Annular pancreas in neonate patients Vomiting and weight loss in a 13-day newborn / Pâncreas Anular no período neonatal Vômitos e perda de peso em neonato com 13 dias de vida

Objective: Reinforce that, despite being a rare condition, the annular pancreas must be considered a differential diagnosis for intestinal obstructions in the newborn period. Case description: This case report refers to a 13-days newborn admitted to the emergency room presenting with postprandial vomiting and progressive weight loss since maternity discharge. The patient did not respond to initial interventions that included IV antibiotics and nasogastric tube insertion. A contrast study of the upper digestive tract (esophagus, stomach, and duodenum) found a luminal narrowing on the second duodenal portion. The patient was submitted to an exploratory laparotomy which found a pancreatic-tissue ring involving the second part of the duodenum. Despite rare, we reinforce that the annular pancreas must be considered a differential diagnosis for intestinal obstructions in the newborn period. Comments: Annular pancreas is a rare congenital defect in which a ring of pancreatic tissue encircles the duodenum, causing different degrees of intestinal obstruction. (AU)

Objetivo: Evidenciar que, apesar de condição rara, o pâncreas anular deve se firmar como diagnóstico dife-rencial das obstruções intestinais no período neonatal. Descrição do caso: Este relato aborda o caso de uma paciente de 13 dias de vida admitida no pronto atendimento com queixa de volumosos vômitos pós-prandiais e perda de peso progressiva desde a alta da maternidade. Apesar das medidas iniciais, com ressuscitação volêmica, antibioticoterapia e passagem de sonda nasogástrica para descompressão, a paciente evolui sem melhora. Exame contrastado de esôfago-estômago-duodeno detectou estreitamento luminal da segunda porção duodenal. Paciente submetida à laparotomia exploradora, que evidenciou anel de tecido pancreático estreitando o trânsito intestinal na região. Comentários: O pâncreas anular é uma anomalia congênita rara na qual um anel de tecido pancreático envolve a porção descendente do duodeno, causando graus variados de obstrução intestinal extrínseca. (AU)

Clinical impact of respiratory virus in pulmonary exacerbations of children with Cystic Fibrosis.

BACKGROUNDS: Cystic Fibrosis (CF) is a genetic, multisystemic, progressive illness that causes chronic suppurative lung disease. A major cause of morbimortality in this condition are pulmonary exacerbations. Although classically attributed to bacterial infections, respiratory virus have been increasingly recognized in its ethiopathogeny. METHODS: Nasopharyngeal swab samples were collected from children < 18 years old with CF in Rio de Janeiro, Brazil, with pulmonary exacerbation criteria. Samples were submitted to RT-PCR for Adenovirus, Influenza A and B, Parainfluenza Virus, Respiratory Syncytial Virus (RSV), Metapneumovirus and Rhinovirus. Virus positive and virus negative groups were compared in regards to clinical presentation, severity of exacerbation and bacterial colonization. RESULTS: Out of 70 samples collected from 48 patients, 35.7% were positive for respiratory viruses. Rhinovirus were the most common (28% of all positive samples), followed by RSV. The virus positive group was associated with change in sinus discharge (p = 0.03). Considering only patients younger than five years old, positive virus detection was also associated with fever (p = 0.01). There was no significant difference in clinical severity or in bacterial colonization between virus positive and negative groups. CONCLUSIONS: Prospective studies are still needed to assess the long term impact of viral infections in patients with CF, and their interaction with the bacterial microbiome in these patients.