Inflammatory Bowel Disease-Experience of a pediatric gastroenterology unit

Inflammatory bowel disease, especially Crohn disease, had increased in the last five decades. We analyzed all the patients of our unit diagnosed with the disease between 2001-2012 but we just considered the patients who respected the Porto criteria to define IBD at presentation. We diagnosed 51 children and adolescents with the disease. Crohn disease was responsible for 62.7% of cases, ulcerative colitis for 31.4% and indeterminate colitis for 5.9%. Considering the 4 different periods of time (2001-2003/2004-2006/2007-2009 and 2010-2012), we observed and increase in the number of cases, but a decrease in the time from onset of symptoms to diagnosis. Our medical approach with tumor necrosis factor antagonists was reserved for severe disease cases and to spare patients from adverse effects of purine analogues and corticosteroids. Mucosal healing and remission of the disease was achieved in all of the patients under biologic therapy and no serious or life-threating event was reported with their use

World Health Organization (WHO) Recommends Exclusive Breastfeeding in the First Six Months of Life

Objective: To obtain the prevalence of breastfeeding/exclusive breastfeeding until 6 months of life. To assess mothers knowledge about the benefits of breastfeeding and exclusive until six months, the impact of information in the desire to breastfeed and reasons for WHO recommendations failure. Methods: Questionnaires applied to recent given birth women in a tertiary hospital maternity, divided into case-group (providing information about breastfeeding advantages/recommendation of exclusive breastfeeding up to six months) and control-group (not informed by the authors). At six months of age, we call mother's to answer a questionnaire about continuity or not of breastfeeding and if exclusive. For statistical analyses frequency tables and McNemar test were used. Results: Answered to the questionnaire 242 mothers, 239 intended to breastfeed, 54% exclusively until six months. In the 2nd survey, out of 192 respondent mothers 63.5% were breastfeeding. Exclusively until 6 months, 35.4%. In case-group, 56.7% of respondents planned to breastfeed exclusively until 6 months and 39.2% did so; control group, 50.5% planned it and 31.6% did so, p = 0.664. In case-group 89.7% intend to breastfeed the next son. In a control group 52.6%, p < 0.001, out of the 54 mothers who didn't breastfeed exclusively, 46.3% invoked labor laws as the reason for introduction of solid food. 36.0% professional advice. The reason given to abandonment was "agalactia" in 78.6%. Conclusions: WHO recommendations for exclusive breastfeeding was followed by 1 in 3 infants. This prevalence was near to the best results worldwide, but still not enough. There were statistically significant differences in behavioral intention, but not in attitude, between case group and control group. Labor law was the reason to early introduction of solid food in most surveyed.info:eu-repo/semantics/publishedVersio

Herpes zoster with cutaneous dissemination: a rare presentation of an uncommon pathology in children

Herpes zoster, caused by varicella zoster virus (VZV) reactivation, affects mainly the adult population, although it can occur in children. This happens when primary infection (varicella) has occurred at a very young age or in immunocompromised patients. Complications are rare in healthy individuals. They include VZV cutaneous dissemination, which affects 2%-10% of immunocompromised patients.We present a previously healthy child, with history of varicella during her first month of life, which presented at age 8 with a severe case of herpes zoster, complicated with cutaneous dissemination. Immunity study was unremarkable. Causes, management and follow-up are discussed.(undefined

Variáveis psicossociais no excesso de peso e na obesidade infantil

Obesity is a complex disease with not only physical consequences but also psychological. The aim of the present work was to analyze differences between community children with normal weight versus community overweight children versus children with overweight in clinical setting, at the level of quality of life, psychological morbidity and self-concept . The study sample has 267 children represented in three groups: group of community children with normal weight (N = 147), group of community overweight children (N = 89) and a group of overweight children in treatment (N = 31). The results from this study showed differences on quality of life, for the total scale and on the dimension of physical health and school health, in which overweight children in the clinical sample are the ones who presented more negative perception of physical health and school health, when compared with community children with normal weight vs community overweight children. For the rest of the dimensions of quality of life, no significant differences were found between the three groups. Regarding the self-concept on the group of children with a clinical diagnosis of obesity they perceived themselves as less competent relative to school competency, athletic competency, physical appearance, social acceptance, behavior and self-esteem. Regarding the variable depression this study suggests that community overweight children present more depressive symptomatology when compared with the other groups. No significant differences were found regarding anxiety symptomatology. To summarize, results from this empirical study demonstrated the importance of psychological variables when in the presence of obesity.A obesidade acarreta consequências para além das meramente relacionadas com a saúde física, sendo também de salientar os aspetos psicossociais. Com o objetivo de avaliar as diferenças ao nível da qualidade de vida, morbilidade psicológica e imagem pessoal (autoconceito) foram avaliadas 267 crianças divididas em três grupos: um grupo de crianças da comunidade com peso normal (N = 147), um grupo de crianças da comunidade com excesso de peso/obesidade (N = 89) e um grupo de crianças com excesso de peso/obesidade em tratamento (grupo clínico) (N = 31). Os resultados mostraram que as crianças com excesso de peso/obesidade em tratamento são as que têm uma percepção mais negativa da sua saúde física e da saúde escolar, quando comparadas com as restantes crianças. Relativamente ao auto-conceito o grupo de crianças com excesso de peso/obesidade do grupo clínico perceciona-se como menos competente no domínio escolar, atlético, aparência física, aceitação social, comportamento e auto-estima. As crianças do grupo clínico com excesso de peso/obesidade apresentam ainda mais sintomatologia depressiva quando comparadas com as crianças da comunidade com peso normal e com as crianças do grupo clínico. Não foram encontradas diferenças significativas ao nível da sintomatologia ansiosa nas três amostras estudadas. Em suma, as diferenças entre os grupos avaliados podem refletir diferentes características das crianças com excesso de peso/obesidade que procuram tratamento

Peutz-Jeghers syndrome : capsule endoscopy to stage disease

Este artigo disponibiliza 2 vídeos http://www.sciencedirect.com/science/article/pii/S0140673612608307#FCANot

Prevalence and predictors of alcohol and tobacco consumption in adolescence: The role of weight status, clinical status and psychosocial dimensions

El objetivo de este estudio ha sido examinar la prevalencia de consumo de alcohol y tabaco en adolescentes (N = 370) con edades comprendidas entre 14 y 19 años en tres grupos: 205 adolescentes con peso normal, 82 adolescentes de la comunidad con el exceso de peso u obesidad, y 83 adolescentes con exceso de peso u obesidad y en el tratamiento ambulatorio para el control de peso. También se examinaron los roles de edad, género, peso, condición de tratamiento y las variables psicosociales (los síntomas psicopatológicos, el apoyo social y las habilidades emocionales) en la presencia de estos consumos. Nuestros principales hallazgos fueron que el grupo clínico de los adolescentes con sobrepeso tenían menos conductas de riesgo, que en el grupo de la comunidad de sobrepeso y los controles de peso normal, sobre todo para las conductas de riesgo relacionadas con el consumo de alcohol. La mayor edad y una menor satisfacción con la familia predijeron el consumo de tabaco. La mayor edad, la no asistencia a un tratamiento para el control del peso y una mayor satisfacción con las relaciones intimas predijeron el consumo de alcohol. El peso no fue un factor de predicción de consumo de alcohol y tabaco. Este estudio analiza las implicaciones teóricas y prácticas de estos hallazgos. Abstract: The aim of this study was to examine the prevalence of alcohol/ tobacco consumption among adolescents (N = 370) aged 14 to 19 years in three groups: 205 adolescents with normal weight, 82 adolescents from the community with overweight or obesity, and 83 adolescents with overweight or obesity and in outpatient treatment for weight control. We also examined the roles of age, gender, weight, treatment condition, and psychosocial variables (psychopathological symptoms, social support, and emotional skills) in the presence of those risk behaviors. Our major findings were that the clinical group of overweight adolescents had fewer risk behaviors, than the overweight community group and the normal weight controls, particularly for risk behaviors related to alcohol use. The increase of age and lower satisfaction with family predicted tobacco consumption. The increase of age, not being integrated in a treatment for weight control and higher satisfaction with intimate relationships predicted alcohol consumption. Weight status was not a predictor of alcohol and cigarette use. This study discusses the theoretical and practical implications of these findings

Pediatric obesity in a health centre file of Minho

Introdução: Portugal é um dos cinco países da Europa com maior prevalência de excesso de peso (EP) e obesidade (OB) em idade pediátrica. Objetivos: Avaliar a prevalência de EP e OB nas crianças/adolescentes dum ficheiro de utentes dos cuidados primários. Material e métodos: Estudo observacional e transversal. A população incluia as crianças, dum ficheiro do ACES do Cávado III, que completassem 3 a 17 anos no ano 2010. Recolha de dados por convocação/agendamento. Parametrizados: peso, estatura e perímetro de cintura. Calculado o índice de massa corporal (IMC), percentil de IMC e percentil de perímetro de cintura, utilizando as classificações do CDC e do NAHNES III, respetivamente. Preenchido um questionário para as crianças/adolescentes com EP ou OB. Resultados: Da população de 263 elementos compareceram 199 (amostra) para a parametrização. A prevalência de EP foi de 14% e de OB de 12%, total de 26% (n=52). Dos 52 elementos com EP/OB, 48 responderam a um questionário, quatro não (dois emigraram; dois não compareceram). Nestes verificou-se uma correlação entre o percentil de perímetro de cintura superior a 90 e a ocorrência de obesidade, p < 0,01; não praticavam uma hora diária ou mais de atividade física 77%, com predomínio no sexo feminino 89%, p = 0,01; despendiam mais de duas horas em atividades sedentárias 46%; verificou-se uma baixa ingestão de hortícolas e fruta e elevada em produtos açucarados e fritos; ingeriam quantidades de carne e peixe maiores que as porções recomendadas para a idade 60%; foram amamentados 88% e pelo menos durante seis meses 54%; iniciaram a diversificação alimentar entre os quatro e os seis meses 66%; a escolaridade parental foi de nove ou menos anos em 83%. Conclusões: Na população pediátrica estudada, verificou-se uma prevalência de EP e de OB próxima dos valores da literatura. A alimentação e atividade física nos com EP/OB foram maioritariamente desadequadas.Introduction: Portugal is the one out of five European countries with highest prevalence of overweight (OW) and childhood obesity (OB). Objectives: To asses and characterize children and adolescents with OW and OB from a health centre file in primary care. Material and methods: Cross-sectional study. All children, in a centre file of the ACES do Cávado III, completing 3-17 years of age in 2010, were included. Participant recruitment was actively undertaken. Data collected included weight, height and waist circumference. Body mass index (BMI), BMI percentile and waist perimeter percentile were then calculated, using CDC and NAHNES III classifications, respectively. A questionnaire was applied for children with OW or OB. Results: Within the population of 263 elements, 199 attended the study (sample). The prevalence of OW and OB was 14% and 12%, respectively, totalizing 26% (n=52). Within the 52 elements with OW / OB, 48 answered a questionnaire, and four did not (two emigrated; two unattended). In theses ones, a correlation between a percentile of waist circumference greater than 90 and the occurrence of obesity, was demonstrated, p < 0,01; practicing one hour or more of daily physical activity, wasn’t achieved by 77%, with predominance in girls 89%, p = 0,01; spending two or more hours daily in sedentary activities was verified in 46%; there was a low intake of fruit and vegetables and high in sugar and fried foods; quantities of meat and fish were larger than the recommended servings for age in 60%; breastfeeding was observed in 88% of which 54% during at least six months; food introduction started between four and six month in 66%; parents had nine or fewer years of schooling in 83% of cases. Conclusions: The prevalence of overweight and obesity in this paediatric population was close to literature values. Diet and physical activity in those with OW/OB was mostly inadequate

Oral manifestations of Crohn's disease

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Immune disease expressed in liver and platelets in an adolescent: a case report

We report a case of a 15-year-old boy with autoimmune hepatitis lacking common serologic markers and normal gammaglobulinemia associated with immune thrombocytopenia and family history of psoriasis. He presented to our department with a 4-year history of a cervical posterior lymphadenopathy and recent petechiae. Previous laboratory results 6 months before already showed hepatocellular injury. After exclusion of other causes, the diagnosis of autoimmune hepatitis was made based on clinical grounds, associated immune disorder and histological features of liver biopsy