Browsing by Author "Fernandes, Andreia"
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- Abordagem a queimaduras na idade pediátrica: ABCDE+FPublication . Pereira, Mafalda João; Oliveira, Iris Rocha e; Fernandes, AndreiaAs queimaduras são acidentes frequentes em pediatria, cuja abordagem não difere da realizada em ambiente pré-hospitalar de um politraumatizado, com potencial de rápida deterioração das lesões e do estado geral. A estabilização do doente deve seguir a sigla de reanimação ABCDE+F. As queimaduras conduzem a vários tipos de resposta fisiopatológica, necessitando de uma correta classificação da profundidade e estimativa da área de superfície corporal queimada (ASCQ). A analgesia e fluidoterapia devem ser instituídas o mais rapidamente possível a fim de melhorar o prognóstico. A abordagem deve ainda permitir recolher o máximo de informação possível das circunstâncias, sempre sem prejuízo dos cuidados. Apresentamos o caso de uma criança de 23 meses trazida à urgência pediátrica com cerca 16% de ASCQ, a sua abordagem e encaminhamento.
- Comparing international guidelines for the remission of hypertension after bariatric surgeryPublication . Dias, Carina Vieira; Silva, Ana Lúcia; Dias, Joana; Cardoso, Paulo; Castanheira, Rute; Fernandes, Andreia; Nunes, Filipa; Sanai, Tina; Sanchez, Mercedes; Maia-Teixeira, João; De Sousa-Coelho, Ana LuísaBackground/Objectives: Obesity remains a global health concern and is associated with increased risk of type 2 diabetes, hypertension, and cardiovascular disease overall. Dissimilar hypertension guidelines are available for clinicians, namely those prepared by the American Heart Association (AHA) and the European Society of Cardiology (ESC), which may lead to distinctive appreciation of health outcomes of patients with obesity after bariatric and metabolic surgery, such as hypertension remission. The main goal of this study was to compare the effects of applying stricter (AHA) versus looser (ESC) blood pressure criteria on hypertension diagnosis pre-bariatric surgery and remission assessment one year post-op. Methods: A retrospective analysis of clinical data from patients who underwent surgical treatment for obesity at a single university hospital was performed. To evaluate the hypertension improvement or remission, two different types of blood pressure (BP) categorization were considered (based on AHA and ESC guidelines), in which each patient would fit according to their BP values pre- (m0) and 12 months postoperative (m12). Results: From a sample of 153 patients submitted for surgical treatment of obesity, more patients were considered with hypertension based on the AHA guideline (130 vs. 102; p < 0.001), while a higher rate of hypertension remission at 12 months after bariatric surgery was observed when following the ESC guideline (58.82 vs. 53.08%). Baseline patients' clinical characteristics based on each hypertension outcome were mostly independent of the guideline used (p > 0.05), where only age and systolic blood pressure were relatively higher in "ESC groups". Conclusions: We conclude that only minor differences exist between the two guidelines used. If evaluated based on ESC guidelines, it is expected that less patients are considered with hypertension, and the remission rate may be, at least numerically, higher.
- Paragem cardiorrespiratória pediátrica – nem sempre falência respiratóriaPublication . Fernandes, Andreia; Oliveira, Iris; Pereira, MafaldaA paragem cardiorrespiratória (PCR) em idade pediátrica é rara, sendo a causa mais frequente a hipóxia/asfixia. O colapso cardíaco ocorre sobretudo em crianças com patologia cardíaca subjacente.Perante uma PCR, o início de Suporte Básico de Vida (SBV) de alta qualidade e a avaliação do ritmo é essencial para dirigir a atuação, estando esta bem estabelecida em algoritmos amplamente validados. Apresenta-se o caso de uma adolescente com patologia cardíaca que, após uma síncope em ambiente escolar, foi submetida a manobras de reanimação no local. Os autores pretendem alertar para a abordagem da PCR de causa cardíaca, bem como para a importância do início precoce de SBV com influência no prognóstico.
- A rare cause of intellectual disabilityPublication . Oliveira, Íris; Fernandes, Andreia; Pereira, Mafalda; Rodrigues, Márcia; Silva, Noémia; Mendonça, CarlaA seven-year-old female was followed in a developmental clinic from the age of nine months due to delayed psychomotor development. The first physical examination showed a newborn with irritability and a large anterior fontanelle. A transfontanellar ultrasound was performed, revealing mild enlargement of the lateral and third ventricles. Head circumference remained below the third percentile until the age of five months, then rose to the third percentile. Developmental milestones were globally delayed, with expressive language being more severely affected and axial hypotonia with appendicular hypertonia on neurological examination. Subsequent medical observation revealed deep-set eyes, mildly up-slanted palpebral fissures, a high nasal bridge with a broad nasal tip, a thin upper lip, widely spaced teeth, retrognathia, and a slight pectus excavatum. Genetic investigation revealed the diagnosis, with whole-exome sequencing consistent with the genetic diagnosis of autosomal dominant mental retardation type 7 (MRD7). All patients diagnosed with MRD7 have a development delay detected at a young age and, typically, a mild to severe intellectual disability later in life. All individuals present language impairment, especially in verbal expression. Motor development is typically affected by gait disturbances and generalized hypertonia, which are noted early in life. Microcephaly is a prominent feature of this syndrome, present in over 90% of the cases. The most common findings in MRD7 (microcephaly and intellectual disability) have a broad differential diagnosis. Some disorders have multiple findings in common with MRD7, such as Angelman syndrome (AS), MECP2 disorders, or Mowat-Wilson syndrome (MWS). MRD7 is a rare genetic syndrome characterized by developmental delay/intellectual disability, microcephaly, autism spectrum disorder, behavior problems, typical facial features, and seizures. Early intervention is more likely to be effective and potentially change a child's developmental path. Small gains early in life could represent a significant difference in the children's future autonomy.