Publications by authors named "Augusto Ribeiro"

15 Publications

  • Page 1 of 1

ALCAPA syndrome: A rare etiology of cardiac arrest in a teenager.

Int J Pediatr Adolesc Med 2021 Dec 23;8(4):271-272. Epub 2021 Apr 23.

Pediatric Intensive Care Unit, Centro Hospitalar Universitário São João, Porto, Portugal.

ALCAPA syndrome is a rare congenital heart disease and a cause of myocardial ischemia in pediatric population. The authors present the case of a 10-year-old girl admitted to the emergency room after experiencing cardiac arrest at school. In the echocardiogram, the inability to identify the origin of the left coronary artery raised the hypothesis of abnormal origin of the left coronary artery from the pulmonary artery (ALCAPA). A CT-scan and a cardiac catheterization were performed confirming the diagnosis. Infants with the syndrome may have myocardial infarction and congestive heart failure She successfully underwent cardiac surgery. Most undiagnosed patients die within the first year of life, and it is necessary to develop an extensive network of collaterals to ensure survival. ALCAPA syndrome rarely manifests in late childhood, teenagers, and adults and may be an important cause of sudden cardiac arrest.
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http://dx.doi.org/10.1016/j.ijpam.2021.04.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8356116PMC
December 2021

Pulmonary embolism in pediatric age: A retrospective study from a tertiary center.

Pediatr Pulmonol 2021 Aug 16;56(8):2751-2760. Epub 2021 Jun 16.

Department of Obstetrics, Gynecology and Pediatrics, Faculty of Medicine, University of Porto, Porto, Portugal.

Introduction: Pediatric pulmonary embolism (PE) is rare but associated with adverse outcomes. We aimed to characterize PE cases admitted in a tertiary hospital and to evaluate sensitivity of selected PE diagnostic prediction tools.

Methods: Retrospective, descriptive study of PE cases admitted from 2008 to 2020 using data collected from hospital records. Patients were grouped according to PE severity and setting (outpatients vs. inpatients). Links and correlation with demographic characteristics, risk factors, clinical presentation, management, and outcomes were analyzed. PE diagnostic prediction tools were applied.

Results: Twenty-nine PE episodes occurred in 27 patients, 62.9% female, mean age 14.1 years. Most PE were central and split between massive or submassive. One was diagnosed in autopsy. Twenty outpatients, all adolescents, were admitted for classic PE symptoms; in half of them the diagnosis had been previously missed. Risk factors included contraceptives (65%), thrombophilia (35%), obesity (20%) and auto-immunity (20%). Eight inpatients, diagnosed during cardiorespiratory deterioration (n = 5), or through incidental radiological findings (n = 3), were younger and had immobilization (87.5%), complex chronic diseases (75%), infections (75%) and central venous catheter (62.5%) as risk factors. Retrospectively, d -dimer testing and adult scores performed better than pediatric scores (sensitivity 92.9%-96% vs. 85.7%-92.9%). Both pediatric scores missed a case with a positive family history.

Discussion: Pediatric PE diagnosis is often delayed or missed. Development of pediatric prediction tools from validated adult scores merits being explored. We argue clinical presentation and risk factors may be different in inpatients and outpatients and propose broader reliance on family history.
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http://dx.doi.org/10.1002/ppul.25527DOI Listing
August 2021

Assessment of the renal angina index for the prediction of acute kidney injury in patients admitted to a European pediatric intensive care unit.

Pediatr Nephrol 2021 Jun 8. Epub 2021 Jun 8.

Pediatric Intensive Care Unit, Centro Hospitalar e Universitário de São João, Porto, Portugal.

Background: Acute kidney injury (AKI) is associated with worse outcomes and increased morbidity and mortality in pediatric intensive care unit (PICU) patients. The renal angina index (RAI) has been proposed as an early prediction tool for AKI development.

Objectives: The objective was to evaluate outcomes of RAI-positive patients and to compare RAI performance with traditional AKI markers across different patient groups (medical/post-surgical). This was an observational retrospective study. All children admitted to a tertiary hospital PICU over a 3-year period were included. Electronic medical records were reviewed. Day 1 RAI was calculated, as was the presence and staging of day 3 AKI.

Results: A total of 593 patients were included; 56% were male, the mean age was 55 months, and 17% had a positive RAI. This was associated with day 3 AKI development and worse outcomes, such as greater need for kidney replacement therapy, longer duration of mechanical ventilation, vasoactive support and PICU stay, and higher mortality. For all-stage kidney injury, RAI presented a sensitivity of 87.5% and a specificity of 88.1%. Prediction of day 3 all-stage AKI by RAI had an AUC=0.878; its performance increased for severe AKI (AUC = 0.93). RAI was superior to serum creatinine increase and KDIGO AKI staging on day 1 in predicting severe AKI development. The performance remained high irrespective of the type of admission.

Conclusions: The RAI is a simple and inexpensive tool that can be used with medical and post-surgical PICU patients to predict AKI development and anticipate complications, allowing for the adoption of preventive measures.
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http://dx.doi.org/10.1007/s00467-021-05116-6DOI Listing
June 2021

Somatic Embryogenesis from Mature Embryos of L. cv. 'Galega Vulgar' and Long-Term Management of Calli Morphogenic Capacity.

Plants (Basel) 2020 Jun 17;9(6). Epub 2020 Jun 17.

INIAV-Instituto Nacional de Investigação Agrária e Veterinária, I.P., UEIS Biotecnologia e Recursos Genéticos, Estrada de Gil Vaz, Apartado 6, 7350-901 Elvas, Portugal.

Several olive cultivars, characterized by high-quality olive oil show agronomical issues such as excessive vigor, high susceptibility to biotic and abiotic stresses, and low propagation ability. They are strong candidates for breeding based on new technologies to improve their performance in a short period of time. For this reason, the first step is developing efficient somatic embryogenesis (SE) protocols. Somatic embryogenesis in olive is highly genotype-dependent for both adult tissues and mature embryos as initial explants, requiring the development of specific protocols for each genotype. Trials using cotyledons and radicles as initial explants, isolated from ripe seeds from the Portuguese olive cv. 'Galega vulgar', gave more than 95% calli development. Radicles proved to be the most responsive tissue for SE induction, with an average of 2 embryos per callus after callus transfer to expression medium, and 14 embryos per callus after subculture on the olive cyclic embryogenesis medium (ECO). Embryogenic competence could be recovered after several subcultures on ECO medium that maintained cyclic embryogenesis for an indeterminate period of time. Embryo conversion and plant acclimatization were also attained with high success rates. Media management for cyclic embryogenesis maintenance is of general importance for SE protocols in any olive genotype. Somatic embryogenesis was thus attained for the first time in embryo-derived explants of cv. 'Galega vulgar'.
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http://dx.doi.org/10.3390/plants9060758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355655PMC
June 2020

Meningococcemia: rare but life-threatening.

BMJ Case Rep 2018 Oct 17;2018. Epub 2018 Oct 17.

Pediatric Intensive Care, Centro Hospitalar de São João, Porto, Portugal.

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http://dx.doi.org/10.1136/bcr-2018-226914DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254450PMC
October 2018

Septicaemia in an adolescent presenting with potentially fatal CA MRSA osteomyelitis.

BMJ Case Rep 2018 Sep 8;2018. Epub 2018 Sep 8.

Paediatric Intensive Care Unit, Centro Hospitalar de Sao Joao EPE, Porto, Portugal.

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http://dx.doi.org/10.1136/bcr-2018-224938DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129057PMC
September 2018

Hyponatremia in a Teenager: A Rare Diagnosis.

Pediatr Emerg Care 2015 Dec;31(12):860-3

From the *Pediatric Department, Centro Hospitalar do Alto Ave, Guimarães; †Pediatric Department, Centro Hospitalar do Porto; ‡Pediatric Intensive Care Unit; and §Pediatric Department-Pediatric Endocrinology, Centro Hospitalar de São João EPE, Porto, Portugal.

Introduction: Hyponatremia is a common electrolyte alteration which has the potential for significant morbidity and mortality. Endocrine disorders, such as primary hypothyroidism and adrenal insufficiency are uncommon causes of hyponatremia. We present the case of a teenager with symptomatic hyponatremia caused by a rare disorder.

Case: A 17-year-old boy was admitted to the emergency department with abdominal pain, nausea and vomiting, asthenia, and weight loss. He was in poor general condition, hypotensive, and he had dry mucous membranes and skin as well as mucosa hyperpigmentation. The laboratory findings showed severe hyponatremia, hyperkalemia, and renal dysfunction. The patient started inotropic support and antibiotics. Plasma cortisol and corticotropin levels allowed the diagnosis of primary adrenal insufficiency. He began replacement therapy with hydrocortisone and fludrocortisone, with gradual symptom resolution. An abdominal computed tomography scan showed adrenal hypoplasia. Findings for antiadrenal and antithyroid antibodies were positive, allowing the diagnosis of autoimmune polyglandular syndrome type II.

Discussion: Adrenal insufficiency is a rare disease, especially in children, and its clinical manifestations are due to glucocorticoid and mineralocorticoid deficiency. In most of the cases, symptoms are nonspecific, requiring a high index of clinical suspicion. If the diagnosis and treatment are delayed, acute adrenal insufficiency carries a high morbidity and mortality.
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http://dx.doi.org/10.1097/PEC.0000000000000633DOI Listing
December 2015

Bradyrhizobium viridifuturi sp. nov., encompassing nitrogen-fixing symbionts of legumes used for green manure and environmental services.

Int J Syst Evol Microbiol 2015 Dec 10;65(12):4441-4448. Epub 2015 Sep 10.

Universidade Estadual de Londrina, Dept. of Microbiology, C.P. 10.011, 86057-970, Londrina, Paraná, Brazil.

Symbiotic nitrogen-fixing bacteria, commonly called rhizobia, are agronomically important because they can provide significant amounts of nitrogen to plants and help in recovery of impoverished soils and improvement of degraded environments. In recent years, with advances in molecular techniques, several studies have shown that these bacteria have high levels of genetic diversity, resulting in taxonomic reclassifications and descriptions of new species. However, despite the advances achieved, highly conserved 16S ribosomal genes (16S rRNA) do not elucidate differences between species of several genera, including the genus Bradyrhizobium. Other methodologies, such as multilocus sequence analysis (MLSA), have been used in such cases, with good results. In this study, three strains (SEMIAs 690T, 6387 and 6428) of the genus Bradyrhizobium, isolated from nitrogen-fixing nodules of Centrosema and Acacia species, without clear taxonomic positions, were studied. These strains differed from genetically closely related species according to the results of MLSA of four housekeeping genes (dnaK, glnII, gyrB and recA) and nucleotide identities of the concatenated genes with those of related species ranged from 87.8 % to 95.7 %, being highest with Bradyrhizobium elkanii. DNA-DNA hybridization (less than 32 % DNA relatedness) and average nucleotide identity values of the whole genomes (less than 90.5 %) indicated that these strains represented a novel species, and phenotypic traits were determined. Our data supported the description of the SEMIA strains as Bradyrhizobium viridifuturi sp. nov., and SEMIA 690T ( = CNPSo 991T = C 100aT = BR 1804T = LMG 28866T), isolated from Centrosema pubescens, was chosen as type strain.
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http://dx.doi.org/10.1099/ijsem.0.000591DOI Listing
December 2015

Performance of PRISM III and PELOD-2 scores in a pediatric intensive care unit.

Eur J Pediatr 2015 Oct 15;174(10):1305-10. Epub 2015 Apr 15.

Pediatric Intensive Care Unit, Pediatric Integrated Hospital, São João Hospital, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.

Unlabelled: The study aims were to compare two models (The Pediatric Risk of Mortality III (PRISM III) and Pediatric Logistic Organ Dysfunction (PELOD-2)) for prediction of mortality in a pediatric intensive care unit (PICU) and recalibrate PELOD-2 in a Portuguese population. To achieve the previous goal, a prospective cohort study to evaluate score performance (standardized mortality ratio, discrimination, and calibration) for both models was performed. A total of 556 patients consecutively admitted to our PICU between January 2011 and December 2012 were included in the analysis. The median age was 65 months, with an interquartile range of 1 month to 17 years. The male-to-female ratio was 1.5. The median length of PICU stay was 3 days. The overall predicted number of deaths using PRISM III score was 30.8 patients whereas that by PELOD-2 was 22.1 patients. The observed mortality was 29 patients. The area under the receiver operating characteristics curve for the two models was 0.92 and 0.94, respectively. The Hosmer and Lemeshow goodness-of-fit test showed a good calibration only for PRISM III (PRISM III: χ (2) = 3.820, p = 0.282; PELOD-2: χ (2) = 9.576, p = 0.022).

Conclusions: Both scores had good discrimination. PELOD-2 needs recalibration to be a better reliable prediction tool.

What Is Known: • PRISM III (Pediatric Risk of Mortality III) and PELOD (Pediatric Logistic Organ Dysfunction) scores are frequently used to assess the performance of intensive care units and also for mortality prediction in the pediatric population. • Pediatric Logistic Organ Dysfunction 2 is the newer version of PELOD and has recently been validated with good discrimination and calibration. What is New: • In our population, both scores had good discrimination. • PELOD-2 needs recalibration to be a better reliable prediction tool.
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http://dx.doi.org/10.1007/s00431-015-2533-5DOI Listing
October 2015

Neuroborreliosis presenting as acute disseminated encephalomyelitis.

Pediatr Emerg Care 2012 Dec;28(12):1374-6

Pediatric Intensive Care Unit, Centro Hospitalar S João, Porto, Portugal.

We report a case of a 5-year-old boy with acute disseminated encephalomyelitis as the initial presentation of neuroborreliosis. Parents report an upper-airway infection a few days before the development of acute encephalopathy, mild facial palsy, and seizures. The patient needed mechanical ventilation for 10 days, and after extubation, he presented hypotonia, ataxia, dysarthria, as well as weak gag and cough reflexes. Brain magnetic resonance imaging showed hyperintense lesions on T2- and fluid-attenuated inversion recovery sequences on the right subcortical occipital and parietal region, left posterior arm of the internal capsule, and in the medulla oblongata. Borrelia burgdorferi was identified in the plasma and cerebrospinal fluid by polymerase chain reaction and in the plasma by Western blotting. He was treated with ceftriaxone, methylprednisolone, and human immunoglobulin. Recovery was partial.
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http://dx.doi.org/10.1097/PEC.0b013e318276c51dDOI Listing
December 2012

Pulmonary artery sling: An uncommon cause of stridor.

J Pediatr Intensive Care 2012 Sep;1(3):173-177

Department of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland.

Pulmonary artery sling is a rare congenital condition often associated with congenital tracheal stenosis. Untreated pulmonary sling carries a high morbidity and mortality, most of which is due to the airway and other associated anomalies rather than the aberrant artery itself. We report the case of an infant presenting progressive respiratory distress after a viral infection. The workup revealed a left pulmonary sling with concomitant tracheal stenosis. This anomaly was successfully corrected by slide tracheoplasty and left pulmonary artery reinsertion. pulmonary artery is a rare entity with a nonspecific clinical presentation, a high degree of clinical suspicion is needed in order to obtain the correct diagnosis.
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http://dx.doi.org/10.3233/PIC-2012-029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530694PMC
September 2012

[Plasma hypertonicity in children].

Acta Med Port 2010 May-Jun;23(3):455-64. Epub 2010 Jun 14.

Serviço de Cuidados Intensivos e Intermédios de Pediatria, Unidade Autónoma de Gestão da Mulher e da Criança, Hospital do São João, Porto.

The plasma hypertonicity is a severe and quite frequent disorder in children. The most frequent causes are hypernatremia related conditions, even though other causes of hyperosmolarity, such as hyperglycaemia and exogenous solutes accumulation also occur. The management and treatment of this condition is delicate and requires a thorough understanding of the underlying hydro electrolytic disorder. The authors perform a theoretical review of plasma hypertonicity in children, focusing on the three most frequent associated conditions: hypernatremic dehydration, salt poisoning and hyperosmolar coma.
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December 2010

Ischemic subglottic damage following a short-time intubation.

Eur J Emerg Med 2008 Dec;15(6):351-3

Pediatric Intensive Care Unit, Hospital São João, Porto, Portugal.

The objective of this study is to report a case of ischemic subglottic damage after a short-time intubation with a large, overinflated endotracheal tube cuff in a child. The study uses individual case report. A 6-year-old boy was admitted to the pediatric intensive care unit after a head trauma intubated with a 5.5-mm inner diameter cuffed endotracheal tube overinflated with 16 ml of air that produced a pressure of more than 120 cm H2O. The endotracheal tube cuff pressure produced by inflation was reduced after 4 h. The child presented postextubation stridor with subglottic edema. Inappropriate handling of tracheal intubation without accurate measurement of endotracheal tube size and intracuff pressures of endotracheal tubes, can cause airway trauma and place patients at risk.
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http://dx.doi.org/10.1097/MEJ.0b013e3282fc9c5dDOI Listing
December 2008

Systemic polyarteritis nodosa associated with acute Epstein-Barr virus infection.

Clin Rheumatol 2007 Oct 5;26(10):1733-5. Epub 2007 Jan 5.

Pediatric Intensive Care Unit, UAG-MC, Hospital S. João, Alameda Prof. Hernâni Monteiro, 4200 Porto, Portugal.

Polyarteritis nodosa (PAN) is a rare cause of systemic vasculitis in children, affecting medium and small-sized arteries. We report on a patient who presented with prolonged fever, shock, acute renal failure with nephrotic range proteinuria, hypertension, and sudden deterioration of consciousness. Cranial tomography revealed a left extensive hemorrhagic lesion. Renal biopsy revealed a large fibrinoid necrosis lesion consistent with PAN. Epstein-Barr virus (EBV) infection was confirmed by real-time polymerase chain reaction (RT-PCR) detection of EBV DNA. The patient was successfully treated with oral prednisolone and intravenous pulse of cyclophosphamide. To our knowledge, this is the first reported case of c-PAN related to active EBV infection.
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http://dx.doi.org/10.1007/s10067-006-0486-9DOI Listing
October 2007
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