Publications by authors named "Ana Reis Melo"

10 Publications

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Sexually transmitted infections in Portuguese adolescents.

An Pediatr (Engl Ed) 2021 Sep 12. Epub 2021 Sep 12.

Servicio de Pediatría, Hospital Pediátrico Integrado, Centro Hospitalar Universitário de São João, Oporto, Portugal; Unidad Pediátrica de Enfermedades Infecciosas e Inmunodeficiencias, Servicio de Pediatría, Centro Hospitalar Universitário de São João, Oporto, Portugal.

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http://dx.doi.org/10.1016/j.anpede.2021.08.002DOI Listing
September 2021

Varicella Admissions in Children and Adolescents in Portugal: 2000-2015.

Hosp Pediatr 2021 Aug 20;11(8):856-864. Epub 2021 Jul 20.

Department of Pediatrics, Centro Hospitalar São João, Porto, Portugal

Objectives: Varicella is a common, usually benign, and autolimited disease in children but can lead to severe complications and hospitalization. With this study, we aim to analyze all varicella hospitalizations to provide epidemiological information to help outline preventive policies.

Methods: We assessed all varicella hospitalizations in children aged 0 to 17 years, from 2000 to 2015, in mainland, public Portuguese hospitals using a Portuguese administrative database. Seasonality, geographic distribution, severity, complications, risk factors, use of diagnostic and treatment procedures and hospitalization costs were analyzed.

Results: A total of 5120 hospitalizations were registered, with an annual rate of 17.3 hospitalizations per 100 000 inhabitants. A higher number of hospitalizations occurred during the summer period and in Southern regions. The median length of stay was of 4 days (interquartile range: 3.0-7.0). We found a high rate of severe complications, mostly dermatologic (19.6%), neurologic (6.0%), and respiratory (5.1%). Of the total number of patients, 0.8% were immunocompromised and 0.1% were pregnant. Total direct hospitalization costs during the 16-year period were estimated to be 7 110 719€ (8 603 970 USD), with a mean annual cost of 444 419.92€ (537 748.10 USD).

Conculsions: This is the first national study in which useful epidemiological data to evaluate the burden and impact of varicella in Portugal is provided.
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http://dx.doi.org/10.1542/hpeds.2020-004275DOI Listing
August 2021

Multisystem inflammatory syndrome in children (MISC): A systematic review.

Int J Clin Pract 2021 Jun 9:e14450. Epub 2021 Jun 9.

Faculty of Medicine, University of Porto, Porto, Portugal.

Objective: The aim of this systematic review was to analyse current literature and reported cases of multisystem inflammatory syndrome in children (MISC), concerning its clinical spectrum, complications associated, therapeutic strategies and distinguishing features of other clinical syndromes.

Methods: Extensive literature research was performed in MEDLINE (through PubMed), Scopus and Web of Science from December 2019 to December 2020. First analysis included all article titles and abstracts screening to identify relevant studies, and second analysis included a full-text screening of previously selected studies. Eligibility was assessed independently by two authors, and disagreements were resolved by discussion and consensus. Data were extracted on MISC definition, demographic data, clinical features, diagnostic tests, laboratory analysis and imaging, therapeutical approach and outcomes.

Results: Common symptoms included gastrointestinal (70%), rash (57%) and cardiovascular (52% with shock). Notable differences with Kawasaki disease were identified including age, clinical presentation and cardiac involvement. Thirty per cent presented positive severe acute respiratory syndrome coronavirus-2 reverse transcription polymerase chain reaction and 51% positive serologies. Sixty-two per cent received intravenous immunoglobulin and 42% glucocorticoids. Sixty-two per cent required intensive care and 21 children died (<2%). Severe presentations were associated with neurological symptoms, hepatitis and acute kidney injury.

Conclusions: MISC raises concern on its severe cardiac involvement at presentation, with frequent intensive care and immunomodulatory therapy need. Short-term outcomes seem to be favourable, with cardiac dysfunction recovery and low mortality rates.
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http://dx.doi.org/10.1111/ijcp.14450DOI Listing
June 2021

Ulcerated kerion due to Trichophyton mentagrophytes and Sporothrix schenkii.

Eur J Dermatol 2021 Apr;31(2):265-267

Department of Dermatology and Venereology, Centro Hospitalar Universitário São João, EPE Porto.

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http://dx.doi.org/10.1684/ejd.2021.4013DOI Listing
April 2021

Perianal Disease and Granulomas: Think Out of the Box….

GE Port J Gastroenterol 2020 Feb 1;27(2):119-123. Epub 2019 Oct 1.

Pediatric Gastroenterology Unit, Centro Hospitalar Universitário do São João, Porto, Portugal.

Background: Chronic granulomatous disease (CGD) is a primary immunodeficiency due to a malfunction of NADPH oxidase. It is characterized by recurrent and severe infections caused by catalase-positive microorganisms and autoinflammatory manifestations. Recently, there has been described an gene variant that causes a deficiency of p40, a subunit of NADPH oxidase. Patients with this deficiency appear to have a less severe clinical form as compared to classic CGD.

Case: A 15-year-old girl with vulvar lichen planus since she was 2 years old and suspected Crohn's disease (CD) was first seen at our hospital. At the age of 12 years, she had been submitted to sacrococcygeal cyst exeresis, without cicatrization of the surgical wound and extension of the lesion to the perianal area. The diagnosis of CD was questioned, and the patient underwent an endoscopic and radiologic assessment, which was normal. A skin biopsy from the perianal area revealed a granuloma; thus, CD with isolated perianal disease was assumed. After several different treatments including antibiotics, infliximab, and adalimumab, the perianal lesion persisted, with no associated gastrointestinal symptoms. Therefore, the hypothesis of an immunodeficiency was considered. An immunologic and genetic study revealed reduced oxidative burst in the phorbol myristate acetate test, with diminished reactive oxygen species production and a homozygous mutation in the gene. The adolescent started prophylactic trimethoprim-sulfamethoxazole and became asymptomatic.

Conclusions: The present case highlights that alternative diagnoses to CD must be considered in the presence of isolated perianal disease with granulomatous inflammation, especially when the disease is refractory to conventional CD therapy.
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http://dx.doi.org/10.1159/000502358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7113594PMC
February 2020

COMPLICATED PNEUMONIA WITH EMPYEMA CAUSED BY STREPTOCOCCUS ANGINOSUS IN A CHILD.

Rev Paul Pediatr 2020 9;38:e2018258. Epub 2020 Mar 9.

Centro Hospitalar de São João, Porto, Portugal.

Objective: To highlight the pathogenicity of Streptococcus anginosus, which is rare in pediatric patients, but can cause severe infections that are known to have a better outcome when treated early with interventional procedures and prolonged antibiotic therapy.

Case: description: The patient is a 6-year-old boy with global developmental delay, examined in the emergency room due to fever and respiratory distress. The physical examination and diagnostic workout revealed complicated pneumonia with empyema of the left hemithorax; he started antibiotic therapy and underwent thoracic drainage. Pleural fluid cultures grew Streptococcus anginosus. On day 11, the child had a clinical deterioration with recurrence of fever, hypoxia, and respiratory distress. At this point, considering the causative agent, he was submitted to video-assisted thoracoscopic decortication, with good progress thereafter.

Comments: Streptococcus anginosus is a commensal bacterium of the human oral cavity capable of causing severe systemic infections. Although reports of complicated thoracic infections with this agent are rare in the pediatric population, they have been increasing in adults. Streptococcus anginosus has a high capacity to form abscess and empyema, requiring different therapeutic approaches when compared to complicated pneumonia caused by other agents.
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http://dx.doi.org/10.1590/1984-0462/2020/38/2018258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7063598PMC
December 2020

lung abscess in an immunocompetent adolescent.

BMJ Case Rep 2019 Jan 10;12(1). Epub 2019 Jan 10.

Pediatric Pulmonology Unit, Department of Pediatrics, Centro Hospitalar São João EPE, Porto, Portugal.

The authors report a case of a lung abscess caused by sp. in a previously healthy adolescent. A 17-year-old young man presented with tonsillitis that did not respond to β-lactamic antibiotic, dyspnoea and thoracic pain. The X-ray revealed a cavitation in the right pulmonary upper lobe. He was admitted and completed a 14-day empirical antimicrobial therapy for a pulmonar abscess, although no clinical recovery was observed. He then underwent pulmonary biopsy of the lesion and PCR analysis of the collected pulmonary tissue, which revealed the presence of This case emphasises the importance of considering nocardiosis in the differential diagnosis of a lung abscess, particularly if no response to empirical therapy is obtained.
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http://dx.doi.org/10.1136/bcr-2018-227499DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340570PMC
January 2019

[Neuroimaging of Epstein-Barr virus-associated encephalitis].

An Pediatr (Engl Ed) 2020 Jan 3;92(1):53-54. Epub 2018 Dec 3.

Servicio de Neuropediatría, Centro Hospitalar de São João, Oporto, Portugal.

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http://dx.doi.org/10.1016/j.anpedi.2018.09.016DOI Listing
January 2020

Meningococcemia: rare but life-threatening.

BMJ Case Rep 2018 Oct 17;2018. Epub 2018 Oct 17.

Pediatric Intensive Care, Centro Hospitalar de São João, Porto, Portugal.

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http://dx.doi.org/10.1136/bcr-2018-226914DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254450PMC
October 2018
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