Varicela e apendicite, máscaras infantis & Co

Saberão (outros não) que pertenço à Direção da Sociedade Portuguesa de Cirurgia Minimamente Invasiva. Este ano estaremos reunidos em Peniche para o nosso Congresso Anual. Nele, poder-vos-á interessar o workshop de Cirurgia Pediátrca (dedicado às malformações pulmonares) e um simpósio de Medicina do Surf. Este último começou como uma brincadeira por estarmos em frente à Praia de Supertubos, mas foi ganhando forma e dimensão, estando neste momento um programa muito interessante e com palestrantes famosos.

1. Na lista de recomendações, começo por um artigo do qual sou co-autor, mas cujo trabalho de escrita e de diagnóstico do caso está todo do lado dos pediatras envolvidos. Um episódio de urgência que nos deve deixar alerta: menina com varicela retornou ao nosso hospital por dor abdominal e vómitos. Foi publicado na Revista Residência Pediátrica. Appendicitis as a complication of varicella disease: case report and literature review.  “In immunocompetent children, complications of varicella are rare. Acute appendicitis (AA) is one of the most exceptional complications of chickenpox. In this report we describe a case of a 6-year-old girl with a perforated AA in the course of varicella. We intend with this clinical case to remember an extremely rare complication of varicella, which is at the same time the most common cause of abdominal surgery in children.”

2. A minha segunda recomendação vai para outros dois casos instrutivos publicados no Journal of Paediatrics and Child Health. Não revelo o diagnóstico para não quebrar o suspense 🙂 You are what you eat: The diagnosis of recurrent intussusception in the emergency department. “Ileocolic intussusception is the most common abdominal emergency in early childhood and is usually idiopathic.1 Diagnosis requires a high index of suspicion as the pathognomonic triad of redcurrant jelly stools, palpable mass and intermittent abdominal pain is present in less than a quarter of cases.1 It should be differentiated from ileoileal intussusception, which is typically transient and self-limiting.2 However, if children present to the emergency department (ED) with acute, severe abdominal pain due to recurrent intussusception, an underlying diagnosis should be considered, as in the case reports detailed below.

3. No Journal of Pediatrics, saiu um artigo que vem ajudar a responder à pergunta de muitos pais. Devem as crianças usar P2/N95 ou máscara cirúrgica? Effects of N95 Mask Use on Pulmonary Function in Children. “Twenty-two healthy children were assigned at random to 1 of 2 groups: one group wearing N95 masks without an exhalation valve and the other group wearing N95 masks with an exhalation valve. We tracked changes in partial pressure of end-tidal carbon dioxide (PETCO2), oxygen saturation, pulse rate, and respiratory rate over 72 minutes of mask use. All subjects were monitored every 15 minutes, the first 30 minutes while not wearing a mask and the next 30 minutes while wearing a mask. They then performed a 12-minute walking test. Results: The children did not experience a statistically significant change in oxygen saturation or pulse rate during the study. There were significant increases in respiratory rate and PETCO2 in the children wearing an N95 mask without an exhalation valve, whereas these increases were seen in the children wearing a mask with an exhalation valve only after the walking test. Conclusions: The use of an N95 mask could potentially cause breathing difficulties in children if the mask does not have an exhalation valve, particularly during a physical activity. We believe that wearing a surgical mask may be more appropriate for children.

4. Para os maluquinhos dos podcasts (onde me incluo), sugiro-vos este episódio do Heavyweight. A Heavyweight Short: The Sharing Place.Heavyweight often features grownups grappling with childhood trauma. But in today’s Heavyweight Short, Jonathan visits a place where children grapple with trauma in the present. At The Sharing Place, kids talk about things most adults can’t even face.” Uma abordagem muito interessante ao luto infantil.

Abraço,
João

Por João Moreira Pinto, MD PhD, Cirurgião Pediátrico
Linked in  | Facebook | e-Mail: moreirapinto@gmail.com
Cirurgia Pediátrica, Centro Hospitalar Universitário do Porto | Hospital da Luz Arrábida/Guimarães | Hospital-Escola Fernando Pessoa

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