Pediatric Patient with Ischemic Stroke: Initial Approach and Early Management.

Acute Ischemic Stroke (AIS) in children is an acute neurologic emergency associated with significant morbidity and mortality. Although the incidence of AIS in pediatric patients is considerably lower than in adults, the overall cumulative negative impact of the quality of life could be even higher in children. The age-related variable clinical presentation could result in a delay in diagnosis and could negatively influence the overall outcome. The early management should be based on early recognition, acute transfer to pediatric AIS centre, standardised approach (ABCDE), early neurologic examination together with neuroimaging (preferable Magnetic Resonance Imaging-MRI). The treatment is based on supportive therapy (normoxemia, normocapnia, normotension and normoglycemia) in combination with intravenous/intraarterial thrombolytic therapy and/or mechanical thrombectomy in selected cases. Pediatric stroke centres, together with the implementation of local stroke management protocols, could further improve the outcome of pediatric patients with AIS.

Abordagem inicial ao paciente com suspeita de mieloma múltiplo / Initial approach to the patient with suspected multiple myeloma

Introdução: O mieloma múltiplo é uma neoplasia maligna hematológica caracterizada pela proliferação clonal de células plasmocitárias e pela secreção de seus produtos celulares. Métodos: A busca por literatura biomédica foi restrita à base de dados MEDLINE, incluindo artigos publicados nos últimos 5 anos e artigos de revisão e diretrizes internacionais. Resultados: Informações a respeito de epidemiologia, apresentação clínica, diagnóstico e manejo clínico inicial foram apresentados. Conclusão: A suspeita clínica de mieloma múltiplo, baseada em sinais e sintomas típicos, deve levar à investigação diagnóstica e encaminhamento a especialista para tratamento.

Introduction: Multiple myeloma is a malignant haematological malignancy characterized by proliferation of clonal plasma cells and secretion of their cellular end products. Methods: The MEDLINE database was searched for articles published in the last 5 years and included review articles and international guidelines. Results: Information about epidemiology, clinical presentation, diagnosis and initial clinical approach were depicted. Conclusion: Clinical suspicion of multiple myeloma, based on typical signs and symptoms, should lead to diagnosis investigation and referral to a specialist for treatment.