Browsing by Author "Alves, P"
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- Acute Haematogenous Osteomyelitis in Lisbon: An Unexpectedly High Association with Myositis and ArthritisPublication . Gouveia, C; Branco, J; Norte, S; Arcangelo, J; Alves, P; Pinto, M; Tavares, DIntroduction: Despite the current trend toward less aggressive therapeutic approaches, acute haematogenous osteomyelitis (AHO) continues to be a challenge and is associated with significant morbidity worldwide. Our aim was to assess whether compliance with the current protocol was achieved in 80% of cases, to identify complications and the associated risk factors, and to analyse trends in the aetiology and management of AHO in the paediatric population. Methods: We conducted a longitudinal, observational, single-centre study in patients with AHO aged less than 18 years admitted to a paediatric hospital between 2008 and 2018 divided in 2 cohorts (before and after 2014). We analysed data concerning demographic and clinical characteristics and outcomes. Results: The study included 71 children with AHO, 56% male, with a median age of 3 years (interquartile range, 1-11). We found a 1.8-fold increase of cases in the last 5 years. The causative agent was identified in 37% of cases: MSSA (54%), MRSA (4%), S. pyogenes (19%), K. kingae (12%), S. pneumoniae (8%), and N. meningitidis (4%). Complications were identified in 45% of patients and sequelae in 3.6%. In recent years, there was an increase in myositis (30% vs 7%; P=.02), septic arthritis (68 vs 37.2%; p=0.012) and in the proportion of patients treated for less than 4 weeks (37 vs 3.5%; p=0.012), with a similar sequelae rates. The risk factors associated with complications were age 3 or more years, C-reactive protein levels of 20mg/L or higher, time elapsed between onset and admission of 5 or more days and positive culture, although the only factor that continued to be significantly associated in the multivariate analysis was positive culture. The presence of complications was a risk factor for sequelae at 6 months. Conclusions: Our study confirms that AHO can be aggressive. The identification of risk factors for complications is essential for management.
- An Eleven-Year-Old Boy With Arthritis of the Hip Joint, and an 8-Year-Old Boy With SacroiliitisPublication . Mendo, T; Norte, S; Alves, P; Tavares, D; Pinto, M; Gouveia, C
- Avaliação Endoscópica das Alterações da Deglutição em Idade Pediátrica: Experiência de 3 anosPublication . Nascimento, J; Moreira, I; Cunha, I; Forjaco, A; Alves, P; Ximenes Araújo, J; Pinto Sousa, J; Araújo, B; Sousa, H; Barros, EAs alterações da deglutição na criança afetam aproximadamente 1% das crianças/ano, nos Estados Unidos, sendo frequentemente subdiagnosticadas. O desenvolvimento de técnicas diagnósticas não invasivas tem permitido diagnósticos mais precisos, independentemente da idade. Este trabalho tem como objetivo identificar a prevalência das alterações da deglutição e a necessidade de avaliação instrumental por videofuoroscopia da deglutição (VFD) e/ ou videoendoscopia de deglutição fberoptic endoscopic evaluation of swallowing - FEES) nos doentes seguidos na consulta pediátrica de laringe, descrevendo dois casos representativos e enfatizando as particularidades da realização da FEES em crianças. Procedeu-se à análise retrospetiva de doentes em idade pediátrica, seguidos na consulta de laringe no período de 2018-2020. Das 278 crianças avaliadas, verificaram-se alterações da deglutição em 26% (n=71). A FEES foi realizada em 24%, a VFD em 32% e 10% das crianças realizaram ambos os exames. Das crianças que realizaram FEES, a patologia estrutural da laringe foi a alteração mais encontrada, tendo-se registado 3 doentes com patologia neurológica. A VFD e a FEES são exames complementares fundamentais para diagnosticar defeitos anatómicos, e são a única forma objetiva de confirmar ou excluir aspiração, sendo que a FEES em idade pediátrica possui características específicas e requer experiência para a sua realização e interpretação.
- Bilateral Shoulder Arthritis in COVID-19 Patient After Prolonged Mechanical Ventilation Assist: a Case ReportPublication . Resende Neves, T; Lourenço, AL; Alves, P; Teiga, C; Caetano, AProlonged immobilization and, in particular, mechanical ventilation, have been linked to muscle atrophy. Anecdotal reports in the literature describe rhabdomyolysis as a potential late complication of COVID-19 infection which, in severe cases, may coexist with fluid collections. We report a case of a 28-year-old patient that had been recently hospitalized with SARS-CoV-2 pneumonia, with need for invasive ventilation support. Days after being discharged, the patient presents with retrosternal thoracalgia irradiating to the left upper limb. On physical examination, abduction and external rotation were limited due to pain complaints and there was soft tissue swelling of the corresponding shoulder and arm. Imaging evaluation was essential to establish the underlying condition, revealing bilateral arthritis communicating with large rotator cuff collections, which was considered of septic nature.
- Brachial Plexus Cyst in a Patient with Multifocal Motor NeuropathyPublication . Sousa, AP; Alves, P; Maia, B; Medeiros, L
- COVID-19 in a Pediatric Cohort—Retrospective Review of Chest Computer Tomography FindingsPublication . Pina Prata, R; Forjaco, A; Ruano, C; Lopes Dias, J; Fernandes, L; Ferreira, A; Alves, P; Cabrita Carneiro, R; Nunes, A; Soares, EBackground: Radiological features of the novel 2019 coronavirus disease (COVID-19) have been mainly described in adults. Available literature states that imaging findings in children are similar but less pronounced. The aim of this study is to describe and illustrate the chest computer tomography (CT) features of pediatric COVID-19. Results: This retrospective study was based on the review of all the chest CTs performed in pediatric patients with confirmed COVID-19 disease between March 8th and May 26th 2020 (n = 24). The presence of comorbidities and coinfection was assessed, as well as timing of CT examination in relation to the onset of symptoms. CT findings were categorized as typical, indeterminate, atypical, and negative for COVID-19 according to International Expert Consensus Statement on Chest Imaging in Pediatric COVID-19 Patient Management. This study found that CT findings were abnormal in 17 (71%) patients, with 5 (21%), 9 (38%), and 3 (13%) patients considered to have typical, indeterminate, and atypical findings, respectively. The most common CT patterns were multiple ground-glass opacities (58%), followed by consolidations (50%). Six patients showed predominantly peripheral distribution of parenchymal abnormalities. A halo sign was identified in 3 patients and a perilobular pattern was identified in one of the cases with typical findings. Conclusions: Chest CT findings in children infected with SARS-CoV-2 can be subtle or absent. Besides recognizing typical findings, radiologists should be able to identify features that favor different or concomitant diagnosis.
- Hepatitis B Virus Infection and the Kidney: a Wide Range of ManifestationsPublication . Barata, R; Alves, P; Assis Pereira, T; Góis, M; Viana, H; Nolasco, F
- Hypereosinophilia and Severe Bone Disease in an African Child: An Unexpected DiagnosisPublication . Bota, S; Alves, P; Constantino, C; Maia, RHypereosinophilic syndromes are rare in children. Sporadic, mild-severity FIP1L1-platelet-derived growth factor receptor α (PDGFRα) rearrangement cases have been reported, mainly in boys. We present the case of a 5-year-old girl referred from her African country of birth, due to severe constitutional symptoms, multifocal bone pain, headache, gastrointestinal complaints, cardiomyopathy and unexplained hypereosinophilia. She presented multiple end-organ diseases and striking bone involvement. Although she had a positive serology for Strongyloides stercoralis, extensive evaluation detected a FIP1L1-PDGFRA fusion gene. Systemic corticosteroids and low-dose imatinib were started and the child became asymptomatic. After 9 months of treatment, FIP1L1-PDGFRA was no longer detected.
- Imaging the Hypoglossal NervePublication . Alves, PThe hypoglossal nerve is a pure motor nerve. It provides motor control to the intrinsic and extrinsic tongue muscles thus being essential for normal tongue movement and coordination. In order to design a useful imaging approach and a working differential diagnosis in cases of hypoglossal nerve damage one has to have a good knowledge of the normal anatomy of the nerve trunk and its main branches. A successful imaging evaluation to hypoglossal diseases always requires high resolution studies due to the small size of the structures being studied. MRI is the preferred modality to directly visualize the nerve, while CT is superior in displaying the bony anatomy of the neurovascular foramina of the skull base. Also, while CT is only able to detect nerve pathology by indirect signs, such as bony expansion of the hypoglossal canal, MRI is able to visualize directly the causative pathological process as in the case of small tumors, or infectious/inflammatory processes affecting the nerve. The easiest way to approach the study of the hypoglossal nerve is to divide it in its main segments: intra-axial, cisternal, skull base and extracranial segment, tailoring the imaging technique to each anatomical area while bearing in mind the main disease entities affecting each segment.
- Juvenile Dermatomyositis Forty Years On: Case ReportPublication . Rego de Figueiredo, I; Guerreiro Castro, S; Bernardino, V; Silva Nunes, J; Alves, P; Moraes-Fontes, MFWe present a case report of a 42 year old female, diagnosed at the age of 3 with Juvenile Dermatomyositis. The clinical course was severe and refractory to immunosuppressive therapy. Currently, she is mostly affected by severe muscle atrophy, large joint contractures, calcinosis, and a lipodystrophy associated metabolic syndrome with hypertriglyceridemia, insulin resistance, high total testosterone and hepatic steatosis. She developed Hodgkin´s lymphoma in the course of her disease. Personalized therapeutic choices are discussed as regards juvenile dermatomyositis complications.
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