OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of l... more OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.
Anais do 2° Congresso Internacional Sabará de Especialidades Pediátricas, 2014
Introdução: Mycoplasma pneumoniae (Mp) é uma causa comum de pneumonia adquirida na comunidade, re... more Introdução: Mycoplasma pneumoniae (Mp) é uma causa comum de pneumonia adquirida na comunidade, relatada em 10 a 40% dos casos especialmente na idade escolar e adultos jovens.
In the current pandemic, caused by infection with severe acute respiratory syndrome coronavirus 2... more In the current pandemic, caused by infection with severe acute respiratory syndrome coronavirus 2, ultrasound has played a fundamental role in patients who develop the resulting disease, designated coronavirus disease 2019 (COVID-19). In this study we present ultrasound images of the lungs of neonates with a suspected or confirmed diagnosis of COVID-19, distinguishing between the changes related to COVID-19 and those unrelated to the disease. Ultrasound examinations were performed by a pediatric sonographer. A total of 27 neonates were evaluated. Among those who presented no respiratory symptoms, some tested negative for COVID-19 and others tested positive. All of those who were pulmonary symptomatic, negative for COVID-19 presented transient tachypnea of the newborn and respiratory distress syndrome. Lung ultrasound images obtained in COVID-19-negative neonates showed, in some cases, a normal pattern (with A lines, few B lines, a thin, linear pleural line, and no pleural effusion),...
SUMMARY AIM To describe the incidence, diagnosis, and management of systemic arterial hypertensio... more SUMMARY AIM To describe the incidence, diagnosis, and management of systemic arterial hypertension related to renal artery stenosis in patients with Williams-Beuren syndrome. METHODS Sixty-five patients with Williams-Beuren syndrome were evaluated for hypertension. Enrolled patients underwent Doppler sonography of the renal arteries and Doppler echocardiography. Those with Doppler sonography-detected lesions or with normal Doppler sonography but severe hypertension underwent computed tomography or gadolinium-enhanced magnetic resonance angiography of the aorta and renal vessels. Patients needing vascular therapeutic intervention underwent conventional angiography. RESULTS Systemic arterial hypertension was diagnosed in 21/65 patients with Williams-Beuren syndrome (32%; 13 male) with a mean age of 13.9 years (5mo-20yrs). In 8/21 patients renovascular hypertension was detected. Angioplasty was unsuccessful in five patients with renal artery stenosis, requiring additional treatment. Do...
The aim of this report was to present a selection of focal hyperechoic liver lesions of different... more The aim of this report was to present a selection of focal hyperechoic liver lesions of different etiologies, illustrating the wide spectrum of diagnostic possibilities for such lesions in the pediatric population.
Objective: To describe the radiological findings in pediatric patients with hematological or onco... more Objective: To describe the radiological findings in pediatric patients with hematological or oncological diseases who also have an invasive fungal infection (IFI). Materials and Methods: This was a retrospective study of all patients with IFI admitted to a pediatric hematology and oncology hospital in Brazil between 2008 and 2014. Clinical and demographic data were collected. Chest computed tomography (CT) scans of the patients were reviewed by two independent radiologists. Results: We evaluated the chest CT scans of 40 pediatric patients diagnosed with an IFI. Twenty-seven patients (67.5%) had nodules with the halo sign, seven (17.5%) had cavities, two (5.0%) had nodules without the halo sign, and seven (17.5%) had consolidation. The patients with the halo sign and cavities were older (123 vs. 77 months of age; p = 0.03) and had less severe disease (34% vs. 73%; p = 0.04). Ten patients had a proven IFI: with Aspergillus sp. (n = 4); with Candida sp. (n = 5); or with Fusarium sp. (n...
Although contrast-enhanced ultrasound has been shown to provide considerable benefits, particular... more Although contrast-enhanced ultrasound has been shown to provide considerable benefits, particularly in pediatric patients, it is still used relatively rarely in Brazil. It has proven to be a safe technique, and adverse effects are rare. In this review, we address the technique and main applications of contrast-enhanced ultrasound in the pediatric population, including the evaluation of focal liver lesions, abdominal trauma, kidney grafts, liver grafts, bowel loops, and vesicoureteral reflux. It is important for pediatric radiologists to be acquainted with this promising tool, understanding its applications and limitations.
ABSTRACT Computed tomography (CT) is an indispensable imaging technique, but radiation exposure ... more ABSTRACT Computed tomography (CT) is an indispensable imaging technique, but radiation exposure from CT scans is of concern mainly due to the potential risk of developing cancer, mainly in children. Our group recently showed that CT use has greatly increased among outpatients using the Brazilian public health system (SUS) between 2001 and 2011. Further, CT examinations among patients younger than 20 years of age represented around 13.4% of all CT examinations in SUS between 2008 and 2011. In comparison, these examinations represented around 8% of the overall number of CT scans in a private hospital in Rio de Janeiro between 2005 and 2015, In this paper we extended the evaluation of pediatric and young adult CT use in Brazil to 25 private CT services in 8 Brazilian cities for the period 2008-2014. Data from SUS was updated to this period. Information about CT use in SUS was obtained from an online database. Data on the privately funded setting was retrieved from the Radiological Inf...
In the current pandemic, caused by infection with severe acute respiratory syndrome coronavirus 2... more In the current pandemic, caused by infection with severe acute respiratory syndrome coronavirus 2, ultrasound has played a fundamental role in patients who develop the resulting disease, designated coronavirus disease 2019 (COVID-19). In this study we present ultrasound images of the lungs of neonates with a suspected or confirmed diagnosis of COVID-19, distinguishing between the changes related to COVID-19 and those unrelated to the disease. Ultrasound examinations were performed by a pediatric sonographer. A total of 27 neonates were evaluated. Among those who presented no respiratory symptoms, some tested negative for COVID-19 and others tested positive. All of those who were pulmonary symptomatic, negative for COVID-19 presented transient tachypnea of the newborn and respiratory distress syndrome. Lung ultrasound images obtained in COVID-19-negative neonates showed, in some cases, a normal pattern (with A lines, few B lines, a thin, linear pleural line, and no pleural effusion),...
Brazilian Journal of Radiation Sciences, Mar 22, 2020
Computed tomography (CT) is an indispensable imaging technique, but radiation exposure from CT sc... more Computed tomography (CT) is an indispensable imaging technique, but radiation exposure from CT scans is of concern mainly due to the potential risk of developing cancer, mainly in children. Our group recently showed that CT use has greatly increased among outpatients using the Brazilian public health system (SUS) between 2001 and 2011. Further, CT examinations among patients younger than 20 years of age represented around 13.4% of all CT examinations in SUS between 2008 and 2011. In comparison, these examinations represented around 8% of the overall number of CT scans in a private hospital in Rio de Janeiro between 2005 and 2015. In this paper we extended the evaluation of pediatric and young adult CT use in Brazil to 25 private CT services in 8 Brazilian cities for the period 2008-2014. Data from SUS was updated to this period. Information about CT use in SUS was obtained from an online database. Data on the privately funded setting was retrieved from the Radiological Information Systems (RIS) of each CT service. Patients younger than 20 years of age underwent around 8.9% of the CT procedures in the private setting, while in SUS this proportion was around 12.7% in the same period. Pediatric and young adult CT greatly increased in both healthcare systems, but annual growth rates were less pronounced in the private than in the public healthcare system. One third of the patients in the private setting had more than one CT examination over the period investigated.
1) To verify clinical signs correlated with appropriate cranial computed tomography scan indicati... more 1) To verify clinical signs correlated with appropriate cranial computed tomography scan indications and changes in the therapeutic approach in pediatric minor head trauma scenarios. 2) To estimate the radiation exposure of computed tomography scans with low dose protocols in the context of trauma and the additional associated risk. Investigators reviewed the medical records of all children with minor head trauma, which was defined as a Glasgow coma scale ≥13 at the time of admission to the emergency room, who underwent computed tomography scans during the years of 2013 and 2014. A change in the therapeutic approach was defined as a neurosurgical intervention performed within 30 days, hospitalization, >12 hours of observation, or neuro-specialist evaluation. Of the 1006 children evaluated, 101 showed some abnormality on head computed tomography scans, including 49 who were hospitalized, 16 who remained under observation and 36 who were dismissed. No patient underwent neurosurgery...
We present a case of microcephaly associated with Zika virus (ZIKV) in a chronological, multimoda... more We present a case of microcephaly associated with Zika virus (ZIKV) in a chronological, multimodal imaging approach, illustrating the hallmarks of this disease on intrauterine morphological ultrasound, transfontanelar ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). We also determined the serological e immunological status of the mother and newborn. Noticeably, there was evidence for maternal infection by ZIKV, cytomegalovirus (CMV), herpes simplex virus (HSV), dengue virus (DENV) and Toxoplasma gondii, which indicates a possible role of previous exposures to STORCH agents and possibly comorbidities in the severe fetal congenital manifestation.
OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of l... more OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.
Anais do 2° Congresso Internacional Sabará de Especialidades Pediátricas, 2014
Introdução: Mycoplasma pneumoniae (Mp) é uma causa comum de pneumonia adquirida na comunidade, re... more Introdução: Mycoplasma pneumoniae (Mp) é uma causa comum de pneumonia adquirida na comunidade, relatada em 10 a 40% dos casos especialmente na idade escolar e adultos jovens.
In the current pandemic, caused by infection with severe acute respiratory syndrome coronavirus 2... more In the current pandemic, caused by infection with severe acute respiratory syndrome coronavirus 2, ultrasound has played a fundamental role in patients who develop the resulting disease, designated coronavirus disease 2019 (COVID-19). In this study we present ultrasound images of the lungs of neonates with a suspected or confirmed diagnosis of COVID-19, distinguishing between the changes related to COVID-19 and those unrelated to the disease. Ultrasound examinations were performed by a pediatric sonographer. A total of 27 neonates were evaluated. Among those who presented no respiratory symptoms, some tested negative for COVID-19 and others tested positive. All of those who were pulmonary symptomatic, negative for COVID-19 presented transient tachypnea of the newborn and respiratory distress syndrome. Lung ultrasound images obtained in COVID-19-negative neonates showed, in some cases, a normal pattern (with A lines, few B lines, a thin, linear pleural line, and no pleural effusion),...
SUMMARY AIM To describe the incidence, diagnosis, and management of systemic arterial hypertensio... more SUMMARY AIM To describe the incidence, diagnosis, and management of systemic arterial hypertension related to renal artery stenosis in patients with Williams-Beuren syndrome. METHODS Sixty-five patients with Williams-Beuren syndrome were evaluated for hypertension. Enrolled patients underwent Doppler sonography of the renal arteries and Doppler echocardiography. Those with Doppler sonography-detected lesions or with normal Doppler sonography but severe hypertension underwent computed tomography or gadolinium-enhanced magnetic resonance angiography of the aorta and renal vessels. Patients needing vascular therapeutic intervention underwent conventional angiography. RESULTS Systemic arterial hypertension was diagnosed in 21/65 patients with Williams-Beuren syndrome (32%; 13 male) with a mean age of 13.9 years (5mo-20yrs). In 8/21 patients renovascular hypertension was detected. Angioplasty was unsuccessful in five patients with renal artery stenosis, requiring additional treatment. Do...
The aim of this report was to present a selection of focal hyperechoic liver lesions of different... more The aim of this report was to present a selection of focal hyperechoic liver lesions of different etiologies, illustrating the wide spectrum of diagnostic possibilities for such lesions in the pediatric population.
Objective: To describe the radiological findings in pediatric patients with hematological or onco... more Objective: To describe the radiological findings in pediatric patients with hematological or oncological diseases who also have an invasive fungal infection (IFI). Materials and Methods: This was a retrospective study of all patients with IFI admitted to a pediatric hematology and oncology hospital in Brazil between 2008 and 2014. Clinical and demographic data were collected. Chest computed tomography (CT) scans of the patients were reviewed by two independent radiologists. Results: We evaluated the chest CT scans of 40 pediatric patients diagnosed with an IFI. Twenty-seven patients (67.5%) had nodules with the halo sign, seven (17.5%) had cavities, two (5.0%) had nodules without the halo sign, and seven (17.5%) had consolidation. The patients with the halo sign and cavities were older (123 vs. 77 months of age; p = 0.03) and had less severe disease (34% vs. 73%; p = 0.04). Ten patients had a proven IFI: with Aspergillus sp. (n = 4); with Candida sp. (n = 5); or with Fusarium sp. (n...
Although contrast-enhanced ultrasound has been shown to provide considerable benefits, particular... more Although contrast-enhanced ultrasound has been shown to provide considerable benefits, particularly in pediatric patients, it is still used relatively rarely in Brazil. It has proven to be a safe technique, and adverse effects are rare. In this review, we address the technique and main applications of contrast-enhanced ultrasound in the pediatric population, including the evaluation of focal liver lesions, abdominal trauma, kidney grafts, liver grafts, bowel loops, and vesicoureteral reflux. It is important for pediatric radiologists to be acquainted with this promising tool, understanding its applications and limitations.
ABSTRACT Computed tomography (CT) is an indispensable imaging technique, but radiation exposure ... more ABSTRACT Computed tomography (CT) is an indispensable imaging technique, but radiation exposure from CT scans is of concern mainly due to the potential risk of developing cancer, mainly in children. Our group recently showed that CT use has greatly increased among outpatients using the Brazilian public health system (SUS) between 2001 and 2011. Further, CT examinations among patients younger than 20 years of age represented around 13.4% of all CT examinations in SUS between 2008 and 2011. In comparison, these examinations represented around 8% of the overall number of CT scans in a private hospital in Rio de Janeiro between 2005 and 2015, In this paper we extended the evaluation of pediatric and young adult CT use in Brazil to 25 private CT services in 8 Brazilian cities for the period 2008-2014. Data from SUS was updated to this period. Information about CT use in SUS was obtained from an online database. Data on the privately funded setting was retrieved from the Radiological Inf...
In the current pandemic, caused by infection with severe acute respiratory syndrome coronavirus 2... more In the current pandemic, caused by infection with severe acute respiratory syndrome coronavirus 2, ultrasound has played a fundamental role in patients who develop the resulting disease, designated coronavirus disease 2019 (COVID-19). In this study we present ultrasound images of the lungs of neonates with a suspected or confirmed diagnosis of COVID-19, distinguishing between the changes related to COVID-19 and those unrelated to the disease. Ultrasound examinations were performed by a pediatric sonographer. A total of 27 neonates were evaluated. Among those who presented no respiratory symptoms, some tested negative for COVID-19 and others tested positive. All of those who were pulmonary symptomatic, negative for COVID-19 presented transient tachypnea of the newborn and respiratory distress syndrome. Lung ultrasound images obtained in COVID-19-negative neonates showed, in some cases, a normal pattern (with A lines, few B lines, a thin, linear pleural line, and no pleural effusion),...
Brazilian Journal of Radiation Sciences, Mar 22, 2020
Computed tomography (CT) is an indispensable imaging technique, but radiation exposure from CT sc... more Computed tomography (CT) is an indispensable imaging technique, but radiation exposure from CT scans is of concern mainly due to the potential risk of developing cancer, mainly in children. Our group recently showed that CT use has greatly increased among outpatients using the Brazilian public health system (SUS) between 2001 and 2011. Further, CT examinations among patients younger than 20 years of age represented around 13.4% of all CT examinations in SUS between 2008 and 2011. In comparison, these examinations represented around 8% of the overall number of CT scans in a private hospital in Rio de Janeiro between 2005 and 2015. In this paper we extended the evaluation of pediatric and young adult CT use in Brazil to 25 private CT services in 8 Brazilian cities for the period 2008-2014. Data from SUS was updated to this period. Information about CT use in SUS was obtained from an online database. Data on the privately funded setting was retrieved from the Radiological Information Systems (RIS) of each CT service. Patients younger than 20 years of age underwent around 8.9% of the CT procedures in the private setting, while in SUS this proportion was around 12.7% in the same period. Pediatric and young adult CT greatly increased in both healthcare systems, but annual growth rates were less pronounced in the private than in the public healthcare system. One third of the patients in the private setting had more than one CT examination over the period investigated.
1) To verify clinical signs correlated with appropriate cranial computed tomography scan indicati... more 1) To verify clinical signs correlated with appropriate cranial computed tomography scan indications and changes in the therapeutic approach in pediatric minor head trauma scenarios. 2) To estimate the radiation exposure of computed tomography scans with low dose protocols in the context of trauma and the additional associated risk. Investigators reviewed the medical records of all children with minor head trauma, which was defined as a Glasgow coma scale ≥13 at the time of admission to the emergency room, who underwent computed tomography scans during the years of 2013 and 2014. A change in the therapeutic approach was defined as a neurosurgical intervention performed within 30 days, hospitalization, >12 hours of observation, or neuro-specialist evaluation. Of the 1006 children evaluated, 101 showed some abnormality on head computed tomography scans, including 49 who were hospitalized, 16 who remained under observation and 36 who were dismissed. No patient underwent neurosurgery...
We present a case of microcephaly associated with Zika virus (ZIKV) in a chronological, multimoda... more We present a case of microcephaly associated with Zika virus (ZIKV) in a chronological, multimodal imaging approach, illustrating the hallmarks of this disease on intrauterine morphological ultrasound, transfontanelar ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). We also determined the serological e immunological status of the mother and newborn. Noticeably, there was evidence for maternal infection by ZIKV, cytomegalovirus (CMV), herpes simplex virus (HSV), dengue virus (DENV) and Toxoplasma gondii, which indicates a possible role of previous exposures to STORCH agents and possibly comorbidities in the severe fetal congenital manifestation.
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Papers by Lisa Suzuki