Background: Chest pain in children and adolescents is a common complaint in the emergency department (ED), being mostly benign. A thorough patient history and physical examination should be enough in most cases for its proper management. Regarding non-cardiac chest pain, anxiety plays an important role.Methods: Retrospective analysis of all admissions in a pediatric ED of a Portuguese third-level hospital with a chief complaint of chest pain between January and December 2018. Chi-square test was used to compare different etiologies, considering a significance level of 5%.Results: A total of 798 visits were included: 53.6% girls, 80.8% adolescents (mean age: 13 years old). According to the Pediatric Canadian Triage and Acuity Scale, 77.7% was prioritized as level IV: less urgent; 65.3% reported associated symptoms including dyspnea (31.8%), cough (18.2%), and palpitations (16.1%). In physical examination, 45.5% had alterations: 62.8% with chest wall tenderness. Further investigation was done in 84% of patients: 62.4% electrocardiograms (altered in 14.7%), 52.6% chest radiographies (altered in 17.1%) and 8.9% cardiac biomarkers (altered in 12.7%). The 3 main causes of chest pain were musculoskeletal (33%), idiopathic (24.4%) and psychogenic (21.6%), with 1.1% of cardiac etiology. Less than 3% needed hospital admission and 18.9% were oriented to an outpatient consultation. 7.1% readmissions reported. When compared to other causes as a group, psychogenic chest pain presented a statistically significant association with female sex, adolescence, psychiatric antecedents, previous stressful event, and normal physical examination. Of these, <30% were oriented to a pedopsychiatry/ psychology consultation.Conclusions: Opposing to the low priority level in triage, benign diagnosis found, and low hospital admissions, there was a high percentage of complementary diagnostic tests performed with few altered results. In psychogenic chest pain there was a low postdischarge referral. The authors highlight the importance of clinical algorithms to reduce unnecessary tests performed and readmissions and improve orientation and follow-up, particularly in psychogenic etiology.
There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
-Objective: To evaluate the clinical profile of individuals with paraplegia living in São Paulo, Brazil. Method: The sample consisted of 60 outpatients with traumatic paraplegia from whom clinical and demographic data were obtained. Results: The patients were predominately men (86.7%), single (61.7%), with mean age of 32.9 (SD=9.47) years, and complete or incomplete primary education (63.3%). Although 41.7% were born in different states, all patients were current residents of São Paulo, Brazil. The most frequent cause of paraplegia was firearm injury (63.3%) followed by car accident (20%). The most common complications observed in the patients were urinary (88.3%) and anal (45%) incontinence, muscle spasm (65%), and pressure ulcers (26.7%). Conclusion: The data revealed that the sample consisted predominantly of young males with low education level, showing complications due to SCI, and who were victims of urban violence.Key WorDS: paraplegia, spinal cord, caractheristics.Características clínicas e sócio demográficas de pessoas com paraplegia traumática na cidade de são paulo resumo -Objetivo: Avaliar o perfil de paraplégicos que vivem na cidade de São Paulo. Método: Foram incluídos 60 paraplégicos por causa traumática. o instrumento de coleta de dados constava de dados demográficos e clínicos. Resultados: A maioria era do sexo masculino (86,7%), com média de idade igual a 32,9 (DP=9,47) anos, sendo 61,7% solteiros. em relação à naturalidade 41,7% nasceram em outros estados, porém todos residiam em São Paulo. A causa mais freqüente da paraplegia foi por ferimento por arma de fogo (63,3%), seguida por acidente automobilístico (20%). Quanto às complicações decorrentes da lesão medular, destaca-se a presença de incontinência urinária (88,3%) e anal (45%), o espasmo muscular (65%) e a úlcera por pressão (26,7%). Conclusão: os resultados encontrados permitiram verificar uma amostra de pessoas em sua maioria do sexo masculino, jovem, com baixa escolaridade e que apresentam complicações decorrentes da lesão medular e em grande parte, vítimas da violência dos grandes centros urbanos.PAlAvrAS-ChAve: paraplegia, lesão medular, características.
Short bowel syndrome is the most common cause of intestinal failure in children. The treatment is based on a multidisciplinary approach involving pediatricians, pediatric surgeons, and nutritionists. Surgical procedures for intestinal lengthening may be decisive, having been revalued after the recent description of serial transverse enteroplasty (STEP). We reviewed the patients who underwent the STEP operation for short bowel syndrome in our hospital in order to evaluate medium-term outcome. Between April 2006 and December 2008, three children were submitted to STEP without postoperative complications directly related to the procedure. In two cases the autonomy for oral/enteric feeding was obtained within 3 and 7 months after surgery with sustained growth, persisting at 5 years of follow-up after STEP. One child remained dependent of parenteral nutrition and was submitted to intestinal transplantation 30 months after STEP. However, since STEP until transplantation, it was possible to increase enteric volume and decrease intestinal dilation and the frequency of occlusive episodes. STEP is an effective and safe technique for intestinal lengthening that may allow increased tolerance to oral/enteric feeding or at least alleviate some complications of short bowel syndrome.
-Few studies about food consumption of athletes have assessed the quality of their food choices, and the factors that influence these choices. The aim of this study was to assess the diet of team sports athletes through a revised version of the Healthy Eating Index (HEI-R) in order to identify their nutritional knowledge and the stage of intention to change eating behavior (SICEB) and to identify possible association with demographic and anthropometric variables. Seventy-two athletes (35 men) were evaluated for the following variables: body mass, height, Body Mass Index (BMI), body fat percentage (BF%), nutritional knowledge (questionnaire), food intake (24-hour recall), diet quality (HEI-R) and SICEB (transtheoretical model). For statistical analysis, the Student t test and the Pearson correlation coefficient were used. None of the athletes presented diet classified as "healthy" and 45.7% (men) and 51.4% (women) had "inadequate" diets. Low consumption of fruits, vegetables, whole grains, milk and dairy products was observed. The HEI-R "meats, legumes and eggs" component received the best scores. Pre-contemplation (25.0%) and action (23.6%) stages were the most frequent in the group. The mean percentage of correct answers in the nutritional knowledge questionnaire was 55.7% (men) and 57.3% (women). No association was found between HEI-R and variables age, BMI, BF%, SICEB, nutritional knowledge score and energy intake. This group presents inadequate dietary intake. The lack of association between study variables indicates the need to investigate other factors that influence athlete's feeding behavior. Key words: Athletes; Cross-sectional studies; Feeding; Feeding behavior. Resumo -Poucos estudos sobre o consumo alimentar de atletas avaliam a qualidade dos alimentos selecionados e os fatores que interferem nessas escolhas. Objetivou-se avaliar a dieta de atletas de esportes coletivos por meio do Índice de Qualidade da Dieta -Revisado (IQD-R), identificar seu conhecimento nutricional, estágio de intenção de mudança de comportamento alimentar (EIMCA) e identificar possíveis associações com variáveis demográficas e de antropometria. Foram avaliadas as seguintes variáveis em 72 atletas (35 homens): massa corporal (MC), estatura, IMC, percentual de gordura (%G), conhecimento nutricional (questionário), consumo alimentar (recordatório de 24-horas), qualidade da dieta (IQD-R) e EIMCA (modelo transteórico). Para a análise estatística empregou-se o teste t de
Chiari Malformation Type 1 is a congenital, condition characterized by abnormally shaped cerebellar tonsils that are displaced below the level of the foramen magnum.NKX2-1 gene encodes a transcription factor expressed during early development of thyroid, lung, and forebrain, and germline NKX2-1 mutations can lead to dysfunction in any of these three organs, resulting in brain–lung–thyroid syndrome. There have been few reports of structural brain anomalies in patients with an NKX2-1-related disorder. We report the first case of a girl with a genetically identified mutation in NKX2-1 that presents with a Chiari Malformation Type 1, eventually expanding the phenotypic spectrum of NKX2-1-related disorders while also highlighting a novel heterozygous pathogenic variant at exon 3 that disrupts the reading framework, originating an NKX2-1 protein with a different C-terminal.
IntroduçãoAbordamos os textos freudianos iniciais (FREUD, 1894a(FREUD, [1950(FREUD, ]/1980(FREUD, e 1894b(FREUD, [1950/1980) para encontrar as explicações sobre a angústia, a qual estaria na gênese da então denominada "neurose de angústia". Assim, os determinantes dessa angústia estariam na esfera somática, ou, para resumir, na tensão sexual acumulada que não alcançou as ligações psíquicas, exigidas para a formação da libido e descarga adequada. Essa angústia primeira e somática poderia, mais tarde, ser utilizada para fins de defesa. Melhor dizendo, Freud conclui que a angústia neurótica poderia vir a ser angústia histérica. Essa
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