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Left supratentorial ependymoma in a pediatric patient: a case report 小儿左幕上室管膜瘤1例
Pub Date : 2022-03-01 DOI: 10.25060/residpediatr-2022.v12n3-417
Bianca Silva, F. Schmitz, Rafaela Pulice, A. Bedin
This paper represents a 2-year-old patient case report, which started with gait difficulties and ataxia. Brain magnetic resonance was performed, which confirmed the clinic diagnosis of supratentorial neoplasm. The patient was undergone a left frontotemporoparietal craniotomy procedure. The immunohistochemical evaluation result was suggestive of ependymoma (OMS grade II). The patient was discharged with no observed neurological deficit.
本文报告了一名2岁患者的病例报告,该病例始于步态困难和共济失调。行脑磁共振检查,证实了幕上肿瘤的临床诊断。患者接受左额颞顶开颅手术。免疫组化评估结果提示室管膜瘤(OMS II级)。患者出院时未观察到神经功能障碍。
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引用次数: 0
Insulinoma as a rare cause of hypoglycemia in childhood: case report 胰岛素瘤是儿童低血糖的罕见病因:1例报告
Pub Date : 2022-03-01 DOI: 10.25060/residpediatr-2022.v12n3-422
R. Pereira, Alessandra Cavalcante, Nancy Linhares, Milena Sousa, L. Aragão, A. Carvalho, A. Montenegro
INTRODUCTION: Insulinoma is a neuroendocrine tumor that originates in pancreatic beta cells, resulting in severe and frequent preprandial hypoglycemia. The diagnosis should be considered in the presence of the Whipple triad (present in 75% of cases) and confirmed through the demonstration of high insulin levels associated with low serum glucose levels. Treatment is surgical and, in most cases, curative. CASE REPORT: Girl, 10-years-old, hospitalized for the investigation of possible refractory epilepsy with predominant morning seizures, which started 6 months prior to her admission. A pediatric endocrinology evaluation was requested, as hypoglycemia was evidenced during the occurrence of seizures, which improved after intravenous glucose infusion. During the tests of the critical sample, hyperinsulinism associated with hypoglycemia was revealed. The diagnosis of insulinoma was therefore considered and then confirmed, after an intrapancreatic lesion showed up on the imaging tests. She was referred for surgical excision and had good evolution after tumor enucleation. COMMENTS: Insulinoma is a rare neuroendocrine tumor in the pediatric group. It may initially present itself as a hard-to-control convulsive condition, accompanied by behavioral changes and developmental delay, which often leads to misdiagnosis. Thus, early diagnosis and intervention are important since they reduce the morbidity and mortality of affected individuals. The patient did not present neurological sequelae and had a favorable post-surgical evolution, without recurrence of symptoms or further episodes of hyperglycemia.
简介:胰岛素瘤是一种起源于胰腺β细胞的神经内分泌肿瘤,可导致严重和频繁的餐前低血糖。诊断应考虑惠普尔三联征(出现在75%的病例中)的存在,并通过证明高胰岛素水平与低血糖水平相关联来确诊。治疗方法是手术,在大多数情况下是可以治愈的。病例报告:女孩,10岁,住院调查可能的难治性癫痫,主要是早晨癫痫发作,在入院前6个月开始。由于癫痫发作期间出现低血糖,静脉输注葡萄糖后有所改善,因此要求进行儿科内分泌学评估。在关键样本的测试中,发现高胰岛素血症与低血糖相关。因此,在影像学检查显示胰腺内病变后,考虑并确认了胰岛素瘤的诊断。她转介手术切除,肿瘤去核后进展良好。评论:胰岛素瘤是一种罕见的小儿神经内分泌肿瘤。它最初可能表现为难以控制的抽搐状态,伴有行为改变和发育迟缓,这经常导致误诊。因此,早期诊断和干预很重要,因为它们可以降低受影响个体的发病率和死亡率。患者未出现神经系统后遗症,术后进展良好,无症状复发或进一步高血糖发作。
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引用次数: 0
Acute genital ulcer in adolescent: clinical case 青少年急性生殖器溃疡临床一例
Pub Date : 2022-03-01 DOI: 10.25060/residpediatr-2022.v12n3-432
F. Santana, Taiza Diamantino, P. Silva, Luís Rodrigues, T. Diamantino
Acute genital ulcer, also known as Lipschütz ulcer, is an uncommon, non-sexually transmitted condition characterized by the rapid onset of a necrotic and painful ulcer in the vulvar region. It occurs in adolescents and young women, with or without sexual activity. It may be preceded by influenza-like or mononucleosis-like symptoms. Acute genital ulcers have been associated with Epstein-Barr virus (EBV) infection or other viral or bacterial infections. However, in most cases, the cause is not determined. We report the clinical case of an 11-year-old girl without previous vaginal or oral ulceration without sexual contact who sought medical assistance with a rapidly progressive vulvar ulcer wich had started six days before, preceded by episodic low fever. The exclusion of infectious causes, the spontaneous healing of the lesion and the indeterminate serology for Epstein-Barr led to the diagnosis of ulcer of Lipschütz.
急性生殖器溃疡,也称为lipsch溃疡,是一种罕见的非性传播疾病,其特点是外阴区域迅速出现坏死和疼痛的溃疡。它发生在有或没有性活动的青少年和年轻妇女中。它可能先于流感样或单核细胞增多症样症状。急性生殖器溃疡与eb病毒(EBV)感染或其他病毒或细菌感染有关。然而,在大多数情况下,原因无法确定。我们报告的临床病例11岁的女孩以前没有阴道或口腔溃疡没有性接触谁寻求医疗援助迅速进展外阴溃疡开始6天前,之前的阵发性低热。排除感染原因,病变自发愈合和Epstein-Barr不确定的血清学导致lipsch溃疡的诊断。
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引用次数: 0
Urachal sinus in an infant: a case report 婴儿尿管窦1例
Pub Date : 2022-03-01 DOI: 10.25060/residpediatr-2022.v12n3-365
Julia VESCOVi, C. Doria, H. Malfussi
The persistence of the urachus, a tubular structure that connects the bladder to the navel, is an anomaly that consists in its permanence after birth. It can have four different forms and one of the rarest is the urachal sinus. It was reported a 41-day-old female patient with an umbilical scar secretion. Initially, omphalitis was suspected; however, after a diagnostic investigation, it was evidenced, by examining the image, a persistent urachus. Treatment includes surgical correction that can be performed electively.
尿管是连接膀胱和肚脐的管状结构,其持续存在是一种异常,因为它在出生后就会永久存在。它可以有四种不同的形式,其中最罕见的是尿管窦。这是一个41天的女性患者报告脐瘢痕分泌物。最初,怀疑是脐炎;然而,经过诊断调查,通过检查图像证明,它是一个持久的urachus。治疗包括可选择性进行的手术矫正。
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引用次数: 0
Clinical and radiological profile of children hospitalized with complicated pneumonias 住院儿童并发肺炎的临床和放射学分析
Pub Date : 2022-03-01 DOI: 10.25060/residpediatr-2022.v12n3-426
Laís Gabriel, R. Aurilio, C. Sant’Anna
Most children have 4 to 6 acute respiratory infections (IRA) per year. Of these, only 2-3% progress to pneumonia. Community-acquired pneumonia (PAC) is one of the respiratory tract infections. PAC in children remains a global public health problem due to its high morbidity and mortality, being the disease that most kills children between 0 and 5 years of age in the world. Complicated PAC is defined as fever permanence or clinical instability after 48-72 h of PAC admission. The objective of this work is to describe complicated PACs, hospitalized at a pediatric hospital, between April 2006 and April 2018. This is a retrospective, observational and descriptive study with children and adolescents aged 0 to 13 years, hospitalized with complicated PAC in a pediatric hospital, from April 2006 to April 2018. Patients data were collected and a data collection form was completed. The following variables will be studied: age, gender, type of pulmonary/extrapulmonary complication, vaccination status (pneumococcal vaccine), treatment time, daycare regulars or not. Descriptive analysis of categorical variables in frequency form and numerical variables in the form of percentage, mean and median were performed. It was concluded with this study that the clinical and radiological profile of pneumonia in one pediatric hospital is similar to that found in the world literature today.
大多数儿童每年有4到6次急性呼吸道感染。其中,只有2-3%发展为肺炎。社区获得性肺炎(PAC)是呼吸道感染的一种。由于发病率和死亡率高,儿童PAC仍然是一个全球公共卫生问题,是世界上造成0至5岁儿童死亡最多的疾病。复杂性PAC定义为PAC入院48-72 h后持续发热或临床不稳定。这项工作的目的是描述2006年4月至2018年4月期间在儿科医院住院的复杂pac。这是一项回顾性、观察性和描述性研究,研究对象是2006年4月至2018年4月在一家儿科医院因复杂PAC住院的0至13岁儿童和青少年。收集患者资料并填写数据收集表。以下变量将被研究:年龄、性别、肺部/肺外并发症类型、疫苗接种状况(肺炎球菌疫苗)、治疗时间、日托常规与否。对频率形式的分类变量和百分比、平均值和中位数形式的数值变量进行描述性分析。这项研究得出结论,一家儿科医院的肺炎的临床和放射学概况与当今世界文献中发现的相似。
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引用次数: 0
Illness fabricated or induced in a child by a caregiver: what the doctor needs to know 看护人在孩子身上捏造或诱发的疾病:医生需要知道的
Pub Date : 2022-03-01 DOI: 10.25060/residpediatr-2022.v12n3-398
M. Giusti, C. Benites, A. Andrade, Renan Vignardi, Anna Carolina Feitosa, G. Canicoba, C. Miziara, I. Miziara
The caregivers fabrication, induction, or exacerbation of disease has been known as Munchausen syndrome by proxy since the last century, although this name is currently considered inappropriate. For this study, we will adopt this second designation. Child abuse is not a recent problem, nor is it easy to identify. The perpetrator can practice multiple forms of aggression, but one of them assumes importance not only because of the immediate or late consequences but also because the aggressor, in most cases, is the mother. This study aimed to broadly address the syndrome with information about the diagnosis and medical and legal conduct, according to literature data.
自上个世纪以来,看护人制造、诱发或加剧疾病的行为被称为孟乔森综合征,尽管这个名字目前被认为是不合适的。对于这项研究,我们将采用第二个名称。虐待儿童并不是最近才出现的问题,也不容易识别。犯罪者可以实施多种形式的攻击,但其中一种方式之所以重要,不仅是因为其直接或后期的后果,还因为在大多数情况下,攻击者是母亲。根据文献数据,这项研究旨在广泛地解决有关诊断、医疗和法律行为的信息综合症。
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引用次数: 0
Osteomyelitis of the spine due to Salmonella infection: a case report 沙门氏菌感染致脊柱骨髓炎1例报告
Pub Date : 2022-03-01 DOI: 10.25060/residpediatr-2022.v12n3-427
T. Assis, Bárbara Rodrigues, P. Vieira, Ricardo Watanabe
Acute osteomyelitis (OM) is an inflammatory process of bone accompanied by bone destruction, usually of infectious bacterial etiology and hematogenous spread. Among the different forms of osteomyelitis in children, only 1 to 2% affect the spine. We present the case of a previously healthy 12-year-old patient with vertebral OM with an initial clinical presentation of pain, fever and claudication without associated gastrointestinal symptoms. The diagnosis was made by vertebral body biopsy culture with improvement after prolonged and adequate antibiotic therapy.
急性骨髓炎(OM)是一种伴有骨破坏的骨炎症过程,通常由感染性细菌和血液传播引起。在不同形式的儿童骨髓炎中,只有1%至2%影响脊柱。我们提出的病例以前健康的12岁患者椎体OM的最初临床表现为疼痛,发热和跛行,没有相关的胃肠道症状。诊断是通过椎体活检培养,经过长期和充分的抗生素治疗后有所改善。
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引用次数: 0
Enteroviral encephalitis with neurological sequelae treated successfully with corticoids 用皮质激素治疗伴有神经系统后遗症的肠病毒性脑炎
Pub Date : 2022-03-01 DOI: 10.25060/residpediatr-2022.v12n3-378
L. Borrero, D. Gilio
Enteroviral infections are a common condition in childhood that may compromise the central nervous system. The primary concern is the absence of specific treatment for severe cases. Data report uses immunotherapy to reduce neurological sequelae, with limited studies evaluating its efficacy and safety. This case describes enteroviral encephalitis with neurological sequelae, treated successfully with corticosteroids.
肠道病毒感染是儿童时期常见的疾病,可能会损害中枢神经系统。主要问题是缺乏对严重病例的专门治疗。数据报告使用免疫疗法来减少神经系统后遗症,但评估其有效性和安全性的研究有限。本病例描述了伴有神经系统后遗症的肠病毒性脑炎,用皮质类固醇成功治疗。
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引用次数: 0
X-linked hypophosphatemic rickets: case report x连锁低磷血症佝偻病1例报告
Pub Date : 2022-03-01 DOI: 10.25060/residpediatr-2022.v12n3-336
Camila Gonçalves, M. Sales, Alessandra Cavalcante, R. Pereira, Milena Sousa, L. Aragão, A. Carvalho, A. Montenegro
INTRODUCTION: The X-linked hypophosphatemic rickets is considered the most common cause of rickets. It is an X-linked dominant disease, caused by a PHEX gene mutation. It is believed that the biochemical and bone mineralization changes because of the increase of phosphaturic factor, resulting from the PHEX genes inability to inactivate its substrate. CASE REPORT: A seven-year and eleven-month-old girl has been followed by an orthopedist since she was 1 year old, due to lower limb deformity. She was referred to a pediatric endocrinologist for further evaluation. At clinical examination, the patient presented genu varum and Z score of stature/age = 4.8. Laboratory tests: serum phosphorus = 2.3mg/dl (4.5-6.6), ionic calcium = 1,8mmol/l (1.17-1.32), parathyroid hormone = 42pg/ml (12-88), alkaline phosphatase = 600U/L (<300). The patient has always shown low adherence to treatment. Currently, at age 12 and 2 months old, endures with genu varum and short stature, besides the persistence of laboratory alterations. The PHEX gene sequencing, that evidenced a heterozygous mutation on that gene, confirming the X-linked hypophosphatemic rickets diagnosis. COMMENTS: The X-linked hypophosphatemic rickets is a rare disease with clinical manifestations observed since the early years of life. Diagnosis and intervention are important to decrease these patients morbimortality. The patient started follow-up at our service belatedly, with bone deformity and short stature, resulting in low treatment adherence. For these reasons, there wasnt any clinical or laboratory improvement during that time.
简介:x连锁低磷血症佝偻病被认为是佝偻病最常见的原因。它是一种x连锁显性疾病,由PHEX基因突变引起。我们认为,由于PHEX基因无法灭活其底物,导致了磷酸化因子的增加,从而导致了生化和骨矿化的改变。病例报告:一个7岁零11个月大的女孩,由于下肢畸形,从1岁起就被骨科医生随访。她被转介给儿科内分泌学家作进一步评估。临床检查表现为膝内翻,身高/年龄Z评分= 4.8。实验室检测:血清磷= 2.3mg/dl(4.5-6.6),离子钙= 1.8 mmol/l(1.17-1.32),甲状旁腺激素= 42pg/ml(12-88),碱性磷酸酶= 600U/ l(<300)。病人对治疗的依从性一直很低。目前,在12岁和2个月大时,除了持续的实验室改变外,还患有膝内翻和身材矮小。PHEX基因测序证实了该基因的杂合突变,证实了X-linked低磷血症佝偻病的诊断。评论:x连锁低磷血症佝偻病是一种罕见的疾病,临床表现自生命早期观察到。诊断和干预对降低这些患者的死亡率至关重要。患者随访时间较晚,骨骼畸形,身材矮小,治疗依从性较低。由于这些原因,在那段时间里没有任何临床或实验室的改善。
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引用次数: 0
Exclusive breastfeeding by vegetarian mothers and their possible implications for children 素食母亲的纯母乳喂养及其对孩子可能的影响
Pub Date : 2022-03-01 DOI: 10.25060/residpediatr-2022.v12n3-510
Melissa Gershon, Lucca Amorim, Romero Duque, Alegna Sobrinho, R. Garcia, Luciano Costa
It is known that the period of life between pregnancy and the childs two years of age is critical for the promotion of growth and development, which makes adequate nutrition essential for the complete potential development of each human being. In this sense, the present study aims to discuss the peculiarities of exclusive breastfeeding up to 6 months of life of the infant by vegetarian mothers and its possible implications for the child. This is a narrative review based on the evaluation of protocols by the Brazilian Vegetarian Society, Brazilian Society of Pediatrics and Society of Pediatrics of São Paulo, as well as articles comprised between 1982 and 2020, available in online databases. Human milk contains lipids, vitamins, minerals, proteins, carbohydrates, immunoglobulin A, interferon, enzymes, and growth modulators. This composition is generally similar when comparing vegetarian and non-vegetarian breast milk, however it differs quantitatively. In view of this, in the case of exclusive breastfeeding by vegetarian mothers, medical evaluation is necessary to determine whether there is a need for nutritional supplementation, especially vitamin B12, iron and omega-3. In cases where breastfeeding is not possible, an alternative is infant formulas based on soy or rice. Recent studies show that the growth and development of children fed through soy or rice-based formulas may be similar to that of infants who received exclusive breastfeeding or formula based on cows milk.
众所周知,从怀孕到孩子两岁之间的这段时间是促进生长发育的关键时期,这使得充分的营养对每个人的完全潜在发展至关重要。从这个意义上讲,本研究旨在讨论素食母亲纯母乳喂养婴儿至6个月的特点及其对孩子可能的影响。这是一篇叙述性综述,基于巴西素食协会、巴西儿科协会和圣保罗儿科协会对协议的评估,以及在线数据库中1982年至2020年的文章。人乳含有脂质、维生素、矿物质、蛋白质、碳水化合物、免疫球蛋白A、干扰素、酶和生长调节剂。当比较素食和非素食母乳时,这种成分通常是相似的,但在数量上有所不同。鉴于此,在纯素食母亲纯母乳喂养的情况下,有必要进行医学评估,以确定是否需要补充营养,特别是维生素B12、铁和omega-3。在无法母乳喂养的情况下,可以选择以大豆或大米为基础的婴儿配方奶粉。最近的研究表明,以大豆或大米为基础的配方奶粉喂养的儿童的生长发育可能与纯母乳喂养或以牛奶为基础的配方奶粉喂养的婴儿相似。
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引用次数: 0
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Residência Pediátrica
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