Marisa Vieira

Development of a solid state dosimeter based on thermoluminescent CaSO4:Dy crystals☆

Abstract A new technique to obtain a solid state dosimeter based on the thermoluminescent properties of CaSO4:Dy is described. It consists of preparing pellets by cold pressing the mixture of CaSO4:Dy as the active TL material and NaCl as the binder. The method of preparation and main dosimetric characteristics such as reproductibility and linearity are studied. A filter combination for achieving an energy independent response for the dosimeter is studied and a filter configuration giving a nearly energy independent response from 20 keV to 1.25 MeV was obtained. The dosimetric characteristics from the point of view of introducing this dosimeter into the routine personnel monitoring are discussed.

A 3-month-old baby with H1N1 and Guillain–Barré syndrome

Majority of children with pandemic influenza A (H1N1)pdm09 experience mild illness with full recovery without treatment. A previously healthy two and a half month-old girl was admitted to our paediatric intensive care unit because of severe respiratory failure with A (H1N1)pdm09 infection. Despite initial clinical improvement all attempts to extubate to non-invasive ventilation were unsuccessful and 2 to 3 weeks after symptom onset she started periods of cardiovascular instability and a progressive neurological deterioration with distal symmetrical progressive motor weakness and areflexia. All investigations were normal except elevated liver enzymes and cerebrospinal fluid examination that revealed elevated protein without pleocytosis. A possible diagnosis of Guillain–Barré syndrome (GBS) was considered and electromyogram was compatible with axonal form of GBS. To our knowledge this is the youngest case of GBS acquired postnatally and the first in children associated with H1N1 virus.

Septic Pulmonary Embolism Case Report: Optimal Outcome after Insertion of an Inferior Vena Cava Filter in a Patient with Staphylococcus aureus Bacteraemia.

A 14-year-old patient presented with bilateral pneumonia and pleural effusions, septic arthritis of the hip, deep venous thrombosis, and pulmonary thromboembolism. Methicillin-sensitive Staphylococcus aureus (S. aureus) containing the Panton Valentine Leukocidin (PVL) genes was isolated. Contraindication to anticoagulation prompted inferior vena cava filter placement. He completed 4 weeks of treatment with flucloxacillin, with good clinical outcome. S. aureus containing PVL genes should be sought in cases of necrotizing pneumonia as it seems to increase the risk of severe multifocal infection and thrombotic complications. There are few reports of placement of filters during S. aureus sepsis and bacteraemia. This case highlights that when anticoagulation is not feasible, an inferior vena cava filter can be inserted safely, even in patients with active sepsis and high risk for seeding of the filter. Long-term follow-up confirmed a successful outcome with sterilization of the septic thrombosis with no further pulmonary embolism or additional sepsis episodes.

Acidentes Vasculares Cerebrais em Idade Pediátrica: O Papel dos Cuidados Intensivos

Introducao: As lesoes vasculares do sistema nervoso central, nomeadamente o acidente vascular cerebral hemorragico, o acidente vascular cerebral isquemico e trombose venosa cerebral, sao causa importante de morbilidade e mortalidade. Existem poucos estudos sobre a melhor abordagem terapeutica em pediatria. O objetivo deste estudo foi descrever a abordagem e outcome neurologico dos doentes admitidos numa unidade de cuidados intensivos pediatricos com lesoes vasculares cerebrais nao traumaticas. Metodos: Estudo retrospetivo baseado nos processos clinicos de doentes internados numa unidade de cuidados intensivos pediatricos entre janeiro de 2007 e dezembro de 2013 com lesao vascular cerebral nao traumatica. Resultados: Incluiram-se 45 doentes, mediana da idade 8,2 anos, 70% do sexo masculino. Ocorreram 22 casos (49%) de acidente vascular cerebral hemorragico, 15 de acidente vascular cerebral isquemico (33%) e oito de trombose venosa cerebral (18%). Necessitaram de intervencao neurocirurgica 18 doentes e neurorradiologica cinco doentes. Um doente fez trombolise sistemica utilizando alteplase, 76% necessitaram de controlo medico da hipertensao intracraniana, 57% de ventilacao mecânica, 30% de suporte cardiovascular e 28% de terapeutica antiepiletica. Ocorreram cinco obitos (11%), quatro em doentes com acidente vascular cerebral hemorragico. Utilizando a escala KOSCHI (King’s Outcome Scale for Childhood Head Injury), atualmente 23 (51%) doentes sao independentes, incluindo 17 que nao apresentam qualquer sequela. Discussao: Registaram-se, em media, seis internamentos por ano por acidente vascular cerebral nao traumatico, sendo mais frequente o hemorragico. A precocidade do diagnostico e a referenciacao atempada para centros especializados sao cruciais para a melhoria do prognostico. A abordagem multidisciplinar num centro com disponibilidade permanente de recursos humanos e materiais tera contribuido para a sobrevida e boa recuperacao funcional verificada na maioria dos casos.