Portuguese Consensus on Diagnosis, Treatment, and Management of Anemia in Pediatric Inflammatory Bowel Disease.

Anemia is a common extraintestinal manifestation of inflammatory bowel disease (IBD), both in pediatric and in adult patients. Iron deficiency is the main cause of anemia in patients with IBD. Anemia is a clinically relevant comorbidity, with impact on patients' quality of life and it should be timely diagnosed and adequately treated. Currently, an active treatment approach is the recommended strategy, with evidence showing efficacy and safety of intravenous iron formulations. However, evidence in pediatric age remains scarce and no clinical recommendations exist for the diagnosis and treatment of this particular age group. The present document represents the first national consensus on the management of anemia in pediatric IBD and is therefore particularly relevant. The authors anticipate that the proposed recommendations will be useful in daily clinical practice for diagnosing and managing iron deficiency and iron-deficiency anemia in the pediatric population with IBD.

A anemia é uma manifestação extra-digestiva frequente associada à doença inflamatória intestinal, tanto na população pediátrica como adulta, sendo a anemia por défice de ferro a sua forma mais frequente. Constitui uma comorbilidade clinicamente relevante, com repercussão na qualidade de vida. Deve ser atempadamente diagnosticada e adequadamente tratada. A estratégia terapêutica atualmente aceite preconiza uma atitude interventiva. Neste contexto, a evidência científica atual tem demonstrado a eficácia e segurança da utilização das formulações de ferro endovenoso. Contudo, em idade pediátrica a evidência ainda é insuficiente, não existindo orientações de abordagem diagnóstica ou terapêutica especificamente dirigidas a este grupo etário. Este é o primeiro consenso nacional sobre a abordagem da anemia na doença inflamatória intestinal pediátrica, revestindo-se por isso de particular relevância. Pretendese que este documento tenha utilidade e aplicabilidade na prática clínica na avaliação e seguimento do défice de ferro e anemia por défice de ferro em doentes pediátricos com doença inflamatória intestinal.

[Cow's milk protein allergy: a challenging diagnosis]. / Alergia a proteínas de leite de vaca: um desafio diagnóstico.

BACKGROUND: Cow's Milk Protein Allergy (CMPA) is the most common food allergy in infants. It can manifest itself through a wide variety of symptoms depending on the type of immune response is IgE or non-IgE mediated. In most cases acquisition of tolerance to cow's milk protein (CMP) occurs until the second year of life. OBJECTIVE: To evaluate the cases of CMPA followed in our Outpatient Clinic of Pediatric Gastroenterology and compare IgE and non-IgE mediated CMPA. METHODS: CMPA patients observed between December 1992 and December 2009 were included in this prospective study and followed-up according to our CMPA protocol. RESULTS: 199 children were included in the protocol, but only 130 cases were confirmed the diagnoses of CMPA, 77 were IgE mediated (group A) and 53 non-IgE mediated (group B). Comparing the two groups, 45% vs 36% had positive family history of atopy. The median age of onset was 10 and six weeks respectively, and the interval between introduction of PLV into the diet and the onset of symptoms was four and five days. Infant formula was, in both groups, the main dairy product that triggered symptoms (71% vs 81%). In group A over half the children did the first dose of PLV in first 24 hours of life. The value of specific IgE to the major PLV was identified in 76 children and only 15.6% were positive. The most frequent symptoms in both groups were cutaneous (85.7% vs 50.6%), especially urticaria and angioedema, gastrointestinal symptoms (40% vs 38%), including vomiting and diarrhea.

[Sarcoidosis in an adolescent]. / Sarcoidose em adolescente.

Sarcoidosis is a multisystem granulomatous disease. We report the case of 13 years old boy with mediastinal adenopathies. Etiological investigation revealed pulmonary sarcoidosis with periferic adenopathies involvement. Although rare, as the differential diagnosis is with multiple pathologies (infectious,tumor, rheumatoid), is a disease to be consider.

[Childhood obesity]. / Obesidade infantil e juvenil.

UNLABELLED: Childhood obesity, due to the exponential increase of this chronic disease, is now considered a XXI century epidemic disease. Portugal, the sixth European country where this disease is more prevalent, expends 3,5% of the annual health budget with this pathology. AIM: Characterization of the obese children followed in the pediatric outpatient clinic. METHODOLOGY: A twelve year cohort study who comprehended 482 kids, analysing demographic variables; family and social backgrounds; personal backgrounds; habits; body mass index (BMI); comorbidities; blood tests; clinical intervention and follow-up. RESULTS: A positive family history with, at least, two obese elements was found in 64%, of the 246 boys (51%) and 236 girls (49%) analysed. We observed a 93% rate of eutocic delivery for an average birth weight of 3585 gr. These children were exclusively breastfeed for, at least, four months, in 38% of the cases. In our sample, we found an average of three meals per day, with an 81% rate of take-way. The absence of a regular physical activity plan was observed in 89% of the sample. Anthropometric evaluation and counselling about healthy habits were focused through all appointments. For a follow-up of 16 months (+/- 7 months), a 10% success rate was obtained, with an 1,22 BMI reduction. We verified a 20% dismissed rate, averagely occurring in the first 12 months (+/- 3 months). CONCLUSIONS: On the whole, the characterization of our sample seems to be according to the children obesity literature. Trough out follow-up, commitment to the interventional schedule was critical for life-style modification and desirable BMI achievement. Regular appointments and periodic evaluation of the results seems to be reliable strategies in the fight of this epidemic disease.