Publications by authors named "Ana Rita Sandes"

8 Publications

  • Page 1 of 1

Growth Patterns After Kidney Transplantation in European Children Over the Past 25 Years: An ESPN/ERA-EDTA Registry Study.

Transplantation 2020 01;104(1):137-144

Pediatric Nephrology Unit, Bordeaux University Hospital, Bordeaux, France.

Background: Improved management of growth impairment might have resulted in less growth retardation after pediatric kidney transplantation (KT) over time. We aimed to analyze recent longitudinal growth data after KT in comparison to previous eras, its determinants, and the association with transplant outcome in a large cohort of transplanted children using data from the European Society for Paediatric Nephrology/European Renal Association and European Dialysis and Transplant Association Registry.

Methods: A total of 3492 patients transplanted before 18 years from 1990 to 2012 were included. Height SD scores (SDS) were calculated using recent national or European growth charts. We used generalized equation models to estimate the prevalence of growth deficit and linear mixed models to calculate adjusted mean height SDS.

Results: Mean adjusted height post-KT was -1.77 SDS. Height SDS was within normal range in 55%, whereas 28% showed moderate, and 17% severe growth deficit. Girls were significantly shorter than boys, but catch-up growth by 5 years post-KT was observed in both boys and girls. Children <6 years were shortest at KT and showed the greatest increase in height, whereas there was no catch-up growth in children transplanted >12.

Conclusions: Catch-up growth post-KT remains limited, height SDS did not improve over time, resulting in short stature in nearly half of transplanted children in Europe.
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http://dx.doi.org/10.1097/TP.0000000000002726DOI Listing
January 2020

Vitamin D-dependent rickets: a resurgence of the rachitic lung in the 21st century.

BMJ Case Rep 2015 Oct 19;2015. Epub 2015 Oct 19.

Respiratory Unit, Department of Paediatrics, Santa Maria Hospital, Academic Center, Lisbon, Portugal.

Respiratory complications of rickets may be life-threatening particularly in developing countries. A 7-month-old boy presented with recurrent infections, seizures, failure to thrive, wheezing and respiratory distress progressing to global respiratory failure. Several antimicrobial regimens, bronchodilators and corticosteroids resulted in only short-term improvement. He was transferred from Cape Verde to a third-care hospital in Portugal. He was hypotonic and undernourished, with respiratory anguish and classical skeletal signs of rickets, despite vitamin D supplementation. Hypocalcaemia, normal phosphate levels and normal vitamin D status 25(OH)D3 and 1.25(OH)2D3) pointed to vitamin D-dependent rickets type II. Treatment with high doses of calcium and calcitriol allowed progressive respiratory, musculoskeletal and neurological recovery. Although respiratory manifestations of rickets were described many years ago, the present case raises relevant issues about the level of diagnostic support, the risk of complications and how they should be assessed and monitored.
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http://dx.doi.org/10.1136/bcr-2015-212639DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636699PMC
October 2015

[Complications of pediatric renal transplantation].

Acta Med Port 2013 Sep-Oct;26(5):517-22. Epub 2013 Oct 31.

Departamento de Pediatria. Hospital Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal.

Background: Renal transplantation is the treatment of choice for children with end stage renal disease with positive impact on survival and quality of life. However, some complications affect morbidity and mortality. This study examines the renal transplantation complications profile in pediatric patients (<18 y).

Material And Methods: Retrospective analysis of clinical files from renal transplantation patients followed in Pediatric Nephrology Unit from September 1995 to August 2010. Collection of data regarding: demography, end stage renal disease etiology, previous renal replacement therapy, graft loss and death, complications: surgical, infectious and non-infectious (acute and chronic rejection, primary disease recurrence, metabolic and cardiovascular risk factors). Descriptive statistical analysis was performed.

Results: 78 children (male: 48.7%), mean age at renal transplantation: 11.7 4.1 years. Previous peritoneal dialysis in 49 (62.6%). Five patients (6.4%) with preemptive renal transplantation. Median follow up: 37.5 months (1-169). Main end stage renal disease etiologies were urologic conditions in 41% and glomerular disease in 28.2%. Infectious complications occurred in 74%: viral: 56.4% (cytomegalovirus in 39.7%); bacterial in 53.8% (mainly urinary tract infections). Non-infectious complications were: 1) cardiovascular risk factors: hypertension in 85.9%, hyperlipidemia in 16.7% and new onset diabetes post transplantation in 7.7%; 2) acute graft dysfunction in 32.1%; graft chronic nephropathy 17.9%; 3) surgical complications 16.7%. In the first month after renal transplantation, surgical complications (11.5%) and bacterial infections were the most prevalent complications. Between the 1st and the 6th month there were more bacterial (34.6% patients) and viral (17.9% patients) infections. From 6th month on, cardiovascular risk factors (89.7% patients) became the more prevalent. There was one death.

Conclusions: The most frequent infections were viral, mainly CMV. Acute graft dysfunction was frequent after the 6th month, probably associated with poor compliance. New morbidities, namely cardiovascular risk factors, are emerging with the evolution of new diagnostic, prophylactic and therapeutic strategies for renal transplantation.
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October 2014

Severe immune haemolytic anaemia due to ceftriaxone in a patient with congenital nephrotic syndrome.

Acta Paediatr 2011 Oct 8;100(10):e191-3. Epub 2011 Apr 8.

Unidade de Nefrologia Pediátrica, Departamento da Criança e da Família, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.

Aim: To describe the first case of ceftriaxone-related haemolysis in a patient with congenital nephrotic syndrome (CNS).

Background: Severe haemolysis caused by an immune reaction to ceftriaxone has mostly been described in patients with underlying haematological or immune dysfunction.

Case Report: The authors present a 20-month-old boy with CNS of the Finnish type with several previous severe infections treated with ceftriaxone, admitted for suspected sepsis. Following ceftriaxone administration he developed shock secondary to an acute haemolytic reaction, with severe anaemia. Hypersensitivity to ceftriaxone was documented through positive agglutination tests.

Conclusion: Onset of haemolysis following ceftriaxone administration, particularly in a patient previously exposed to the drug, must raise the suspicion of a possible immune reaction.
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http://dx.doi.org/10.1111/j.1651-2227.2011.02268.xDOI Listing
October 2011

[Pregnancy and physical exercise: myths, evidence and recommendations].

Acta Med Port 2007 May-Jun;20(3):209-14. Epub 2007 Jul 2.

Unidade de Neonatologia, Serviço de Pediatria, Hospital de Santa Maria, Instituto de Medicina Preventiva, Faculdade de Medicina de Lisboa, Lisboa.

In recent years there has been a great increase of scientific research regarding physical exercise during pregnancy. Nevertheless, many doubts persist leading to a decrease of its practice. We aimed to evaluate the main factors that influence the practice of physical activity during pregnancy and mothers' knowledge regarding its effects. Physical activity has decreased significantly, although it was higher in nulliparous mothers, with higher educational level, employment and between 25 and 34 years old. Mothers who practiced exercise during pregnancy breastfed longer. No correlation was found concerning birth weight, gestational age or obstetric pathology. Although most mothers understand the benefits of physical activity in pregnancy, that doesn't seem to translate in an increasing practice. We believe there should be an increased awareness of health professionals in order to promote controlled physical exercise in pregnant woman.
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November 2007

[Pregnancy and smoking: an opportunity to change behaviours].

Acta Med Port 2007 May-Jun;20(3):201-7. Epub 2007 Jul 2.

Serviço de Pediatria, Unidade de Neonatologia Hospital de Santa Maria, Instituto de Medicina Preventiva, Faculdade de Medicinade Lisboa, Lisboa.

Introduction: Maternal smoking during pregnancy is related not only to perinatal adverse events but also to important postnatal problems. Smoking is very prevalent in women with several socio-demographic factors playing an important role.

Aims: To assess the frequency of smoking as well as mothers' change in behaviours during pregnancy. To identify socio-demographic factors associated to smoking and to assess women's knowledge and sources of information about adverse effects of smoking during pregnancy.

Methods: We started a cohort study between March and October 2003 at the Maternity, Hospital Santa Maria. After an informed consent the mothers in the post natal ward were asked to fill in a questionnaire.

Results: Four hundred and seventy five mothers responded to the questionnaire and among them 30% were smokers before pregnancy. Thirty five percent stopped smoking during pregnancy and those who continued significantly reduced the number of cigarettes per day. Smoking was less prevalent in married women, with higher educational level and with stable employment (statistically significant correlations). Forty five percent of the mothers were misinformed or had no information about the adverse effects of smoking during pregnancy. Their main source of information were the media.

Discussion: Smoking prevalence was high (30%) among the respondents but the pregnancy lowered the numbers of cigarettes per day. The percentage of misinformed mothers concerned about the adverse effects of smoking during pregnancy was high (45%), which also showed that doctors' role as a source of information was surpassed by the media. The study also brought to light the need for the health professionals to improve their competences in their role on prevention of smoking during pregnancy and the postnatal period.
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November 2007

[Breastfeeding: prevalence and determinant factors].

Acta Med Port 2007 May-Jun;20(3):193-200. Epub 2007 Jul 2.

Clínica Universitária de Pediatria, Hospital de Santa Maria, Instituto de Medicina Preventiva, Faculdade de Medicina de Lisboa, Lisboa.

Breastfeeding is the best way of feeding the baby for the first six months of life. However, in Portugal the abandonment rate of breastfeeding is very high during the baby first's months of life. The aim of this study was to assess prevalence of breastfeeding and to identify related factors during the six months after delivery, as socio demographic variables and life styles. We conducted a cohort study at the Maternity of the Hospital Santa Maria. A standard questionnaire was applied to 475 women after delivery, at three and six months postpartum. We studied socio demographics aspects, life styles and the way of feeding during the six months after delivery. Multivariate analysis was performed. The women studied (mean age of 29.8 +/- 5,4 years), 52.2% were primiparous, 86.1% were Caucasian, 40% had a high school degree and 33% had a University degree. Four hundred and sixty (96.8%) received prenatal care. The mean gestational age was 38.8 +/- 2 weeks and the birth weight was 3198.3 +/- 545.3 g. At the discharge 91% were breastfeeding (77% exclusively), 54.7% at third month and 34.1% at sixth month. The main causes pointed for abandoning breastfeeding were insufficient milk production, bad sucking and return to work. The milk formula introduction was in 68.6% cases by medical recommendation. The decision in maintenance breastfeeding at third and sixth months was correlated with a previous positive breastfeed experience, high educational level, healthy lifestyles, as non-smoking, regular physical activity, and information about advantage of breastfeed for mother health. Information about breastfeeding was received by media, friends, family and only 9% by health professionals. Fifty (13%) women had no information about breastfeeding. Although breastfeeding rate at discharge was high, there was an important rate of abandonment at third and sixth month. Healthy lifestyles, high educational level, a previous positive breastfeed experience had a positive influence in breastfeeding. Understanding attitudes towards pregnancy and breastfeeding can lead to new strategies for its promotion and maintenance.
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November 2007

Orbital cysticercosis: diagnosis and treatment controversies.

Pediatr Infect Dis J 2007 Feb;26(2):180-1

Department of Pediatrics, Hospital de Santa Maria, Lisbon, Portugal.

Orbital cysticercosis is a rare condition and its management is controversial. We report 2 cases of orbital cellulitis associated with cysticercosis in which the treatment with antihelminthics was withheld. The 2 children had good evolution with spontaneous progressive resolution. The current literature is reviewed.
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http://dx.doi.org/10.1097/01.inf.0000250688.44544.1aDOI Listing
February 2007