater and seawater. Microphagous larvae generally spend 4–5 years burrowed in the substrate of rivers and streams before undergoing metamorphosis that ends with the beginning of the juvenile trophic migration. Once metamorphosis is complete, sea lamprey juvenile downstream migrants are fully tolerant to 35 PSU seawater. Pollution resulting from industrial effluents may disturb the seawater acclimatization causing oxidative damages, and ultimately may lead to a decrease of sea lamprey population. The aim of this study was to compare salt acclimation of sea lamprey juveniles captured in river basins with different levels of aquatic pollution, using mitochondrial glutathione and malondialdehyde of gills and liver as markers of physiological stress and cell damages. The results showed that juveniles from Lima basin exhibited the highest levels of mitochondrial malondialdehyde in gills, even though significant changes in the stress markers of mitochondrial gills of all animals subject to salt acclimation were not detected. In addition, an increase in the oxidative damages of hepatic mitochondria of macrophthalmia from Vouga basin suggests the occurrence of metabolic failures with the potential to disturb the capacity to adaptation to the marine environment

Sarcoidosis or Tuberculosis? Difficulties in Diagnosis

A sarcoidose é uma doença multissistémica rara, caracterizada por granulomas não caseosos. A clínica e os testes diagnósticos são pouco sensíveis e específicos, dificultando o diagnóstico diferencial, particularmente com a tuberculose. Relata-se o caso clínico de um rapaz de 17 anos com nódulos cutâneos dolorosos, astenia, hipersudorese e uveíte recorrente com dois anos de evolução. Apresentava prova tuberculínica e interferon gamma release assay positivos, anemia e velocidade de sedimentação elevada, hipergamaglobulinemia, lisozima e enzima de conversão de angiotensina elevadas. A tomografia computorizada torácica mostrava opacidades micronodulares centrilobulares, gânglios mediastinicos e hilares calcificados; a broncofibroscopia e o teste de difusão de monóxido de carbono foram normais. A biópsia de nódulo cutâneo revelou paniculite septolobular. A cintigrafia das glândulas lacrimal e salivar sugeriu sarcoidose. Não se podendo excluir tuberculose concomitante, iniciou antibacilares. Dois meses depois, foram associados prednisolona e metotrexato. Seis meses depois verificou-se remissão dos sintomas e normalização dos exames laboratoriais. Este caso mostra as dificuldades no diagnóstico de sarcoidose e tuberculose na ausência dos achados microbiológicos e histológicos típicos e a possibilidade da coexistência destas entidades.info:eu-repo/semantics/publishedVersio

Hepatitis and Cholestasis: What Are Plants Hiding?

O diagnóstico diferencial de hepatite colestática aguda na criança em idade escolar previamente saudável inclui múltiplas causas, sendo as infeciosas, tóxicas e autoimunes as mais comuns. Descreve-se o caso clínico de um rapaz de 10 anos com icterícia prolongada, eosinofilia e evidência bioquímica de lesão hepática de tipo misto (transaminases, fosfatase alcalina,bilirrubina total e direta elevadas), com gama-glutamiltransferase e função hepática normais. Após investigação detalhada, incluindo biópsia hepática, admitiu-se etiologia tóxica, tendo-se identificado consumo recente de chás de Cymbopogon citratus (erva-príncipe) e Equisetum arvense (erva-cavalinha) contaminados com pesticidas. A hipótese de hepatotoxicidade induzida por chás contaminados com pesticidas foi admitida como a causa mais provável, após exclusão de outras causas de doença hepática e considerando a recuperação total do doente após quatro meses de terapêutica com ácido ursodesoxicólico e evicção dos referidos consumos. Na última década, assistiu-se a um aumento substancial de publicações referentes a lesão hepática induzida por tóxicos (fármacos, suplementos alimentares, produtos de ervanária, metais e mesmo pesticidas). O diagnóstico é de exclusão e requer um elevado índice de suspeição.info:eu-repo/semantics/publishedVersio