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Foles AI, Eiras Dias M, Figueiredo M, Marçal M. Congenital syphilis: the re-emergence of a forgotten disease. BMJ Case Rep 2024; 17:e257694. [PMID: 38233003 PMCID: PMC10806924 DOI: 10.1136/bcr-2023-257694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
A preterm newborn presented at birth with generalised oedema, disseminated bullous and desquamative exanthema with palmoplantar involvement and hepatomegaly, admitted to the neonatal intensive care unit with severe multisystemic disease, haemodynamic instability and respiratory distress. The mother had a history of treated latent syphilis before pregnancy. Venereal Disease Research Laboratory screening was negative in the first trimester, titre 1:2 in second trimester and 1:32 in the third trimester, a result only available to the medical team at birth. The mother's rapid plasma reagin (RPR) titre was 1:64 at birth. The newbon's RPR titre was 1:256, confirming the diagnosis of early congenital syphilis. The newborn was treated with aqueous penicillin G, with clinical and laboratorial progressive recovery. Congenital syphilis is a preventable disease, but despite prenatal screening programmes, it remains a significant public health issue worldwide with high morbidity and mortality.
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Affiliation(s)
- Ana Isabel Foles
- Neonatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
| | - Mariana Eiras Dias
- Neonatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
| | - Melissa Figueiredo
- Neonatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
| | - Mónica Marçal
- Neonatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
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Chasqueira MJ, Fernandez C, Marques A, Rodrigues L, Marçal M, Tuna M, Braz M, S Neto A, Mendes C, Lito D, Vasconcellos G, Rocha P, Cassiano G, Silva P, Monteiro L, Sequeira A, Favila Menezes M, Albuquerque M, Rego de Sousa MJ, Paixão P. Pooling Saliva Sample as an Effective Strategy for the Systematic CMV Screening of Newborns-A Multicentric Prospective Study. Pediatr Infect Dis J 2023; 42:1117-1120. [PMID: 37725820 PMCID: PMC10629604 DOI: 10.1097/inf.0000000000004096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Cytomegalovirus is the most common cause of congenital infections worldwide. Screening all newborns in the first 2 weeks of life is the only way to detect all cases of congenital infection, allowing the monitoring of children with asymptomatic infection at birth and early intervention. AIM In this multicenter study, we aimed to evaluate the feasibility of using a saliva pool strategy for mass screening in 7 Portuguese hospitals, and to estimate the current prevalence of this congenital infection in these hospitals. METHODS A total of 7033 newborns were screened between June 2020 and June 2022, and 704 pools of 10 saliva samples were analyzed by polymerase chain reaction (PCR). RESULTS Of the 704 pools analyzed, 685 were negative and 19 had positive PCR results for cytomegalovirus. After individual PCR testing, 26 newborns had positive saliva results, of which 15 were confirmed by urine testing. Thus, this study's prevalence of congenital infection was 0.21% (95% confidence interval: 0.12%-0.35%). CONCLUSIONS In this study, the pooling strategy proved to be effective for the systematic screening of newborns, although this low prevalence raises questions regarding the cost-effectiveness of implementing universal screening. However, this prevalence is probably the result of the control measures taken during the pandemic; therefore, the rates are expected to return to prepandemic values, but only a new study after the pandemic will be able to confirm this.
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Affiliation(s)
| | - Catarina Fernandez
- From the CHRC, NOVA Medical School, NMS, Universidade NOVA de Lisbon, Lisbon, Portugal
| | - Augusta Marques
- From the CHRC, NOVA Medical School, NMS, Universidade NOVA de Lisbon, Lisbon, Portugal
| | - Lucia Rodrigues
- From the CHRC, NOVA Medical School, NMS, Universidade NOVA de Lisbon, Lisbon, Portugal
| | - Mónica Marçal
- Serviço de Pediatria, Unidade de Neonatologia, Hospital São Francisco Xavier CHLO, Estrada do Forte do Alto do Duque, Lisbon, Portugal
| | - Madalena Tuna
- From the CHRC, NOVA Medical School, NMS, Universidade NOVA de Lisbon, Lisbon, Portugal
- Serviço de Neonatologia, Maternidade Dr. Alfredo da Costa CHLC, R. Viriato, Lisbon, Portugal
| | - Monica Braz
- Serviço de Pediatria, Hospital CUF Descobertas, Rua Mário Botas, Lisbon, Portugal
| | - Ana S Neto
- Serviço de Pediatria, Hospital CUF Descobertas, Rua Mário Botas, Lisbon, Portugal
| | - Candida Mendes
- Serviço de Pediatria, Hospital Vila Franca de Xira, Estrada Carlos Lima Costa, Vila Franca de Xira, Portugal
| | - David Lito
- Serviço de Pediatria, Hospital Vila Franca de Xira, Estrada Carlos Lima Costa, Vila Franca de Xira, Portugal
| | | | - Paula Rocha
- Serviço de Pediatria, Hospital CUF Porto, Estrada da Circunvalação, Porto, Portugal
| | - Gonçalo Cassiano
- Neonatologia, Hospital da Luz, Avenida Lusíada, Lisbon, Portugal
| | - Pedro Silva
- Hospital Lusíadas Lisboa, Rua Abílio Mendes, Lisbon, Portugal
| | - Luísa Monteiro
- Hospital Lusíadas Lisboa, Rua Abílio Mendes, Lisbon, Portugal
| | - Ana Sequeira
- Serviço de Neonatologia, Maternidade Dr. Alfredo da Costa CHLC, R. Viriato, Lisbon, Portugal
| | - Maria Favila Menezes
- Centro de Medicina Laboratorial Germano de Sousa, Rua Cupertino de Miranda, Lisbon, Portugal
| | - Margarida Albuquerque
- Centro de Medicina Laboratorial Germano de Sousa, Rua Cupertino de Miranda, Lisbon, Portugal
| | | | - Paulo Paixão
- From the CHRC, NOVA Medical School, NMS, Universidade NOVA de Lisbon, Lisbon, Portugal
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Serôdio M, Silva I, Novais C, Correia C, Marçal M, Tuna M. A Rare Cause of Neonatal Hypoxemia. Indian J Pediatr 2023; 90:523. [PMID: 36826749 DOI: 10.1007/s12098-023-04519-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/16/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Margarida Serôdio
- Department of Pediatrics, Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Estr. Forte do Alto Duque, 1449-005, Lisbon, Portugal.
| | - Inês Silva
- Department of Pediatrics, Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Estr. Forte do Alto Duque, 1449-005, Lisbon, Portugal
| | - Cristina Novais
- Department of Pediatrics, Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Estr. Forte do Alto Duque, 1449-005, Lisbon, Portugal
| | - Cátia Correia
- Department of Pediatrics, Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Estr. Forte do Alto Duque, 1449-005, Lisbon, Portugal
| | - Mónica Marçal
- Department of Pediatrics, Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Estr. Forte do Alto Duque, 1449-005, Lisbon, Portugal
| | - Madalena Tuna
- Department of Pediatrics, Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Estr. Forte do Alto Duque, 1449-005, Lisbon, Portugal
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Almeida TL, Mendo T, Costa R, Novais C, Marçal M, Martins F, Tuna M. Carbapenemase-Producing Enterobacteriaceae (CPE) Newborn Colonization in a Portuguese Neonatal Intensive Care Unit (NICU): Epidemiology and Infection Prevention and Control Measures. Infect Dis Rep 2021; 13:411-417. [PMID: 34062713 PMCID: PMC8162345 DOI: 10.3390/idr13020039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 11/16/2022] Open
Abstract
Infections due to carbapenemase-producing Enterobacterales (CPE) are increasing worldwide and are especially concerning in a neonatal intensive care unit (NICU). Risk factors for CPE gut colonization in neonates need to be clarified. In this work, we describe the epidemiological and clinical features of CPE-colonized newborns and the infection control measures in a Portuguese NICU. We performed a prospective, observational, longitudinal, cohort study for surveillance of CPE colonization. Maternal and neonatal features of colonized newborns and surveillance strategy were described. A statistical analysis was performed with SPSS23.0, and significance was indicated by p-value ≤ 0.05. Between March and November 2019, CPE was isolated in 5.8% of 173 admitted neonates. Carbapenemase-producing Klebsiella pneumoniae were the most frequently isolated. There was no associated infection. Birth weight, gestational age, length of stay, and days of central line were the identified risk factors for CPE colonization (bivariate analysis with Student's t-test or Mann-Whitney U test, according to normality). No independent risk factors for CPE colonization were identified in the logistic regression analysis. CPE colonization risk factors are still to be determined accurately in the neonatal population. Active surveillance and continuous infection control measures restrained the current cluster of colonized newborns and helped to prevent infection and future outbreaks.
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Affiliation(s)
- Teresa L. Almeida
- Neonatal Intensive Care Unit, Centro Hospitalar Lisboa Ocidental, Department of Pediatrics, Hospital de São Francisco Xavier, 1449-005 Lisboa, Portugal; (T.M.); (R.C.); (C.N.); (M.M.); (M.T.)
- Department of Pediatrics, Hospital do Espírito Santo de Évora, EPE, 7000-811 Évora, Portugal
| | - Tânia Mendo
- Neonatal Intensive Care Unit, Centro Hospitalar Lisboa Ocidental, Department of Pediatrics, Hospital de São Francisco Xavier, 1449-005 Lisboa, Portugal; (T.M.); (R.C.); (C.N.); (M.M.); (M.T.)
- Department of Pediatrics, Hospital José Joaquim Fernandes, ULSBA, 7801-849 Beja, Portugal
| | - Raquel Costa
- Neonatal Intensive Care Unit, Centro Hospitalar Lisboa Ocidental, Department of Pediatrics, Hospital de São Francisco Xavier, 1449-005 Lisboa, Portugal; (T.M.); (R.C.); (C.N.); (M.M.); (M.T.)
- Department of Pediatrics, Hospital do Espírito Santo de Évora, EPE, 7000-811 Évora, Portugal
| | - Cristina Novais
- Neonatal Intensive Care Unit, Centro Hospitalar Lisboa Ocidental, Department of Pediatrics, Hospital de São Francisco Xavier, 1449-005 Lisboa, Portugal; (T.M.); (R.C.); (C.N.); (M.M.); (M.T.)
- Paediatric and Neonatal Functional Unit, Department of Paediatrics, Hospital de Cascais, 2755-009 Alcabideche, Portugal
| | - Mónica Marçal
- Neonatal Intensive Care Unit, Centro Hospitalar Lisboa Ocidental, Department of Pediatrics, Hospital de São Francisco Xavier, 1449-005 Lisboa, Portugal; (T.M.); (R.C.); (C.N.); (M.M.); (M.T.)
| | - Filomena Martins
- GCL-PPCIRA, Grupo Coordenador Local de Prevenção e Controlo da Infecção e Resistência aos Antimicrobianos, Centro Hospitalar Lisboa Ocidental, 1449-005 Lisboa, Portugal;
| | - Madalena Tuna
- Neonatal Intensive Care Unit, Centro Hospitalar Lisboa Ocidental, Department of Pediatrics, Hospital de São Francisco Xavier, 1449-005 Lisboa, Portugal; (T.M.); (R.C.); (C.N.); (M.M.); (M.T.)
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Pragosa H, Marçal M, Gonçalves E, Martins F, Lopo-Tuna M. Multi-drug-resistant Enterobacteriaceae in a Portuguese neonatal intensive care unit. J Hosp Infect 2017; 96:130-131. [PMID: 28433397 DOI: 10.1016/j.jhin.2017.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/13/2017] [Indexed: 11/25/2022]
Affiliation(s)
- H Pragosa
- Hospital de Sao Francisco Xavier, Lisboa, Portugal.
| | - M Marçal
- Unidade de Neonatologia, Serviço de Pediatria, Hospital de São Francisco Xavier, Lisboa, Portugal
| | - E Gonçalves
- Serviço de Patologia Clínica, Laboratório de Microbiologia, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - F Martins
- Coordenadora do Grupo de Coordenação local do Programa de Prevenção e Controlo da Infecção e Resistência aos Antimicrobianos, Centro Hospitalar de Lisboa Ocidental, Portugal
| | - M Lopo-Tuna
- Coordenadora da Unidade de Neonatologia, Serviço de Pediatria, Hospital de São Francisco Xavier, Lisboa, Portugal
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Araújo AR, Marçal M, Tuna M, Anjos R. Cardiac dysfunction and prenatal exposure to venlafaxine. Clin Case Rep 2016; 4:383-6. [PMID: 27099733 PMCID: PMC4831389 DOI: 10.1002/ccr3.412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 08/22/2015] [Accepted: 09/10/2015] [Indexed: 11/07/2022] Open
Abstract
Venlofaxine, a widely used antidepressant, is known to cause a withdrawal syndrome. We present a case of neonatal transient ventricular dysfunction in a neonate exposed to venlafaxine in utero. Other causes of ventricular dysfunction were excluded. Neonatal ventricular dysfunction can be a possible side effect of maternal use of this drug.
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Affiliation(s)
- Ana R Araújo
- Pediatric Cardiology DepartmentHospital de Santa CruzCentro Hospitalar de Lisboa OcidentalLisboaPortugal
| | - Mónica Marçal
- Neonatal Intensive Care UnitHospital de São Francisco XavierCentro Hospitalar de Lisboa OcidentalLisboaPortugal
| | - Madalena Tuna
- Neonatal Intensive Care UnitHospital de São Francisco XavierCentro Hospitalar de Lisboa OcidentalLisboaPortugal
| | - Rui Anjos
- Pediatric Cardiology DepartmentHospital de Santa CruzCentro Hospitalar de Lisboa OcidentalLisboaPortugal
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8
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Abstract
Pituitary gland duplication is a particularly rare finding. Different theories have been proposed to explain its pathogenesis, however, this phenomenon is not yet totally understood. Recently, duplication of the pituitary gland (DPG)-plus syndrome has been described, associating DPG with other blastogenic defects. We present the clinical and imaging findings of a newborn girl with DPG, associated with multiple other midline anomalies, including a nasopharyngeal teratoma, palate cleft deformity, bifid nasal bridge, tongue and uvula, hypoplasia of the basis pontis and corpus callosum, duplication of the basilar artery and hypothalamic hamartoma. We describe our patient's multidisciplinary team approach and emphasise the importance of reporting upcoming cases, in order to give more insight into the understanding of this complex entity.
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Affiliation(s)
- Laura Azurara
- Department of Pediatrics, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Mónica Marçal
- Department of Pediatrics, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Filipa Vieira
- Department of Pediatrics, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Madalena Lopo Tuna
- Department of Pediatrics, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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9
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Costa P, Biscoito L, Vieira M, Marçal M, Camilo C, Neto L, Abecasis F, Almeida M, Correia M. [Endovascular thrombolysis for massive cerebral venous thrombosis in a teenager with nephrotic syndrome]. ACTA MEDICA PORT 2010; 23:1141-1146. [PMID: 21627891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 11/13/2009] [Indexed: 05/30/2023]
Abstract
Cerebral venous thrombosis is a rare but potentially severe condition in children. We present the case of a teenager with corticodependent nephrotic syndrome diagnosed at five months of age and treated with cyclosporine A. In the context of recurrence of nephrotic syndrome he presented with headache, vomiting and severe intracranial hypertension. While the raised intracranial pressure and the status epilepticus were controlled, the brain imaging revealed venous thrombosis of all venous sinus, with absence of venous drainage. He was submitted to local thrombolysis with recombinant tissue plasminogen activator, with recanalization of the venous sinuses. The outcome was favourable, without neurological deficits. In this case, the early radiologic intervention was crucial, enabling a full neurological recovery, in a teenager whose initial prognosis was very poor.
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Affiliation(s)
- Paula Costa
- Unidade de Cuidados Intensivos Pediátricos e Unidade de Nefrologia Pediátrica, Departamento da Criança e da Família, Serviço de Imagiologia Neurológica, Hospital Santa Maria, Lisbon
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Santos V, Marçal M, Amaral D, Pina R, Lopes L, Fonseca G. [Turner syndrome. From child to adult... A multidisciplinary approach]. ACTA MEDICA PORT 2010; 23:873-882. [PMID: 21144329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 10/22/2009] [Indexed: 05/30/2023]
Abstract
Turner syndrome is one of the most frequent chromosome disorders in clinical practice. It is characterized by a multisystemic involvement, responsible for a high morbidity and an increased mortality at all ages. Therefore it is essential that there is a continuous and integrated approach in reference centers to improve the quality of life and prevent early mortality. There has been a growing interest in the scientific community to achieve these goals, with the publication of clinical guidelines. This article intends to review these guidelines, with particular emphasis on a multidisciplinary care of these patients from the age of diagnosis and throughout their adult life.
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Affiliation(s)
- Vera Santos
- Unidade de Endocrinologia Pediátrica, Área Departamental de Pediatria Médica, Hospital Dona Estefânia, Lisboa
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