Browsing by Author "Pinto, F"
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- Acute Cardiovascular Manifestations in 286 Children With Multisystem Inflammatory Syndrome Associated With COVID-19 Infection in EuropePublication . Valverde, I; Singh, Y; Sanchez-de-Toledo, J; Theocharis, P; Chikermane, A; Di Filippo, S; Kuciñska, B; Mannarino, S; Tamariz-Martel, A; Gutierrez-Larraya, F; Soda, G; Vandekerckhove, K; Gonzalez-Barlatay, F; McMahon, C; Marcora, S; Napoleone, C; Duong, P; Tuo, G; Deri, A; Nepali, G; Ilina, M; Ciliberti, P; Miller, O; Iriart, X; Hubrechts, J; Kuipers, I; Sousa, A; Donti, A; Sharpe, A; Reinhardt, Z; Cairello, F; De Wolf, D; Vieira, M; Lazea, C; Gran, F; Medrano-Lopez, C; Ortiz-Garrido, A; Vukomanovic, V; Brent, B; Milanesi, O; Dewals, W; Manso, B; Valsangiacomo-Buchel, E; Francisco, A; Seghaye, MC; Loeckx, I; Rodriguez-Gonzalez, M; ReyGarcía, S; Ziesenitz, V; Bordin, G; Doros, G; Grangl, G; Fadl, S; Perminow, K; Centeno, F; Pinto, F; Niemelä, J; Kanthimathinathan, H; Randanne, P; Niszczota, C; Zuccotti, G; Gordillo, I; Obeyasekhara, M; Armstrong, C; Butler, K; Ciuffreda, M; Villar, AM; Pappula, N; Caorsi, R; Singh, D; Durairaj, S; McLeod, K; Calcagni, G; Quizad, Y; Gewillig, M; Kuijpers, T; Ataide, R; Fabi, M; Bharucha, T; Abbas, K; Magrass, S; Wong, J; Iacob, D; Balcells, J; GilVillanueva, N; Cuenca-Peiro, V; Cerovi, I; Sarfatt, A; Zaqout, M; Sanchez-Valderrabanos, E; Kelly-Geyer, J; Diogo, F; Cajgfinger, N; Françoise, M; Rueda-Nuñez, F; Gorenflo, M; Grison, A; Mihailov, D; Koestenberger, M; Alcalde, C; Trigo, C; Arola, A; Hanseus, KBackground: The aim of the study was to document cardiovascular clinical findings, cardiac imaging, and laboratory markers in children presenting with the novel multisystem inflammatory syndrome associated with coronavirus disease 2019 (COVID-19) infection. Methods: This real-time internet-based survey has been endorsed by the Association for European Paediatric and Congenital Cardiologists Working Groups for Cardiac Imaging and Cardiovascular Intensive Care. Children 0 to 18 years of age admitted to a hospital between February 1 and June 6, 2020, with a diagnosis of an inflammatory syndrome and acute cardiovascular complications were included. Results: A total of 286 children from 55 centers in 17 European countries were included. The median age was 8.4 years (interquartile range, 3.8-12.4 years) and 67% were boys. The most common cardiovascular complications were shock, cardiac arrhythmias, pericardial effusion, and coronary artery dilatation. Reduced left ventricular ejection fraction was present in over half of the patients, and a vast majority of children had raised cardiac troponin when checked. The biochemical markers of inflammation were raised in most patients on admission: elevated C-reactive protein, serum ferritin, procalcitonin, N-terminal pro B-type natriuretic peptide, interleukin-6 level, and D-dimers. There was a statistically significant correlation between degree of elevation in cardiac and biochemical parameters and the need for intensive care support (P<0.05). Polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 was positive in 33.6%, whereas immunoglobulin M and immunoglobulin G antibodies were positive in 15.7% cases and immunoglobulin G in 43.6% cases, respectively, when checked. One child in the study cohort died. Conclusions: Cardiac involvement is common in children with multisystem inflammatory syndrome associated with the Covid-19 pandemic. The majority of children have significantly raised levels of N-terminal pro B-type natriuretic peptide, ferritin, D-dimers, and cardiac troponin in addition to high C-reactive protein and procalcitonin levels. In comparison with adults with COVID-19, mortality in children with multisystem inflammatory syndrome associated with COVID-19 is uncommon despite multisystem involvement, very elevated inflammatory markers, and the need for intensive care support.
- Doença de Kawasaki e Fleimão Retrofararíngeo: Uma Doença?Publication . Garcia, AM; Laranjo, S; Pinto, F; Gouveia, C; Varandas, L
- Luxação Palmar Isolada da Quinta Articulação Carpo-MetacárpicaPublication . Barros, A; Pinto, F; Varela, E; Almeida, R; Côrte-Real, NA luxação palmar isolada da quinta articulação carpo-metacárpica é rara. Esta lesão pode passar despercebida, sendo importante a suspeita clínica, levando a uma avaliação radiológica no perfil e incidências obliquas. O tratamento é controverso, estando descritas a redução fechada com fixação percutânea com fios de Kirshner percutâneos e a redução aberta com fixação interna. Apresentamos um caso clínico de luxação palmar do tipo cubital isolada e o seu tratamento. O resultado funcional aos 6 meses, de acordo com o score DASH, foi de 0.8. Apresentava-se sem queixas, desempenhado as suas atividades diárias sem restrições.
- Mechanical Circulatory Support in Children: Strategies, Challenges and Future DirectionsPublication . Abreu, S; Brandão, C; Trigo, C; Rodrigues, R; Pinto, F; Fragata, JIntroduction: The use of mechanical circulatory support (MCS) in the pediatric population has evolved significantly in the past 20 years, but its management still poses several challenges. We aim to describe patient characteristics, outcomes, and morbidity associated with different modalities of MCS, in a tertiary center. Methods: Retrospective analysis of data from all the children who underwent MCS between 2002 and 2018 at a pediatric cardiology unit. Results: Between 2002 and 2018, 22 devices were implanted in 20 patients. Patients were divided into three groups: Group A (n=11) extracorporeal membrane oxygenator (ECMO); Group B (n=8) pulsatile paracorporeal ventricular assist device (VAD) and group C (n=3) paracorporeal continuous flow VAD. The median age was similar in groups A and B (18 and 23 months, respectively), and higher in group C (13 years). ECMO patients were cannulated mainly as a bridge to recovery (post cardiotomy- 8) while group B and C patients were bridged to transplantation. The most frequent complications were bleeding (group A - 36%, group C - 66.6%) and thromboembolic events (group B - 50%, group C - 33.3%). As for outcomes, in group A the majority of patients (54.5%) were weaned and 27.3% died. Half of group B and all of group C patients underwent transplantation. Conclusion: Bleeding and thromboembolic events were the main complications observed. Group B showed the highest mortality, probably related to the low weight of the patients. Overall, outcomes and complications are related to the type of device and patient status and characteristics.
- Perinatal Ischemic Stroke: a Five-Year Retrospective Study in a Level-III MaternityPublication . Machado, V; Pimentel, S; Pinto, F; Nona, JObjective To study the incidence, clinical presentation, risk factors, imaging diagnosis, and clinical outcome of perinatal stroke. Methods Data was retrospectively collected from full-term newborns admitted to the neonatal unit of a level III maternity in Lisbon with cerebral stroke, from January 2007 to December 2011. Results There were 11 cases of stroke: nine were arterial ischemic stroke and two were cerebral venous sinus thrombosis. We estimated an incidence of arterial ischemic stroke of 1.6/5,000 births and of cerebral venous sinus thrombosis of 7.2/100,000 births. There were two cases of recurrent stroke. Eight patients presented with symptoms while the remaining three were asymptomatic and incidentally diagnosed. The most frequently registered symptoms (8/11) were seizures; in that, generalized clonic (3/8) and focal clonic (5/8). Strokes were more commonly left-sided (9/11), and the most affected artery was the left middle cerebral artery (8/11). Transfontanelle ultrasound was positive in most of the patients (10/11), and stroke was confirmed by cerebral magnetic resonance in all patients. Electroencephalographic recordings were carried out in five patients and were abnormal in three (focal abnormalities n=2, burst-suppression pattern n=1). Eight patients had previously identified risk factors for neonatal stroke which included obstetric and neonatal causes. Ten patients were followed up at outpatients setting; four patients developed motor deficits and one presented with epilepsy. Conclusions Although a modest and heterogeneous sample, this study emphasizes the need for a high level of suspicion when it comes to neonatal stroke, primarily in the presence of risk factors. The prevalence of neurological sequelae in our series supports the need of long-term follow-up and early intervention strategies.
- Pneumonia Grave por Influenza B em Recém-NascidoPublication . Dâmaso, C; Fernandes, C; Nona, J; Santos, M; Pinto, F; Valido, AMA infecção por vírus influenza B é rara no período neonatal com uma incidência desconhecida. Relata-se o caso de uma recém-nascida de termo, reinternada ao nono dia de vida por quadro de má perfusão periférica, gemido, dificuldade alimentar e dificuldade respiratória com necessidade de ventila ção mecânica, óxido nítrico inalado e surfactante. A radiografia de tórax no primeiro dia apresentava infiltrado intersticial ligeiro, difuso. Esteve sob ventilação invasiva durante 11 dias e oxigenoterapia 15 dias, tendo tido alta ao 20º dia, clinicamente bem. É fundamental pensar em infecção por vírus influenza B quando existe história de possível contágio, e em mães sem imunização anti-influenza. Não há terapêutica aprovada neste grupo etário, devendo ser tomadas medidas de suporte, de contenção e prevenção da disseminação da infecção.
- Rubéola congénita: diagnóstico esquecido?Publication . Gomes, I; Gouveia, C; Rebelo, M; Pinto, F; Brito, MJ
- Use of Therapeutic Hypothermia in Sudden Unexpected Postnatal Collapse: a Retrospective StudyPublication . Brito, S; Sampaio, I; Dinis, A; Proença, E; Vilan, A; Soares, E; Pinto, F; Tomé, T; Graça, AIntroduction: Sudden and unexpected postnatal collapse is a rare event with potentially dramatic consequences. Intervention approaches are limited, but hypothermia has been considered after postnatal collapse. The aim of this study was to analyse sudden and unexpected postnatal collapse cases that underwent therapeutic hypothermia in the five Portuguese hypothermia centres. Material and methods: In this multicentre, retrospective and descriptive study, clinical, ultrasonography, amplitude-integrated electroencephalography and brain magnetic resonance findings of newborns with postnatal collapse that underwent therapeutic hypothermia are reported (2010 - 2018). Statistical analysis was performed by using IBM SPSS Statistics version 21. Results: Twenty-two cases of sudden and unexpected postnatal collapse were referred for therapeutic hypothermia (82% outborn), all ≥ 36 weeks, with Apgar 5´ ≥ 8. Collapse occurred during the first two hours in 73% (all < 24 hours), 50% during skin-to-skin care, 55% related to feeding and 23% during co-bedding. Moderate-severe encephalopathy and severe acidosis were observed (median: Thompson score 16, pH 6.90, base deficit 22 mmol/L). Amplitude-integrated electroencephalogram was abnormal in 95% and magnetic resonance imaging showed severe brain injury in 46%. The mortality rate was 50%. A possible cause was identified in 27%. Discussion: The incidence rate of 2.7 sudden cases of postnatal collapse per 100 000 births, is possibly under-estimated. All infants suffered the collapse in the first day, mostly within the first two hours, as reported before. Possible causes were identified in less than a third of cases, but multiple predisposing conditions were identified, suggesting that prevention may be possible. Newborn positioning and skin-to-skin care have been the most discussed practices. A significant proportion of infants had poor outcomes. Lower Thompson score, electroencephalogram amplitude normalization and normal magnetic resonance imaging seemed to indicate better outcomes. Although conclusive trials on therapeutic hypothermia after postnatal collapse are not available, its use has been considered individually. No severe adverse effects directly related to hypothermia were registered in this study, but the results do not allow drawing meaningful conclusions. Conclusion: In our national sample of 22 infants who suffered sudden and unexpected postnatal collapse and underwent therapeutic hypothermia, a significant proportion had poor outcomes. Absolute conclusions from our experience with hypothermia in postnatal collapse cannot be drawn, but systematic reporting of cases and long-term clinical evaluation would facilitate understanding of the real benefits of hypothermia. As this procedure has not been validated with clinical trials for this indication, its use should be considered on a case-by-case approach. The potentially avoidable nature of unexpected postnatal collapse is evident from its association with certain behaviours and risk factors. Surveillance practices during the first hours should be implemented, whilst the benefits of breastfeeding and skin-to-skin care should continue to be widely promoted.