Search

Resumen Introduccion Aunque actualmente se tiende a un abordaje terapeutico menos agresivo, la osteomielitis hematogena aguda (OHA) sigue suponiendo un reto, con una morbilidad significativa a nivel mundial. El objetivo del estudio fue evaluar si se alcanzo una adherencia del 80% con el protocolo vigente, identificar las complicaciones y riesgos asociados y analizar las tendencias en la etiologia y el manejo de la OHA en la poblacion pediatrica. Metodos Estudio observacional longitudinal unicentrico en pacientes menores de 18 anos con OHA ingresados en un hospital pediatrico entre 2008 y 2018 divididos en 2 cohortes (antes y despues de 2014). Se analizaron datos demograficos, clinicos y concernientes a la evolucion de la enfermedad. Resultados El estudio incluyo a 71 ninos con OHA, 56% varones, con una edad mediana de 3 anos (rango intercuartilico, 1-11). Se observo una incidencia 1,8 veces mayor en los ultimos 5 anos. El agente causal se identifico en el 37% de los casos: SASM (54%), SARM (4%), Streptococcus pyogenes (19%), Kingella kingae (12%), Streptococcus pneumoniae (8%) y Neisseria meningitidis (4%). Se identificaron complicaciones en el 45% y secuelas en 3,6% de los pacientes. En los ultimos anos aumento la incidencia de miositis (30% vs. 7%; p = 0,02) y de artritis septica (despues de 2015, 68% vs. 37,2%, p = 0,012), asi como la proporcion de pacientes con tratamiento inferior a 4 semanas (37% vs. 3,5%; p = 0,012), con tasas de secuelas similares. Los factores de riesgo de complicaciones fueron la edad ≥ 3 anos, nivel de PCR ≥ 20 mg/l, duracion de los sintomas al ingreso de 5 o mas dias y cultivo positivo, aunque en el analisis multivariado solo se valido el cultivo positivo. La presencia de complicaciones se identifico como factor de riesgo de secuelas a los 6 meses. Conclusiones El presente estudio confirma que la OHA puede ser agresiva. La identificacion de los factores de riesgo es fundamental para su abordaje.

Toe injuries are common in the emergency department and most of them are treated conservatively. In some circumstances, these injuries can present as a physeal fracture with concomitant soft-tissue injury affecting the nail bed and resulting in a hidden open fracture. To adequately treat these patients, a high index of suspicion is needed to diagnose and treat the open fractures and to prevent complications such as infection, osteomyelitis, malunion and premature physeal arrest.We report a case of a patient that was admitted to the hospital with a Salter-Harris type I fracture of the distal phalanx of the hallux. After confirming the diagnosis, antibiotic treatment was started and the fracture was reduced and fixed.The literature on this entity is sparse and most of the management protocols are based on its hand equivalent—the Seymour fracture, emphasising the low threshold for treating these lesions as an open fracture.

Submitted by Dulce Barreto (mdulce.barreto@chlc.min-saude.pt) on 2021-04-29T16:50:47Z No. of bitstreams: 1 Pediatr Int 2020_97.pdf: 235658 bytes, checksum: 2b411432a4fdff2c9b10cb1e4f6f6680 (MD5) Made available in DSpace on 2021-04-29T16:50:47Z (GMT). No. of bitstreams: 1 Pediatr Int 2020_97.pdf: 235658 bytes, checksum: 2b411432a4fdff2c9b10cb1e4f6f6680 (MD5) Previous issue date: 2020-01 info:eu-repo/semantics/publishedVersion

Submitted by Dulce Barreto (mdulce.barreto@chlc.min-saude.pt) on 2021-01-22T15:16:37Z No. of bitstreams: 1 Br J Haematol 2020_189_e147.pdf: 102932 bytes, checksum: 10bbb87fe929516a3f9d51c2cfa47c39 (MD5) Made available in DSpace on 2021-01-22T15:16:37Z (GMT). No. of bitstreams: 1 Br J Haematol 2020_189_e147.pdf: 102932 bytes, checksum: 10bbb87fe929516a3f9d51c2cfa47c39 (MD5) Previous issue date: 2020 info:eu-repo/semantics/publishedVersion

We present a 10-year-old boy with 2-month duration non-traumatic wrist pain and inflammatory signs. Due to elevated inflammatory markers on blood tests, with an increase in radiocarpal and intercarpal joints synovial fluid and no bony lesions, the patient was submitted to wrist arthrocentesis for the suspicion of septic arthritis. The patient did not improve on conventional treatment, however. An MRI showed synovitis around the carpus and a lytic lesion of the capitate bone due to osteomyelitis. A biopsy was able to identify the causative agent as Mycobacterium tuberculosis, and the patient was treated with antibiotics. He improved significantly, with no pain and signs of normal capitate bone remodelling on the last radiograph. info:eu-repo/semantics/publishedVersion

Introdução/Objectivos: A osteogénese imperfeita (OI) é uma doença genética caracterizada por fragilidade óssea e osteopenia. O tratamento implica uma abordagem multidisciplinar e tem como objectivo a melhoria da qualidade de vida. Os autores pretendem descrever as características de uma amostra de crianças com OI, avaliar o tratamento realizado e a evolução clínica pré e pós terapêutica. Material e Métodos: Estudo observacional, longitudinal, retrospectivo e analítico, com base nos dados obtidos da consulta dos processos de todos os doentes com OI incluídos no protocolo de tratamento com pamidronato no Hospital Dona Estefânia. As variáveis estudadas foram: sexo, idade de diagnóstico, antecedentes familiares de OI, idade de fractura, localização da fractura, número de fracturas, terapêutica médica/cirúrgica, idade de início do tratamento médico, número de ciclos de terapêutica médica, idade da terapêutica cirúrgica, complicações da terapêutica cirúrgica. Adoptou-se um nível de significância de 5%. Resultados: De 21 doentes, 61,9% eram do sexo masculino e 11 tinham registado o diagnóstico do tipo de OI (cinco do tipo I, três tipo III, três tipo IV). A idade média de diagnóstico foi de 20,6 meses, verificando-se dois picos diagnósticos: no primeiro mês – 37%, e aos 24 meses - 26%. Em média os doentes apresentaram 0,62 fracturas/doente/ano, 17,4% das quais no período perinatal e 62% antes dos três anos de idade. A maioria das fracturas ocorreu nos membros inferiores (55,6%). Todos os doentes realizaram tratamento médico, com início em média aos 4,3 anos. Na amostra com seguimento (n=14) verificou-se diminuição no número de fracturas após o início do tratamento com pamidronato (de 0,76 para 0,35 fracturas/doente/ano). Foram colocadas cavilhas endomedulares em nove doentes (64,3%). Em oito doentes foram colocadas nos fémures, quatro unilaterais e quatro bilaterais, não existindo antecedentes de fractura em três casos. Não se registaram novas fracturas nos ossos encavilhados. Conclusão: A OI é uma doença com uma ampla variabilidade clínica que depende maioritariamente do seu tipo. Apesar de não existir tratamento curativo, o tratamento médico com bifosfonatos e o tratamento cirúrgico, com colocação de cavilhas endomedulares, parece reduzir a incidência de novas fracturas.

During pre and post graduation in Medicine, the traumatic aetiology concepts that guide the diagnosis and treatment of lesions in children (and adults) are often watered down in the immensity of medical knowledge to which medical students are subjected. Despite being frequently confronted with cases of paediatric traumatology, family physicians often feel they are poorly prepared to evaluate and treat these cases. In order to surpass these limitations, a few notions of physiopathology, epidemiology, semiology - common in a context of paediatric traumatology - are presented. Some general therapeutic principles that allow to solve a number of these situations are also discussed.

The Ponseti method is reportedly effective for treating clubfoot in children up to 9 years of age. However, whether age at the beginning of treatment influences the rate of successful correction and the rate of relapse is unknown. We therefore retrospectively reviewed 68 consecutive children with 102 idiopathic clubfeet treated by the Ponseti technique in four Portuguese hospitals. We followed patients a minimum of 30 months (mean, 41.4 months; range, 30–61 months). The patients were divided into two groups according to their age at the beginning of treatment; Group I was younger than 6 months and Group II was older than 6 months. All feet (100%) were initially corrected and no feet required extensive surgery regardless of age at the beginning of treatment. There were no differences between Groups I and II in the number of casts, tenotomies, success in terms of rate of initial correction, rate of recurrence, and rate of tibialis anterior transference. The rate of the Ponseti method in avoiding extensive surgery was 100% in Groups I and II; relapses occurred in 8% of the feet in younger and older children. Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.