Catarina Maia

Risk of recurrence after a first unprovoked seizure in children

OBJECTIVES This study aimed to evaluate the first episode of unprovoked epileptic seizure in children and assess recurrence risk factors. METHODS This was a retrospective observational study, based on the analysis of medical records of patients admitted between 2003 and 2014, with first epileptic seizure, at the pediatric service of a secondary hospital. The data were analyzed using the SPSS 20.0 program. RESULTS Of the 103 patients, 52.4% were boys. The median age at the first seizure was 59 (1-211) months. About 93% of children were submitted to an electroencephalogram at the first episode and 47% underwent neuroimaging assessment. Treatment with an antiepileptic drug was started in 46% of patients. The recurrence rate was 38% and of these, 80% had the second seizure within six months after the first event. Of the assessed risk factors, there was a statistically significant association between seizure during sleep and recurrence (p=0.004), and between remote symptomatic etiology seizure and occurrence of new seizure (p=0.02). The presence of electroencephalogram abnormalities was also associated with the occurrence of new seizures (p=0.021). No association was found between age, duration of the seizure, and family history of epilepsy with increased risk of recurrence. CONCLUSIONS Most children with a first unprovoked epileptic seizure had no recurrences. The risk of recurrence was higher in patients with seizure occurring during sleep or remote symptomatic ones and those with abnormal electroencephalogram results.

Trial of labour after caesarean section: Two-year analysis at a Portuguese centre

Abstract We conducted a retrospective study aimed at determining variables associated with a higher success rate for vaginal delivery after caesarean section, and assessing the impact of induction of labour. Secondarily, we aimed to describe our vaginal delivery and uterine rupture rates with the use of a controlled-release dinoprostone vaginal insert for cervical ripening. Of 292 women who met the inclusion criteria, induction of labour occurred in 48% (94% with dinoprostone). There was a non-significant difference between the vaginal delivery rate of spontaneous labour (57%) and induction of labour (33%), after adjusting for confounding variables. The success rate was influenced by a Bishop score ≥6, previous vaginal delivery and previous caesarean for dystocia or failed induction. There was only one case of uterine rupture, which was associated with dinoprostone use (overall rate 0.34%, 0.77% for dinoprostone). Impact statement Trial of labour after caesarean section is considered an alternative to elective repeat caesarean. Both present associated benefits and risks, the most fearsome of which is uterine rupture during labour (0.78% in term pregnancies). Induction is also possible but carries a higher risk of uterine rupture and lower success rate for vaginal birth. Prostaglandins have been of particular concern due to a higher risk of uterine scar rupture, estimated at 2% for dinoprostone; however, its use as a controlled-release vaginal insert has been under-reported. Our study confirms the reported impact of previous vaginal delivery, previous caesarean indication and Bishop score at admission on success rate for vaginal birth after caesarean. We were unable to prove a lower success rate for induction of labour after adjusting for other variables. Despite our study limitations, we report on the use of a controlled-release vaginal insert with 10mg of dinoprostone in 130 women with a uterine rupture rate of 0.77%, lower than previously reported and similar to the overall rate estimated for term pregnancies. This dinoprostone formulation may be safer than previously reported but larger studies, and preferably randomised controlled trials, are needed to confirm these findings.

Artigo OriginalRisk of recurrence after a first unprovoked seizure in childrenRisco de recorrência após uma primeira crise epilética não provocada em idade pediátrica

Objectives This study aimed to evaluate the first episode of unprovoked epileptic seizure in children and assess recurrence risk factors.

Neonatal septic arthritis - a challenging diagnosis

Introduction: The diagnosis of septic arthritis in newborns is difficult and requires a high degree of suspicion. Case report: We present a case of a newborn who developed right brachial plexus palsy on the 10th day of life. By day 17, limited abduction of the right hip led to the suspicion of developmental dysplasia of the hip. An ultrasound corroborated this diagnosis and the newborn was referred to Pediatric Orthopedics. After proper study the diagnosis of a polyarticular septic arthritis was confirmed. At the age of eight years the child has a right upper limb deformity and shortening. Discussion/conclusion: The delay in diagnosis and treatment of this pathology leads to future sequels that may be irreversible. This report underlines how difficult and important is