Helena Almeida | Faculdade de Medicina de Lisboa (original) (raw)
Papers by Helena Almeida
A Necrose Gorda do Tecido Subcutâneo (NGTS) e uma doenca do tecido adiposo subcutâneo pouco comum... more A Necrose Gorda do Tecido Subcutâneo (NGTS) e uma doenca do tecido adiposo subcutâneo pouco comum, descrita em recem-nascidos que sofreram hipoxia durante ou apos o parto. Caracteriza-se por nodulos subcutâneos e tem um padrao histologico preciso. Esta situacao e autolimitada, geralmente benigna, raramente complicado de hipercalcemia. Os autores descrevem 2 casos de NGTS com evolucao e complicacoes distintas. O primeiro caso e um recem-nascido com asfixia perinatal grave que apresentou NGTS com um mes e meio de vida, associado a hipercalcemia importante e persistente, controlada com hidratacao e hidrocortisona endovenosas. O segundo caso e de um recem-nascido com cardiopatia congenita dueto-dependente que entra em falencia multiorgânica secundaria a choque cardiogenico ao 4° dia de vida, surgindo os nodulos subcutâneos ao 7° dia complicados de flutuacao, drenagem espontânea de gordura necrotica e infeccao local. A proposito destes casos faz-se uma breve revisao da entidade clinica.
A tuberculose congenita e uma doenca considerada pouco comum mas provavelmente subestimada. Apres... more A tuberculose congenita e uma doenca considerada pouco comum mas provavelmente subestimada. Apresenta-se o caso clinico de uma lactente de 4 meses de idade internada por sindrome febril prolongado, hepatoesplenomegalia e malnutricao grave. Todos os exames foram inconclusivos e a biopsia hepatica confirmou o diagnostico de tuberculose congenita. Faz-se a revisao bibliografica dos criterios de diagnostico entre tuberculose congenita e tuberculose adquirida posnatal.
Pearson syndrome is a rare, usually fatal mitochondrial disorder involving the hematopoietic syst... more Pearson syndrome is a rare, usually fatal mitochondrial disorder involving the hematopoietic systemic in early infancy. We report a 20-months-old child admitted with persistent vomiting, prostration and hypotonia, which had started occasional vomiting since 18 months. Laboratory investigation revealed macrocitic anaemia, renal tubular acidosis, cholestasis. The mitochondrial DNA analysed from blood cells, muscle and liver samples, had a simple delection, that suggested Pearson Syndrome. The child died due to electrolyte disturbances related to her tubulopathy. This case emphasizes the importance of considering mitochondrial DNA disorder in patients with multisystemic symptoms that cannot be explained by a specific diagnosis.
![Research paper thumbnail of [Adult type respiratory distress syndrome (ARDS) induced by hydrocarbons]](https://attachments.academia-assets.com/109322094/thumbnails/1.jpg)
](Acta medica portuguesa, 1996
The authors present a case of a child aged 32 months, victim of accidental ingestion of an uniden... more The authors present a case of a child aged 32 months, victim of accidental ingestion of an unidentified hydrocarbon product. Sixteen hours following hospitalization, the patient began polypnea with progressive hypoxemia, with the radiograph showing ARDS pattern. Mechanical ventilation was initiated on the 2nd day of admission. During hospitalization the patient developed pneumomediastinum and bilateral pneumothorax which justified active drainage. Inspite of the initial poor prognosis, the patient improved, with no symptoms after discharge. The authors discuss certain theoretical considerations regarding hydrocarbon intoxication.
Introducao: A doenca das celulas falciformes pode ter consequencias graves e as transfusoes tem u... more Introducao: A doenca das celulas falciformes pode ter consequencias graves e as transfusoes tem um papel fundamental no prognostico da doenca. Existem poucos estudos sobre a utilizacao da tecnica manual de transfusao permuta parcial (TPP) de hemacias no tratamento de complicacoes agudas da drepanocitose na populacao pediatrica. A tecnica pretende diminuir os niveis de HbS, mantendo estaveis a concentracao de hemoglobina e hematocrito, evitando a sobrecarga hidrica e de ferro. Pretendemos descrever a nossa experiencia na utilizacao da TPP na abordagem destas complicacoes.Metodos: Estudo retrospectivo de criancas internadas que realizaram TPP manual numa Unidade de Cuidados Intensivos Pediatricos em um periodo de tres anos. Resultados: Foram realizados dez procedimentos a sete doentes. Idade mediana de nove anos, todos homozigotos para HbS. A indicacao foi AVC em um e sindrome toracica aguda em nove. A reducao media de HbS foi de 30% com incremento de hemoglobina de 0.38g/dL. O volume...
Serviço Social e Saúde, 2015
O presente artigo realça a importância e premência da aposta na saúde mental da população, princi... more O presente artigo realça a importância e premência da aposta na saúde mental da população, principalmente nos primeiros anos de vida dos indivíduos. A intervenção precoce é essencial para prevenir patologias mais graves no futuro e assim reduzir custos futuros para o indivíduo, família, sistema de saúde e até para a economia do país. Mas é sobre o «outro lado» da saúde mental que o artigo se vai debruçar primordialmente, ou seja, a família que acompanha o utente, presta cuidados, auxilia no diagnóstico e tratamento. Assim, a família sente-se sobrecarregada e a braços com uma reestruturação de papéis e expectativas familiares. Serão apontadas algumas orientações estratégicas e modalidades para a intervenção em contexto de crise familiar.
Case Reports in Pediatrics, 2015
Noninvasive ventilation (NIV) is a method to be applied in acute respiratory failure, given the p... more Noninvasive ventilation (NIV) is a method to be applied in acute respiratory failure, given the possibility of avoiding tracheal intubation and conventional ventilation. A previous healthy 5-month-old boy developed low-grade intermittent fever, flu-like symptoms, and dry cough for 3 days. On admission, he showed severe respiratory distress with SpO2/FiO2ratio of 94. Subsequent evaluation identified an RSV infection complicated with an increase of inflammatory parameters (reactive C protein 15 mg/dL). Within the first hour after NIV-helmet CPAP SpO2/FiO2ratio increased to 157. This sustained improvement allowed the continuing of this strategy. After 102 h, he was disconnected from the helmet CPAP device. The NIV use in severe hypoxemic acute respiratory failure should be carefully monitored as the absence of clinical improvement has a predictive value in the need to resume to intubation and mechanical ventilation. We emphasize that SpO2/FiO2ratio is a valuable monitoring instrument. ...
Pediatric Research, 2005
Pain in the postoperative period is a rising concern in paediatrics. Ideal management should be t... more Pain in the postoperative period is a rising concern in paediatrics. Ideal management should be the most effective with minimal adverse effects. Objective: Compare two regimens of analgesia, intravenous morphine, continuous infusion versus intermittent bolus in postoperative children (appendectomy). Methods: Randomised, triple-blinded, placebo controlled study in children aged 1 month to 14 years (November 2001 to December 2003). Children were randomised in two groups: (A) morphine continuous perfusion (0,02 mg/Kg/h); (B) normal saline continuous perfusion. Both groups received bolus of morphine (0,03 mg/Kg), according to pain scale. Demographic data; duration of symptoms; surgical appendicitis staging; duration of perfusion, number of boluses; pain measurement (Faces Rating Scale), every 4 hours (first 48 hours); time until enteric feeding, first stool emission; complications and duration of hospitalization were analysed. Results: Included 102 children (A ϭ52 ;Bϭ50). Groups were identical in age (mean years: Aϭ9,7; Bϭ10,1), sex , duration of symptoms before surgery (mean hours: Aϭ40,2, Bϭ31,8), surgical appendicitis staging. There was no statistical significant difference in: duration of perfusion (mean hours: Aϭ26,4, Bϭ25,8; pϭ0,8), number of boluses (mean: Aϭ1,27, Bϭ2,0; pϭ0,09), and pain rating. In group B, children with peritonitis showed more pain in the first 24h and needed more boluses
Journal of Hospital Infection, 2004
![Research paper thumbnail of [Inter-hospital transfer in pediatrics]](https://attachments.academia-assets.com/109322004/thumbnails/1.jpg)
](Acta medica portuguesa, 1996
We present the results of a prospective study of the technical and human characteristics of the t... more We present the results of a prospective study of the technical and human characteristics of the transport of children transferred from other Hospitals to our PICU. During eight months of 1994, 153 children were transferred and 138 included in our study. Their ages varied between one month and fourteen years and the majority (60%) were males. 67% of the patients transferred required Pediatric specialties and 30% required surgical specialties. Accidents were the most common pathology (40%), followed by neurologic, respiratory and infectious situations (15% each) The most frequently used means of transport was an ambulance, in 88% of the cases. Only 12% of these were medically equipped and 10% had CPR material available. In 23% of the transports the patient was accompanied by both a nurse and a medical doctor. In 25% by a nurse only and in 14% by a medical doctor. None of them had training in transport medicine. The length of the transport varied between 30 min. and 14 h, with a mean o...
Jornal de Pediatria, 2015
Objectives: To study the effect of two intravenous maintenance fluids on plasma sodium (Na), and ... more Objectives: To study the effect of two intravenous maintenance fluids on plasma sodium (Na), and acid-base balance in pediatric intensive care patients during the first 24 h of hospitalization. Methods: A prospective randomized controlled study was performed, which allocated 233 patients to groups: (A) NaCl 0.9% or (B) NaCl 0.45%. Patients were aged 1 day to 18 years, had normal electrolyte concentrations, and suffered an acute insult (medical/surgical). Main outcome measured: change in plasma sodium. Parametric tests: t-tests, ANOVA, X 2 statistical significance level was set at ˛ = 0.05. Results: Group A (n = 130): serum Na increased by 2.91 (±3.9) mmol/L at 24 h (p < 0.01); 2% patients had Na higher than 150 mmol/L. Mean urinary Na: 106.6 (±56.8) mmol/L. No change in pH at 0 and 24 h. Group B (n = 103): serum Na did not display statistically significant changes. Fifteen percent of the patients had Na < 135 mmol/L at 24 h. The two fluids had different effects on respiratory and post-operative situations. Conclusions: The use of saline 0.9% was associated with a lower incidence of electrolyte disturbances.
Acta medica portuguesa, Jan 31, 2017
The benefits of manual versus automated red blood cell exchange have rarely been documented and s... more The benefits of manual versus automated red blood cell exchange have rarely been documented and studies in young sickle cell disease patients are scarce. We aim to describe and compare our experience in these two procedures. Young patients (≤ 21 years old) who underwent manual- or automated-red blood cell exchange for prevention or treatment of sickle cell disease complications were included. Clinical, technical and hematological data were prospectively recorded and analyzed. Ninety-four red blood cell exchange sessions were performed over a period of 68 months, including 57 manual and 37 automated, 63 for chronic complications prevention, 30 for acute complications and one in the pre-operative setting. Mean decrease in sickle hemoglobin levels was higher in automated-red blood cell exchange (p < 0.001) and permitted a higher sickle hemoglobin level decrease per volume removed (p < 0.001), while hemoglobin and hematocrit remained stable. Ferritin levels on chronic patients dec...
Jornal de pediatria, Jan 27, 2017
This article comprises a sample of abuse modalities observed in a pediatric emergency room (PER) ... more This article comprises a sample of abuse modalities observed in a pediatric emergency room (PER) of a public hospital in the Lisbon metropolitan area and a multifactorial characterization of physical and sexual violence. The objectives are: (1) to discuss the importance of social and family variables in the configuration of both types of violence; (2) to show how physical and sexual violence have subtypes and internal diversity. A statistical analysis was carried out in a database (1063 records of child abuse between 2004 and 2013). A form was applied to cases with suspected abuse, containing data on the child, family, abuse episode, abuser, medical history, and clinical observation. A factorial analysis of multiple correspondence was performed to identify patterns of association between social variables and physical and sexual violence, as well as their internal diversity. The prevalence of abuse in this PER was 0.6%. Physical violence predominated (69.4%), followed by sexual viole...
Revista Brasileira de terapia intensiva
Rhabdomyolysis is a process of muscle destruction that can present with varying clinical manifest... more Rhabdomyolysis is a process of muscle destruction that can present with varying clinical manifestations. In pediatric patients, its main etiology is infectious diseases. We present a previously healthy adolescent who was admitted to our emergency department with a four-day history of myalgia, muscle weakness and dark urine. At presentation, she was dehydrated. Blood analysis revealed acute renal failure and increased muscular enzymes. She was transferred to our pediatric intensive care unit. Medical therapies for correction of dehydration and the ionic and metabolic consequences of renal failure were performed. Due to oliguria, renal replacement therapy was initiated. An etiological investigation revealed a beta-oxidation defect. Metabolic diseases are a known cause of rhabdomyolysis. Muscular destruction should be diagnosed early in order to avoid its potential consequences. Generally, the treatment of rhabdomyolysis is conservative, although in some situations, a more invasive app...
Revista Brasileira de Terapia Intensiva, 2016
Jornal De Pediatria, 2013
Revista Portuguesa de Cardiologia, 2016
Takotsubo syndrome (TTS) is an acquired transient type of systolic dysfunction which mimics myoca... more Takotsubo syndrome (TTS) is an acquired transient type of systolic dysfunction which mimics myocardial infarction clinically and electrocardiographically. TTS is also known as stress cardiomyopathy, broken heart syndrome, apical ballooning, reversible acute heart failure, neurogenic stunned myocardium or acute catecholamine cardiomyopathy. This case report describes an uncommon presentation of myocardial stunning after an anesthetic procedure. A 14-year-old girl with a history of pineal cyst and hemiplegic migraine was admitted for control brain magnetic resonance imaging. During anesthesia induction with propofol she suffered bradycardia, which was reversed with atropine, followed by tachyarrhythmia, reversed with lidocaine and precordial thump. Within hours she developed pulmonary edema and global respiratory failure due to acute left ventricular dysfunction. A transthoracic echocardiogram showed a dilated left ventricle with global hypokinesia and depressed left ventricular systolic function (ejection fraction &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;30%). The electrocardiogram showed persistent sinus tachycardia and nonspecific ST-T wave abnormalities. Cardiac biomarkers were elevated (troponin 2.42 ng/ml, proBNP 8248 pg/ml). She was placed on diuretics, angiotensin-converting enzyme inhibitors, digoxin and dopamine. The clinical course was satisfactory with clinical, biochemical and echocardiographic improvement within four days. Subsequent echocardiograms showed no ventricular dysfunction. The patient was discharged home on carvedilol, which was discontinued after normalization of cardiac function on cardiac magnetic resonance imaging. Few cases of TTS have been described in children, some of them triggered by acute central nervous system disorders and others not fulfilling all the classical diagnostic criteria. In this case the anesthetic procedure probably triggered the TTS.
Acta Pediatrica Portuguesa, 2011
Introdução e Objectivos: A exposição a fármacos na idade pediátrica pode ser nociva. A utilização... more Introdução e Objectivos: A exposição a fármacos na idade pediátrica pode ser nociva. A utilização elevada de medicamentos não aprovados em Pediatria, bem como o uso para sintomas em que a sua eficácia não foi comprovada, tem sido descrita de forma preocupante. Foi objectivo deste estudo avaliar o padrão de consumo de fármacos numa população pediátrica portuguesa. Métodos: Estudo transversal, com recrutamento prospectivo dos casos e amostra de conveniência; recolha de dados por inquérito; incluídas crianças, sem doença crónica, que recorreram ao serviço de urgência de um hospital na área da Grande Lisboa, num período de dois meses. Resultados: Foram incluídas 189 crianças com idade média de 5,8 anos. A proporção de crianças com consumo de fármacos, nos três meses precedentes, foi de 120/189 (63,5%)-superior entre os seis e 24 meses (74% vs 58,5%; p=0,038). Os fármacos mais prescritos foram os analgésicos/antipiréticos e anti-inflamatórios (83/202, 41,1%), os antibióticos (52/202, 25,8%) e os anti-histamínicos (14/202, 7%). Em 96/202 casos (47,5%) eram medicamentos não sujeitos a receita médica e em 33/174 (19,1%) "automedicações". Verificou-se utilização de anti-histamínicos, expectorantes, analgésicos e anti-inflamatórios não recomendados para a faixa etária. O consumo de antibióticos foi mais elevado entre os seis e 24 meses (36% vs 18,5%; p=0,012), com predomínio da associação amoxicilina/ácido clavulânico (21/52, 40,4%). Em seis casos foram relatados possíveis efeitos secundários. Conclusões: De acordo com o nosso conhecimento este é o primeiro estudo em Portugal a avaliar o padrão de utilização de fármacos em Pediatria. Este consumo foi elevado, sobretudo na infância precoce, evidenciando a necessidade de vigilância e regulamentação adequadas. Os medicamentos não sujeitos a receita médica, amplamente utilizados, poderão associar-se a riscos acrescidos, pela facilidade no seu acesso. O uso frequente de antibióticos, sobretudo de largo espectro, poderá vir a associar-se ao desenvolvimento de resistências.
Revista Brasileira de Terapia Intensiva, 2015
Uso da tomografia por impedância elétrica torácica como ferramenta de auxílio às manobras de recr... more Uso da tomografia por impedância elétrica torácica como ferramenta de auxílio às manobras de recrutamento alveolar na síndrome do desconforto respiratório agudo: relato de caso e breve revisão da literatura
Acta Pediatrica Portuguesa, 2011
A crescente afluência de crianças vítimas de maus tratos (MT) à urgência pediátrica (UP) do Hospi... more A crescente afluência de crianças vítimas de maus tratos (MT) à urgência pediátrica (UP) do Hospital Prof. Doutor Fernando Fonseca (HFF) ou Amadora-Sintra, despoletou a necessidade de caracterizar esta realidade, compará-la com os dados nacionais, tendo como objectivo final a optimização da sua abordagem. Métodos: Análise das ficha de MT das crianças observadas na UP entre 2000 e 2005. Foram estudadas variáveis sócio-demográficas, de caracterização do MT e do tipo de intervenção realizada. Resultados: Foram analisadas 416 fichas. Os tipos de MT mais detectados foram a agressão física (60,3%) e o abuso sexual (30,3%). A maioria das vítimas (60%) era do sexo feminino, mediana de 8 anos de idade. Os MT ocorreram no domicílio em 58,9% das situações, com agressor do sexo masculino em 67,8% dos casos e coabitante em 53,1%. No total 89% das sinalizações foram avaliadas pela assistente social; apenas 3% tiveram apoio psicológico. O destino de 83% destas crianças foi o domicílio. Dos casos mais graves destacamse 2 óbitos, 7 crianças com fracturas ósseas e 1 caso de shaking baby syndrome. Conclusão: Os dois tipos mais representados de MT, a agressão física e o abuso sexual, têm especificidades sobreponíveis às dos dados nacionais. Com este estudo foram identificadas e caracterizadas as situações de MT, bem como as principais lacunas na sua abordagem na UP, o que permitiu implementar medidas mais adequadas. Palavras-chave: criança vítima de maus tratos, urgência pediátrica, hospital Prof. Doutor Fernando Fonseca, agressão física, abuso sexual
A Necrose Gorda do Tecido Subcutâneo (NGTS) e uma doenca do tecido adiposo subcutâneo pouco comum... more A Necrose Gorda do Tecido Subcutâneo (NGTS) e uma doenca do tecido adiposo subcutâneo pouco comum, descrita em recem-nascidos que sofreram hipoxia durante ou apos o parto. Caracteriza-se por nodulos subcutâneos e tem um padrao histologico preciso. Esta situacao e autolimitada, geralmente benigna, raramente complicado de hipercalcemia. Os autores descrevem 2 casos de NGTS com evolucao e complicacoes distintas. O primeiro caso e um recem-nascido com asfixia perinatal grave que apresentou NGTS com um mes e meio de vida, associado a hipercalcemia importante e persistente, controlada com hidratacao e hidrocortisona endovenosas. O segundo caso e de um recem-nascido com cardiopatia congenita dueto-dependente que entra em falencia multiorgânica secundaria a choque cardiogenico ao 4° dia de vida, surgindo os nodulos subcutâneos ao 7° dia complicados de flutuacao, drenagem espontânea de gordura necrotica e infeccao local. A proposito destes casos faz-se uma breve revisao da entidade clinica.
A tuberculose congenita e uma doenca considerada pouco comum mas provavelmente subestimada. Apres... more A tuberculose congenita e uma doenca considerada pouco comum mas provavelmente subestimada. Apresenta-se o caso clinico de uma lactente de 4 meses de idade internada por sindrome febril prolongado, hepatoesplenomegalia e malnutricao grave. Todos os exames foram inconclusivos e a biopsia hepatica confirmou o diagnostico de tuberculose congenita. Faz-se a revisao bibliografica dos criterios de diagnostico entre tuberculose congenita e tuberculose adquirida posnatal.
Pearson syndrome is a rare, usually fatal mitochondrial disorder involving the hematopoietic syst... more Pearson syndrome is a rare, usually fatal mitochondrial disorder involving the hematopoietic systemic in early infancy. We report a 20-months-old child admitted with persistent vomiting, prostration and hypotonia, which had started occasional vomiting since 18 months. Laboratory investigation revealed macrocitic anaemia, renal tubular acidosis, cholestasis. The mitochondrial DNA analysed from blood cells, muscle and liver samples, had a simple delection, that suggested Pearson Syndrome. The child died due to electrolyte disturbances related to her tubulopathy. This case emphasizes the importance of considering mitochondrial DNA disorder in patients with multisystemic symptoms that cannot be explained by a specific diagnosis.
Acta medica portuguesa, 1996
The authors present a case of a child aged 32 months, victim of accidental ingestion of an uniden... more The authors present a case of a child aged 32 months, victim of accidental ingestion of an unidentified hydrocarbon product. Sixteen hours following hospitalization, the patient began polypnea with progressive hypoxemia, with the radiograph showing ARDS pattern. Mechanical ventilation was initiated on the 2nd day of admission. During hospitalization the patient developed pneumomediastinum and bilateral pneumothorax which justified active drainage. Inspite of the initial poor prognosis, the patient improved, with no symptoms after discharge. The authors discuss certain theoretical considerations regarding hydrocarbon intoxication.
Introducao: A doenca das celulas falciformes pode ter consequencias graves e as transfusoes tem u... more Introducao: A doenca das celulas falciformes pode ter consequencias graves e as transfusoes tem um papel fundamental no prognostico da doenca. Existem poucos estudos sobre a utilizacao da tecnica manual de transfusao permuta parcial (TPP) de hemacias no tratamento de complicacoes agudas da drepanocitose na populacao pediatrica. A tecnica pretende diminuir os niveis de HbS, mantendo estaveis a concentracao de hemoglobina e hematocrito, evitando a sobrecarga hidrica e de ferro. Pretendemos descrever a nossa experiencia na utilizacao da TPP na abordagem destas complicacoes.Metodos: Estudo retrospectivo de criancas internadas que realizaram TPP manual numa Unidade de Cuidados Intensivos Pediatricos em um periodo de tres anos. Resultados: Foram realizados dez procedimentos a sete doentes. Idade mediana de nove anos, todos homozigotos para HbS. A indicacao foi AVC em um e sindrome toracica aguda em nove. A reducao media de HbS foi de 30% com incremento de hemoglobina de 0.38g/dL. O volume...
Serviço Social e Saúde, 2015
O presente artigo realça a importância e premência da aposta na saúde mental da população, princi... more O presente artigo realça a importância e premência da aposta na saúde mental da população, principalmente nos primeiros anos de vida dos indivíduos. A intervenção precoce é essencial para prevenir patologias mais graves no futuro e assim reduzir custos futuros para o indivíduo, família, sistema de saúde e até para a economia do país. Mas é sobre o «outro lado» da saúde mental que o artigo se vai debruçar primordialmente, ou seja, a família que acompanha o utente, presta cuidados, auxilia no diagnóstico e tratamento. Assim, a família sente-se sobrecarregada e a braços com uma reestruturação de papéis e expectativas familiares. Serão apontadas algumas orientações estratégicas e modalidades para a intervenção em contexto de crise familiar.
Case Reports in Pediatrics, 2015
Noninvasive ventilation (NIV) is a method to be applied in acute respiratory failure, given the p... more Noninvasive ventilation (NIV) is a method to be applied in acute respiratory failure, given the possibility of avoiding tracheal intubation and conventional ventilation. A previous healthy 5-month-old boy developed low-grade intermittent fever, flu-like symptoms, and dry cough for 3 days. On admission, he showed severe respiratory distress with SpO2/FiO2ratio of 94. Subsequent evaluation identified an RSV infection complicated with an increase of inflammatory parameters (reactive C protein 15 mg/dL). Within the first hour after NIV-helmet CPAP SpO2/FiO2ratio increased to 157. This sustained improvement allowed the continuing of this strategy. After 102 h, he was disconnected from the helmet CPAP device. The NIV use in severe hypoxemic acute respiratory failure should be carefully monitored as the absence of clinical improvement has a predictive value in the need to resume to intubation and mechanical ventilation. We emphasize that SpO2/FiO2ratio is a valuable monitoring instrument. ...
Pediatric Research, 2005
Pain in the postoperative period is a rising concern in paediatrics. Ideal management should be t... more Pain in the postoperative period is a rising concern in paediatrics. Ideal management should be the most effective with minimal adverse effects. Objective: Compare two regimens of analgesia, intravenous morphine, continuous infusion versus intermittent bolus in postoperative children (appendectomy). Methods: Randomised, triple-blinded, placebo controlled study in children aged 1 month to 14 years (November 2001 to December 2003). Children were randomised in two groups: (A) morphine continuous perfusion (0,02 mg/Kg/h); (B) normal saline continuous perfusion. Both groups received bolus of morphine (0,03 mg/Kg), according to pain scale. Demographic data; duration of symptoms; surgical appendicitis staging; duration of perfusion, number of boluses; pain measurement (Faces Rating Scale), every 4 hours (first 48 hours); time until enteric feeding, first stool emission; complications and duration of hospitalization were analysed. Results: Included 102 children (A ϭ52 ;Bϭ50). Groups were identical in age (mean years: Aϭ9,7; Bϭ10,1), sex , duration of symptoms before surgery (mean hours: Aϭ40,2, Bϭ31,8), surgical appendicitis staging. There was no statistical significant difference in: duration of perfusion (mean hours: Aϭ26,4, Bϭ25,8; pϭ0,8), number of boluses (mean: Aϭ1,27, Bϭ2,0; pϭ0,09), and pain rating. In group B, children with peritonitis showed more pain in the first 24h and needed more boluses
Journal of Hospital Infection, 2004
Acta medica portuguesa, 1996
We present the results of a prospective study of the technical and human characteristics of the t... more We present the results of a prospective study of the technical and human characteristics of the transport of children transferred from other Hospitals to our PICU. During eight months of 1994, 153 children were transferred and 138 included in our study. Their ages varied between one month and fourteen years and the majority (60%) were males. 67% of the patients transferred required Pediatric specialties and 30% required surgical specialties. Accidents were the most common pathology (40%), followed by neurologic, respiratory and infectious situations (15% each) The most frequently used means of transport was an ambulance, in 88% of the cases. Only 12% of these were medically equipped and 10% had CPR material available. In 23% of the transports the patient was accompanied by both a nurse and a medical doctor. In 25% by a nurse only and in 14% by a medical doctor. None of them had training in transport medicine. The length of the transport varied between 30 min. and 14 h, with a mean o...
Jornal de Pediatria, 2015
Objectives: To study the effect of two intravenous maintenance fluids on plasma sodium (Na), and ... more Objectives: To study the effect of two intravenous maintenance fluids on plasma sodium (Na), and acid-base balance in pediatric intensive care patients during the first 24 h of hospitalization. Methods: A prospective randomized controlled study was performed, which allocated 233 patients to groups: (A) NaCl 0.9% or (B) NaCl 0.45%. Patients were aged 1 day to 18 years, had normal electrolyte concentrations, and suffered an acute insult (medical/surgical). Main outcome measured: change in plasma sodium. Parametric tests: t-tests, ANOVA, X 2 statistical significance level was set at ˛ = 0.05. Results: Group A (n = 130): serum Na increased by 2.91 (±3.9) mmol/L at 24 h (p < 0.01); 2% patients had Na higher than 150 mmol/L. Mean urinary Na: 106.6 (±56.8) mmol/L. No change in pH at 0 and 24 h. Group B (n = 103): serum Na did not display statistically significant changes. Fifteen percent of the patients had Na < 135 mmol/L at 24 h. The two fluids had different effects on respiratory and post-operative situations. Conclusions: The use of saline 0.9% was associated with a lower incidence of electrolyte disturbances.
Acta medica portuguesa, Jan 31, 2017
The benefits of manual versus automated red blood cell exchange have rarely been documented and s... more The benefits of manual versus automated red blood cell exchange have rarely been documented and studies in young sickle cell disease patients are scarce. We aim to describe and compare our experience in these two procedures. Young patients (≤ 21 years old) who underwent manual- or automated-red blood cell exchange for prevention or treatment of sickle cell disease complications were included. Clinical, technical and hematological data were prospectively recorded and analyzed. Ninety-four red blood cell exchange sessions were performed over a period of 68 months, including 57 manual and 37 automated, 63 for chronic complications prevention, 30 for acute complications and one in the pre-operative setting. Mean decrease in sickle hemoglobin levels was higher in automated-red blood cell exchange (p < 0.001) and permitted a higher sickle hemoglobin level decrease per volume removed (p < 0.001), while hemoglobin and hematocrit remained stable. Ferritin levels on chronic patients dec...
Jornal de pediatria, Jan 27, 2017
This article comprises a sample of abuse modalities observed in a pediatric emergency room (PER) ... more This article comprises a sample of abuse modalities observed in a pediatric emergency room (PER) of a public hospital in the Lisbon metropolitan area and a multifactorial characterization of physical and sexual violence. The objectives are: (1) to discuss the importance of social and family variables in the configuration of both types of violence; (2) to show how physical and sexual violence have subtypes and internal diversity. A statistical analysis was carried out in a database (1063 records of child abuse between 2004 and 2013). A form was applied to cases with suspected abuse, containing data on the child, family, abuse episode, abuser, medical history, and clinical observation. A factorial analysis of multiple correspondence was performed to identify patterns of association between social variables and physical and sexual violence, as well as their internal diversity. The prevalence of abuse in this PER was 0.6%. Physical violence predominated (69.4%), followed by sexual viole...
Revista Brasileira de terapia intensiva
Rhabdomyolysis is a process of muscle destruction that can present with varying clinical manifest... more Rhabdomyolysis is a process of muscle destruction that can present with varying clinical manifestations. In pediatric patients, its main etiology is infectious diseases. We present a previously healthy adolescent who was admitted to our emergency department with a four-day history of myalgia, muscle weakness and dark urine. At presentation, she was dehydrated. Blood analysis revealed acute renal failure and increased muscular enzymes. She was transferred to our pediatric intensive care unit. Medical therapies for correction of dehydration and the ionic and metabolic consequences of renal failure were performed. Due to oliguria, renal replacement therapy was initiated. An etiological investigation revealed a beta-oxidation defect. Metabolic diseases are a known cause of rhabdomyolysis. Muscular destruction should be diagnosed early in order to avoid its potential consequences. Generally, the treatment of rhabdomyolysis is conservative, although in some situations, a more invasive app...
Revista Brasileira de Terapia Intensiva, 2016
Jornal De Pediatria, 2013
Revista Portuguesa de Cardiologia, 2016
Takotsubo syndrome (TTS) is an acquired transient type of systolic dysfunction which mimics myoca... more Takotsubo syndrome (TTS) is an acquired transient type of systolic dysfunction which mimics myocardial infarction clinically and electrocardiographically. TTS is also known as stress cardiomyopathy, broken heart syndrome, apical ballooning, reversible acute heart failure, neurogenic stunned myocardium or acute catecholamine cardiomyopathy. This case report describes an uncommon presentation of myocardial stunning after an anesthetic procedure. A 14-year-old girl with a history of pineal cyst and hemiplegic migraine was admitted for control brain magnetic resonance imaging. During anesthesia induction with propofol she suffered bradycardia, which was reversed with atropine, followed by tachyarrhythmia, reversed with lidocaine and precordial thump. Within hours she developed pulmonary edema and global respiratory failure due to acute left ventricular dysfunction. A transthoracic echocardiogram showed a dilated left ventricle with global hypokinesia and depressed left ventricular systolic function (ejection fraction &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;30%). The electrocardiogram showed persistent sinus tachycardia and nonspecific ST-T wave abnormalities. Cardiac biomarkers were elevated (troponin 2.42 ng/ml, proBNP 8248 pg/ml). She was placed on diuretics, angiotensin-converting enzyme inhibitors, digoxin and dopamine. The clinical course was satisfactory with clinical, biochemical and echocardiographic improvement within four days. Subsequent echocardiograms showed no ventricular dysfunction. The patient was discharged home on carvedilol, which was discontinued after normalization of cardiac function on cardiac magnetic resonance imaging. Few cases of TTS have been described in children, some of them triggered by acute central nervous system disorders and others not fulfilling all the classical diagnostic criteria. In this case the anesthetic procedure probably triggered the TTS.
Acta Pediatrica Portuguesa, 2011
Introdução e Objectivos: A exposição a fármacos na idade pediátrica pode ser nociva. A utilização... more Introdução e Objectivos: A exposição a fármacos na idade pediátrica pode ser nociva. A utilização elevada de medicamentos não aprovados em Pediatria, bem como o uso para sintomas em que a sua eficácia não foi comprovada, tem sido descrita de forma preocupante. Foi objectivo deste estudo avaliar o padrão de consumo de fármacos numa população pediátrica portuguesa. Métodos: Estudo transversal, com recrutamento prospectivo dos casos e amostra de conveniência; recolha de dados por inquérito; incluídas crianças, sem doença crónica, que recorreram ao serviço de urgência de um hospital na área da Grande Lisboa, num período de dois meses. Resultados: Foram incluídas 189 crianças com idade média de 5,8 anos. A proporção de crianças com consumo de fármacos, nos três meses precedentes, foi de 120/189 (63,5%)-superior entre os seis e 24 meses (74% vs 58,5%; p=0,038). Os fármacos mais prescritos foram os analgésicos/antipiréticos e anti-inflamatórios (83/202, 41,1%), os antibióticos (52/202, 25,8%) e os anti-histamínicos (14/202, 7%). Em 96/202 casos (47,5%) eram medicamentos não sujeitos a receita médica e em 33/174 (19,1%) "automedicações". Verificou-se utilização de anti-histamínicos, expectorantes, analgésicos e anti-inflamatórios não recomendados para a faixa etária. O consumo de antibióticos foi mais elevado entre os seis e 24 meses (36% vs 18,5%; p=0,012), com predomínio da associação amoxicilina/ácido clavulânico (21/52, 40,4%). Em seis casos foram relatados possíveis efeitos secundários. Conclusões: De acordo com o nosso conhecimento este é o primeiro estudo em Portugal a avaliar o padrão de utilização de fármacos em Pediatria. Este consumo foi elevado, sobretudo na infância precoce, evidenciando a necessidade de vigilância e regulamentação adequadas. Os medicamentos não sujeitos a receita médica, amplamente utilizados, poderão associar-se a riscos acrescidos, pela facilidade no seu acesso. O uso frequente de antibióticos, sobretudo de largo espectro, poderá vir a associar-se ao desenvolvimento de resistências.
Revista Brasileira de Terapia Intensiva, 2015
Uso da tomografia por impedância elétrica torácica como ferramenta de auxílio às manobras de recr... more Uso da tomografia por impedância elétrica torácica como ferramenta de auxílio às manobras de recrutamento alveolar na síndrome do desconforto respiratório agudo: relato de caso e breve revisão da literatura
Acta Pediatrica Portuguesa, 2011
A crescente afluência de crianças vítimas de maus tratos (MT) à urgência pediátrica (UP) do Hospi... more A crescente afluência de crianças vítimas de maus tratos (MT) à urgência pediátrica (UP) do Hospital Prof. Doutor Fernando Fonseca (HFF) ou Amadora-Sintra, despoletou a necessidade de caracterizar esta realidade, compará-la com os dados nacionais, tendo como objectivo final a optimização da sua abordagem. Métodos: Análise das ficha de MT das crianças observadas na UP entre 2000 e 2005. Foram estudadas variáveis sócio-demográficas, de caracterização do MT e do tipo de intervenção realizada. Resultados: Foram analisadas 416 fichas. Os tipos de MT mais detectados foram a agressão física (60,3%) e o abuso sexual (30,3%). A maioria das vítimas (60%) era do sexo feminino, mediana de 8 anos de idade. Os MT ocorreram no domicílio em 58,9% das situações, com agressor do sexo masculino em 67,8% dos casos e coabitante em 53,1%. No total 89% das sinalizações foram avaliadas pela assistente social; apenas 3% tiveram apoio psicológico. O destino de 83% destas crianças foi o domicílio. Dos casos mais graves destacamse 2 óbitos, 7 crianças com fracturas ósseas e 1 caso de shaking baby syndrome. Conclusão: Os dois tipos mais representados de MT, a agressão física e o abuso sexual, têm especificidades sobreponíveis às dos dados nacionais. Com este estudo foram identificadas e caracterizadas as situações de MT, bem como as principais lacunas na sua abordagem na UP, o que permitiu implementar medidas mais adequadas. Palavras-chave: criança vítima de maus tratos, urgência pediátrica, hospital Prof. Doutor Fernando Fonseca, agressão física, abuso sexual