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1.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334753

RESUMO

A 2-month-old full-term female infant with medical history of situs inversus totalis presented to the emergency department with congestion and abnormal breathing. She was discovered to have failure to thrive (FTT) and subsequently admitted. Investigations revealed a large vallecular mass at the base of her tongue which was noted to cause severe, intermittent airway obstruction. The mass underwent marsupialisation by otolaryngology (ENT) and pathology confirmed a diagnosis of vallecular cyst. The patient made a full recovery and is now growing and thriving. This case emphasises the need to consider anatomic airway abnormalities in the differential diagnosis of young infants with the constellation of respiratory symptoms and FTT. Such airway abnormalities can cause life-threatening airway obstruction if not discovered.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Cistos/diagnóstico , Insuficiência de Crescimento/etiologia , Doenças da Língua/diagnóstico , Obstrução das Vias Respiratórias/diagnóstico , Cistos/complicações , Cistos/cirurgia , Insuficiência de Crescimento/diagnóstico , Feminino , Humanos , Lactente , Língua/cirurgia , Doenças da Língua/complicações , Doenças da Língua/cirurgia , Resultado do Tratamento
4.
Rev. Rol enferm ; 43(3): 169-183, mar. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193818

RESUMO

INTRODUCCIÓN: La supervivencia de cáncer infantil a los 5 años está aumentando gracias a los tratamientos existentes; no obstante, los efectos de esta enfermedad y su tratamiento siguen causando grandes afectaciones en todo el organismo. OBJETIVOS: Conocer cómo afecta la quimioterapia y radioterapia al crecimiento y desarrollo del niño a corto y largo plazo. Identificar si en el seguimiento enfermero pediátrico se tienen en cuenta los efectos de este tratamiento en la valoración del niño. METODOLOGÍA: Tipo de estudio: Revisión bibliográfica. Bases de datos: PUBMED, CINAHL, CUIDATGE y CUIDEN. Para una estrategia de búsqueda exhaustiva se utilizó la combinación de filtros (artículos de los últimos 6 años, idioma español o inglés), truncamientos, operadores lógicos, subtemas y thesaurus. RESULTADOS: Se obtuvieron 29 referencias. Estas se clasificaron en función de los sistemas corporales afectados por el tratamiento y del desarrollo y crecimiento en la edad pediátrica. Se añadió una segunda clasificación en función del método de seguimiento utilizado por las enfermeras. DISCUSIÓN: El análisis de los resultados aporta grandes similitudes y diferencias entre autores, así como en el seguimiento enfermero de los pacientes pediátricos con cáncer, la confrontación ética y legal en la conservación de gónadas y diferencias por edad y sexo. CONCLUSIONES: Actualmente el papel de la enfermera oncológica pediátrica tiene gran importancia por los cuidados proporcionados. Pero existe poca evidencia respecto el seguimiento de los efectos del tratamiento, por lo que es necesario seguir realizando investigación e incrementar conocimiento para reducir complicaciones


INTRODUCTION: Childhood cancer survival at five years old is increasing thanks to existing treatments. However, the effects of this disease and its treatment are still causing major effects throughout the body. OBJECTIVES: Know how chemotherapy and radiotherapy affect growth and development of child in short and long term. Identify if in the pediatric nursing monitoring the effects of this treatments are taken into account in the assessment of the child. METHOD: Type of study: Review of the literature. Databases: PUBMED, CINAHL, CUIDATGE and CUIDEN. The combination of filters (articles from the last 6 years, Spanish or English language), truncation, logical operators, sub themes and thesaurus were used for a thorough search strategy. RESULTS. Twenty-nine references were found. These were classified according to the body systems affected by the treatment, the development and growth in the pediatric age. A second classification was added depending on the monitoring method used by the nurses. CONCLUSIONS: Oncology pediatric nurse paper has a great importance for the care provided at present. There is little evidence in relation to the monitoring of treatment effects so it is necessary to continue making research and increasing knowledge to minimize complications


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Radioterapia/efeitos adversos , Antineoplásicos/efeitos adversos , Deficiências do Desenvolvimento/etiologia , Insuficiência de Crescimento/etiologia , Enfermagem Oncológica , Enfermagem Pediátrica , Cuidados de Enfermagem , Seguimentos
5.
J Pediatr Surg ; 55(5): 855-860, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32089273

RESUMO

PURPOSE: One of the most common procedures in the pediatric population is the placement of a gastrostomy tube. There are significant medical, emotional, and social implications for both patients and caregivers. We hypothesized that socioeconomic status had a significant impact on gastrostomy complications. METHODS: A retrospective chart review was performed. Patient and census data including median household income, unemployment rate, health insurance status, poverty level, and caregiver education level were merged. Statistical tests were conducted against a 2-sided alternative hypothesis with a 0.05 significance level. Outcomes examined were minor and major complications in association with socioeconomic variables. RESULTS: Patients with mechanical complications were younger, weighed less, and had a 72% greater chance of having commercial insurance. Patients with Medicare/self-pay were three times more likely to have a minor complication. The average unemployment rate was 23% greater in families with a major complication. Individuals with a minor complication came from community tracts with a lower percentage of families below the poverty level. CONCLUSION: An association between socioeconomic factors and gastrostomy complications was identified. Insurance status and employment status were more significant predictors than poverty level. Further work with variables for targeted interventions to provide specific family support will allow these children and families to thrive. LEVEL OF EVIDENCE: Level II prognosis study.


Assuntos
Insuficiência de Crescimento/etiologia , Gastrostomia/efeitos adversos , Fatores Socioeconômicos , Cuidadores , Pré-Escolar , Feminino , Humanos , Renda , Cobertura do Seguro , Masculino , Medicare , Pobreza , Estudos Retrospectivos , Classe Social , Estados Unidos
6.
Nutrients ; 12(2)2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32069783

RESUMO

Objectives-Failure to thrive (FTT) in infants is characterized by growth failure. Although, cow's milk allergy (CMA) may have an impact on growth and leads to FTT, data are still limited. We focused on FTT as a possible clinical marker for an early diagnosis of CMA. The aim of the present study was to evaluate the implications of cow's milk hypersensitivity in infants with FTT and the growth catch-up after a cow's milk-free diet (CMFD). Methods-A cross-sectional study of all consecutive infants evaluated at the Pediatric Nutrition and Allergy Unit of the University Hospital of Bari (Italy) from January 2016 to April 2018 with a medical-driven diagnosis of FTT. Eligible infants were investigated for possible IgE mediated or non-IgE mediated CMA. Results-43 infants were included, mean age 5.7 months. 33/43 (77%) FTT presented a CMA related disease: 3/43 (7%) were diagnosed as presenting an IgE mediated CMA, 30 (93%) had a non IgE-mediated CMA, confirmed by the elimination diet for diagnostic purposes, that led to a significant improvement of symptoms and recrudescence after milk reintroduction. A total of 29 out of 30 patients (one patient was lost at follow-up) moved up to their original growth percentile after dietary changes. Growth z-scores were computed based on WHO anthropometric data. In 10 out of 43 patients (23%) were diagnosed with gastro-esophageal reflux disease (GERD). Conclusions-when evaluating an infant with FTT, physicians should include in their evaluation an extensive search for IgE mediated and non IgE mediated CMA. When in vivo and in vitro analysis are not conclusive, a 4- to 8-weeks trial of CMFD and a consecutive re-introduction of milk proteins may be helpful in less common diagnoses.


Assuntos
Insuficiência de Crescimento/diagnóstico , Hipersensibilidade a Leite/diagnóstico , Leite/efeitos adversos , Animais , Biomarcadores/análise , Estudos Transversais , Diagnóstico Precoce , Insuficiência de Crescimento/etiologia , Feminino , Humanos , Lactente , Itália , Masculino , Hipersensibilidade a Leite/complicações
7.
BMC Geriatr ; 20(1): 62, 2020 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-32059639

RESUMO

BACKGROUND: "Failure to thrive" and associated diagnoses are non-specific terms applied to older adults when there is lack of diagnostic clarity and imply an absence of medical acuity. We investigated the effect of such admission diagnoses on delivery of patient care in a cohort of older adults admitted to a tertiary care teaching hospital. METHODS: Retrospective matched cohort study conducted at a tertiary care hospital in Vancouver, BC. Cases identified were adults aged ≥65 years admitted to acute medical wards with an admission diagnosis of "failure to thrive", "FTT", "failure to cope", or "FTC", between January 1, 2016 and November 1, 2017 (n = 60, median age 80 years). Age-matched controls met the same inclusion criteria with admission diagnoses other than those of interest (n = 60, median age 79 years). RESULTS: The primary outcome was time to admission, measured from time points in the emergency room that spanned from triage to completion of admission orders. Secondary outcomes were concordance of admission and discharge diagnoses and length of stay in hospital. The total time from triage to admission for older adults admitted with FTT and associated diagnoses was 10 h 40 min, compared to 6 h 58 min for controls (p = .02). Concordance of admission and discharge diagnoses was only 12% for the "failure to thrive" cohort, and 95% for controls. Notably, 88% of the "failure to thrive" cohort had an acute medical diagnosis at the time of discharge. Patients in this cohort stayed 18.3 days in hospital compared to 10.2 days (p = .001). CONCLUSIONS: Patients with an admission diagnosis of FTT or other associated diagnoses had significant delays in care when presenting to the emergency room, despite often having acute medical conditions on presentation. The use of this non-specific label can lead to premature diagnostic closure and should be avoided in clinical practice.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Insuficiência de Crescimento/diagnóstico , Tempo de Internação/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Triagem , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Insuficiência de Crescimento/etiologia , Insuficiência de Crescimento/terapia , Feminino , Avaliação Geriátrica , Humanos , Masculino , Qualidade de Vida/psicologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
8.
Nutrients ; 12(1)2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31935859

RESUMO

The frequency of celiac disease (CD) has increased along time, with relevant changes reported in geographical variations, clinical presentation and nutritional repercussions. In recent years, some celiac patients are presenting overweight/obesity, but it is unclear how frequent this is and to what extent undernutrition remains a concern. This is relevant because CD tends to be overlooked in overweight patients. With this in mind, we assessed age at diagnosis, clinical characteristics and nutritional status of 155 celiac patients diagnosed between 1994-2017 in four pediatric hospitals in Santiago, Chile. Since 2003, the number of patients diagnosed has increased (p < 0.0033), coinciding with antitransglutaminase and antiendomysial antibodies becoming available to public health systems. In 2000, 4.5% of patients were asymptomatic at diagnosis, suggesting that active search is not routinely applied. Gastrointestinal symptoms plus failure to thrive were significantly more frequent under 2 years (p = 0.0001). Nutritional status has improved at diagnosis and during follow up, but undernutrition remains more frequent in children <2 and <5 years (p < 0.002 and p < 0.0036, respectively). Overweight at diagnosis was reported in 2002 and obesity in 2010. After initiating treatment, since 2010, patients changing from undernourishment to overweight has sometimes been observed after only 6 months on a gluten-free diet.


Assuntos
Índice de Massa Corporal , Doença Celíaca/complicações , Dieta Livre de Glúten , Estado Nutricional , Obesidade Pediátrica , Magreza/etiologia , Ganho de Peso , Fatores Etários , Autoanticorpos , Doença Celíaca/diagnóstico , Doença Celíaca/dietoterapia , Doença Celíaca/epidemiologia , Criança , Pré-Escolar , Chile/epidemiologia , Insuficiência de Crescimento/diagnóstico , Insuficiência de Crescimento/dietoterapia , Insuficiência de Crescimento/epidemiologia , Insuficiência de Crescimento/etiologia , Feminino , Gastroenteropatias/diagnóstico , Gastroenteropatias/dietoterapia , Gastroenteropatias/epidemiologia , Gastroenteropatias/etiologia , Hospitais , Humanos , Lactente , Masculino , Sobrepeso , Prevalência , Magreza/diagnóstico , Magreza/dietoterapia , Magreza/epidemiologia
11.
Malawi Med J ; 31(3): 227-229, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31839894

RESUMO

Heiner syndrome (HS) is a rare hypersensitivity reaction of an infant or young child to cow milk proteins. It is a disease characterised by failure to thrive, respiratory symptoms like cough, dyspnoea, wheeze and rhinitis with accompanying chest infiltrates on chest radiograph; gastrointestinal symptoms like vomiting, diarrhoea; and anaemia. The non-specific nature of the disease can result in delayed diagnosis and treatment and central to the condition is hypersensitivity to cow milk proteins. Several cases have been reported worldwide but there has been no report of this condition in Africa. We highlight the case of a sixteen week old child seen in our facility with features typical of Heiner syndrome. Clinicians should have a high index of suspicion for this condition especially in children predominantly on infant formula.


Assuntos
Insuficiência de Crescimento/etiologia , Hipersensibilidade a Leite/diagnóstico , Proteínas do Leite/efeitos adversos , Animais , Bovinos , Tosse , Humanos , Lactente , Pulmão/diagnóstico por imagem , Masculino , Radiografia , Síndrome , Taquipneia
12.
Am Surg ; 85(10): 1089-1093, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657300

RESUMO

Older adults undergoing nonelective surgery are at risk for geriatric events (GEs: delirium, dehydration, falls/fractures, failure to thrive, and pressure ulcers), but the impact of GEs on postoperative outcomes is unclear. Using the 2013 to 2014 National Inpatient Sample, we analyzed nonelective hospital admissions for five common operations (laparoscopic cholecystectomy, colectomy, soft tissue debridement, small bowel resection, and laparoscopic appendectomy) in older adults (aged ≥65 years) and a younger referent group (aged 55-64 years). Nationally weighted descriptive statistics were generated for GEs. Logistic regression controlling for patient, procedure, and hospital characteristics estimated the association of 1) age with GEs and 2) GEs with outcomes. Of 471,325 overall admissions, 64.7 per cent were aged ≥65 years. The rate of any GE in older adults was 26.9 per cent; GEs varied by age and procedure (P < 0.001). After adjustment, the probability of any GE increased with age category (P < 0.001); having any GE was associated with higher probability of all outcomes (P < 0.001): mortality (4.5% vs 0.8%), postoperative complications (61.7% vs 24.9%), prolonged length of stay (24.3% vs 7.9%), and skilled nursing facility discharge (46.6% vs 10.3%). In addition, there was a dose-response relationship between GEs and negative outcomes. GEs are prevalent in the nonelective surgery setting and associated with worse clinical outcomes. Quality improvement efforts should focus on addressing GEs.


Assuntos
Apendicectomia/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Colectomia/efeitos adversos , Desbridamento/efeitos adversos , Intestino Delgado/cirurgia , Complicações Pós-Operatórias/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Fatores Etários , Idoso , Apendicectomia/estatística & dados numéricos , Colecistectomia Laparoscópica/estatística & dados numéricos , Colectomia/estatística & dados numéricos , Desbridamento/estatística & dados numéricos , Desidratação/epidemiologia , Desidratação/etiologia , Delírio/epidemiologia , Delírio/etiologia , Insuficiência de Crescimento/epidemiologia , Insuficiência de Crescimento/etiologia , Feminino , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Lesão por Pressão/epidemiologia , Lesão por Pressão/etiologia , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Resultado do Tratamento
17.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31289170

RESUMO

Diencephalic syndrome is one of the rare causes of failure to thrive in infants and young children. It is caused by a tumour in diencephalon (thalamus and hypothalamus), characterised by profound emaciation with uniform loss of body weight despite normal or slightly decreased appetite, locomotor hyperactivity, euphoria and visual symptoms. Anaesthetic considerations due to decreased body fat include positioning to avoid pressure necrosis, measures to avoid hypothermia, proper drug dosing, treating electrolyte imbalances and delayed recovery. We report successful anaesthetic management of a child with diencephalic syndrome scheduled for an endoscopic biopsy of suprasellar space occupying lesion under general anaesthesia.


Assuntos
Anestesia/métodos , Diencéfalo/patologia , Doenças Hipotalâmicas/patologia , Doenças da Hipófise/patologia , Anestésicos/administração & dosagem , Biópsia , Criança , Insuficiência de Crescimento/etiologia , Humanos , Doenças Hipotalâmicas/diagnóstico por imagem , Doenças Hipotalâmicas/metabolismo , Unidades de Terapia Intensiva Pediátrica/normas , Cuidados Intraoperatórios , Masculino , Doenças da Hipófise/sangue , Doenças da Hipófise/diagnóstico por imagem , Cuidados Pré-Operatórios , Prognóstico , Tomografia Computadorizada por Raios X , Derivação Ventriculoperitoneal/métodos
18.
Pediatr Dev Pathol ; 22(6): 590-593, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31333056

RESUMO

Reversible infantile respiratory chain deficiency, previously termed reversible infantile cytochrome c oxidase (COX) deficiency myopathy, is a rare mitochondrial disorder that is characterized by severe hypotonia and generalized muscle weakness in infancy that is associated with lactic acidosis. Affected infants will spontaneously recover, if they survive the first months of life. Here, we present the case of a 4-week-old girl who initially presented with hyperammonemia, hypotonia, and failure to thrive, for which she was referred for genetic evaluation. After several tests, a distinct genetic syndrome could not be identified and she continued to deteriorate. A muscle biopsy was performed and demonstrated severe mitochondrial myopathy with abundant COX-negative fibers. Ultrastructural abnormalities of the mitochondria, diagnostic of mitochondrial myopathy, were identified on electron microscopy. Molecular studies revealed the classic homoplasmic disease causing mutation, m.14674 T>C in the MT-TE gene, associated with reversible COX deficiency. Although hyperammonemia is an unusual presentation for mitochondrial myopathies, specifically reversible infantile respiratory chain deficiency, it should be included in the list of possible presenting symptoms for this condition.


Assuntos
Deficiência de Citocromo-c Oxidase/diagnóstico , Insuficiência de Crescimento/etiologia , Hiperamonemia/etiologia , Hipotonia Muscular/etiologia , Deficiência de Citocromo-c Oxidase/complicações , Deficiência de Citocromo-c Oxidase/patologia , Deficiência de Citocromo-c Oxidase/fisiopatologia , Insuficiência de Crescimento/diagnóstico , Feminino , Humanos , Hiperamonemia/diagnóstico , Lactente , Hipotonia Muscular/diagnóstico , Hipotonia Muscular/patologia
20.
BMC Med Genet ; 20(1): 98, 2019 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-31164167

RESUMO

BACKGROUND: X-linked Adrenal Hypoplasia Congenita (AHC) is a rare cause of primary adrenal insufficiency due to mutations in the NR0B1 gene, causing a loss of function of the nuclear receptor protein DAX-1. Adrenal insufficiency usually appears in the first 2 months of life, but can sometimes emerge during childhood. Hypogonadotropic Hypogonadism is often associated later in life and patients may develop azoospermia. We describe an unusual onset of AHC started with isolated hypoaldosteronism as first and only sign of the disease. CASE PRESENTATION: A 18-days-old newborn presented with failure to thrive and feeding difficulties. Blood tests showed severe hyponatremia, hyperkalemia and hypochloremia. Renin was found over the measurable range and aldosterone was low whereas cortisol level was normal with a slightly increased ACTH. In the suspicion of Primary Hypoaldosteronism, correction of plasmatic electrolytes and replacement therapy with Fludrocortisone were promptly started. The subsequent evidence of low plasmatic and urinary cortisol and increased ACTH required the start of Hydrocortisone replacement therapy and it defined a clinical picture of adrenal insufficiency. Genetic analysis demonstrated a novel mutation in the DAX-1 gene leading to the diagnosis of AHC. CONCLUSIONS: AHC onset may involve the aldosterone production itself, miming an isolated defect of aldosterone synthesis. NR0B1/DAX-1 mutations should be considered in male infants presenting with isolated hypoaldosteronism as first sign of adrenal insufficiency.


Assuntos
Receptor Nuclear Órfão DAX-1/genética , Hipoadrenocorticismo Familiar/genética , Hipoaldosteronismo/genética , Mutação , Insuficiência Adrenal/etiologia , Insuficiência Adrenal/genética , Insuficiência de Crescimento/etiologia , Insuficiência de Crescimento/genética , Humanos , Hipoadrenocorticismo Familiar/complicações , Hipoaldosteronismo/etiologia , Recém-Nascido , Masculino
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