Publications by authors named "Henedina Antunes"

41 Publications

A novel mutation in the COL12A1 gene.

Gene 2021 Feb 29;768:145266. Epub 2020 Oct 29.

Paediatric Gastroenterology Hepatology and Nutrition Unit, Hospital de Braga. Braga, Portugal; Academic Clinical Center (2CA Braga), Hospital de Braga. Braga, Portugal; Life Sciences and Health Institute (ICVS), University of Minho. Braga, Portugal; ICVS/3B's, University of Minho. Braga/Guimarães, Portugal; School of Medicine, University of Minho. Braga, Portugal.

Mutations in collagen XII have been recently described to cause modifications in the connective tissue which phenotypic demonstration resembles that of collagen VI related myopathies. We describe a Caucasian 14-year old girl who complained to her doctor about not being able to practice schools' sports due to recurrent clavicle dislocation when trying to throw a ball. In addition, when questioned, she also reported a notion of lower strength in the upper limbs when compared to same age peers. Based on the clinical exam performed, a joint hypermobility with a slight reduction of the muscular strength of the upper limbs diagnosis was noted. Targeted sequencing identified a heterozygous missense mutation in COL12A1 - c.8336G > A (p. Arg2779His). Algorithms developed to predict the effect of the changes on the protein structure and function do not agree on the potential impact of this modification. This case shows the importance to consider collagen XII-related disorders when in presence of patients with an overlapping phenotype with both muscle and connective tissue abnormalities, once mutations in collagen VI have been excluded.
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http://dx.doi.org/10.1016/j.gene.2020.145266DOI Listing
February 2021

Portuguese Consensus on Diagnosis, Treatment, and Management of Anemia in Pediatric Inflammatory Bowel Disease.

GE Port J Gastroenterol 2020 Jul 10;27(4):244-254. Epub 2020 Jan 10.

Pediatric Gastroenterology, Hepatology and Nutrition Unit and Clinical Academic Center 2CA-Braga, Hospital de Braga, Braga, Portugal.

Anemia is a common extraintestinal manifestation of inflammatory bowel disease (IBD), both in pediatric and in adult patients. Iron deficiency is the main cause of anemia in patients with IBD. Anemia is a clinically relevant comorbidity, with impact on patients' quality of life and it should be timely diagnosed and adequately treated. Currently, an active treatment approach is the recommended strategy, with evidence showing efficacy and safety of intravenous iron formulations. However, evidence in pediatric age remains scarce and no clinical recommendations exist for the diagnosis and treatment of this particular age group. The present document represents the first national consensus on the management of anemia in pediatric IBD and is therefore particularly relevant. The authors anticipate that the proposed recommendations will be useful in daily clinical practice for diagnosing and managing iron deficiency and iron-deficiency anemia in the pediatric population with IBD.
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http://dx.doi.org/10.1159/000505071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383296PMC
July 2020

Portuguese Prevalence of Pediatric Chronic Intestinal Failure.

J Pediatr Gastroenterol Nutr 2020 04;70(4):e85

Unidade de Nutrição, Centro Materno Infantil do Norte (CMIN), Porto, Portugal.

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http://dx.doi.org/10.1097/MPG.0000000000002635DOI Listing
April 2020

Prevalence of Portuguese Children Exposed to Secondhand Smoke at Home and in the Car.

Acta Med Port 2019 Aug 1;32(7-8):499-504. Epub 2019 Aug 1.

Serviço de Pediatria. Hospital de Braga. Braga. Instituto de Ciências da Vida e da Saúde (ICVS). Escola de Ciências da Saúde da Universidade do Minho. Braga. Laboratório associado ICVS/3B's. Braga/Guimarães. Braga. Portugal.

Introduction: Children's exposure to secondhand smoke is a cause of serious health problems and infant morbidity. This is the first nationally representative study conducted in Portugal to describe the prevalence of children exposed to secondhand smoke at home and in the car.

Material And Methods: This is a descriptive cross-sectional study with a representative sample of 2396 Portuguese children aged 0 to 9 years old, stratified by age and administrative region NUTS II. Questionnaires were administered between January and September 2016.

Results: Results showed that 6.1% of mothers and 11.2% of fathers reported smoking at home. It was found that 4.5% of mothers and 8.3% of fathers reported smoking in the car. Results also showed that 5.4% of children were double exposed to secondhand smoke at home and in the car. Children whose parents were smokers and had a lower level of education were more exposed to secondhand smoke at home.

Discussion: Children's exposure to secondhand smoke has been decreasing in Portugal. Parental smoking and a low educational level were risk factors for children's exposure to secondhand smoke at home.

Conclusion: The main source of children's exposure to secondhand smoke is parental smoking. As such, it is crucial to implement effective measures to control parental smoking. It is necessary to promote smoking cessation among parents and to ban smoking inside the car.
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http://dx.doi.org/10.20344/amp.11655DOI Listing
August 2019

Deep venous thrombosis of lower limbs in adolescents: a study in a tertiary hospital.

Int J Adolesc Med Health 2019 Feb 1;33(2). Epub 2019 Feb 1.

Unit of Adolescent Medicine, Department of Pediatrics, Hospital of Braga, Braga, Portugal.

Background: Venous thromboembolism (VTE) - which includes deep venous thrombosis (DVT) and pulmonary embolism (PE) - has been increasingly recognized in the pediatric population. The estimated incidence is 0.07-0.14 cases per 10,000 children. Most cases are associated with two or more risk factors. Medium and long-term complications include recurrence and post-thrombotic syndrome (PTS).

Objective: To characterize the adolescent population with the diagnosis of DVT of lower limbs in a tertiary hospital, regarding its clinical presentation, associated risk factors, treatment and outcome.

Methods: Retrospective analysis of adolescents with the diagnosis of DVT of lower limbs in our hospital for a period of 7 years.

Results: Eight patients were identified; seven were females; median age was 15 years. The main symptoms were local pain and edema. Left lower limb was affected in six patients. PE occurred in two cases. Positive family history of venous thromboembolism was found in five patients. Seven patients had at least two identifiable risk factors. Combined oral contraceptive pill use was the most common (seven patients). Factor V Leiden mutation was found in three patients and protein C deficiency in one. Iliac vein compression syndrome was diagnosed in one patient. The median time for discharge was 8 days. Election treatment was enoxaparin followed by warfarin, for a median period of 10.9 months. Three patients developed PTS.

Conclusions: Although uncommon, VTE is an emerging reality in adolescents, particularly in females using oral contraceptive pills. Appropriated prevention strategies and treatment are required as most orientations are extrapolated from adults.
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http://dx.doi.org/10.1515/ijamh-2018-0137DOI Listing
February 2019

Images in paediatrics: Rapunzel syndrome: the pathway for a prompt diagnosis.

Arch Dis Child 2020 03 3;105(3):298. Epub 2018 Dec 3.

Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.

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http://dx.doi.org/10.1136/archdischild-2018-315910DOI Listing
March 2020

Herpes zoster with cutaneous dissemination: a rare presentation of an uncommon pathology in children.

BMJ Case Rep 2018 Jun 12;2018. Epub 2018 Jun 12.

Department of Pediatrics, Hospital de Braga, Braga, Portugal.

Herpes zoster, caused by varicella zoster virus (VZV) reactivation, affects mainly the adult population, although it can occur in children. This happens when primary infection (varicella) has occurred at a very young age or in immunocompromised patients. Complications are rare in healthy individuals. They include VZV cutaneous dissemination, which affects 2%-10% of immunocompromised patients.We present a previously healthy child, with history of varicella during her first month of life, which presented at age 8 with a severe case of herpes zoster, complicated with cutaneous dissemination. Immunity study was unremarkable. Causes, management and follow-up are discussed.
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http://dx.doi.org/10.1136/bcr-2018-225355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6011528PMC
June 2018

Prevalence of iron deficiency anemia and iron deficiency in a pediatric population with inflammatory bowel disease.

Scand J Gastroenterol 2017 Oct 23;52(10):1099-1103. Epub 2017 Jun 23.

a Gastroenterology, Hepatology and Nutrition Unit, Pediatrics Department , Hospital de Braga , Braga , Portugal.

Objectives: Iron deficiency is the most common cause of anemia in children with inflammatory bowel disease, although the real prevalence is unknown. Intravenous iron is suggested as the first line treatment. This study aims to determine the prevalence of iron deficiency anemia in children with inflammatory bowel disease followed in a Pediatric Gastroenterology Unit of a tertiary center and to evaluate this unit's experience with intravenous iron.

Materials And Methods: A retrospective cohort study was designed involving children with inflammatory bowel disease followed in that unit between January 2001 and April 2016. Laboratory results were collected at the moment of diagnosis, after one-year follow-up and prior each IV iron administration performed during the study period. Anemia was defined according to World Health Organization criteria and the iron deficiency was defined using recent guidelines.

Results: Were studied 69 patients 71% had CD and 29% UC. 50.7% were female. Mean patient age at diagnosis was 13.3 years (range 1--17 years). Prevalence of ID and IDA at diagnosis was 76.8% and 43.5%, respectively. After one year follow-up, those values decreased to 68.1% (p = .182) and 21.7% (p = .002), respectively. Hemoglobin significantly increased (p < .001). Intravenous iron was administered to 92.8% of patients. No adverse reactions were reported.

Conclusions: Intravenous iron is the first line in the treatment of Iron deficiency anemia in Inflammatory Bowel disease and it is safe and effective. Persistent anemia and iron deficiency are common.
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http://dx.doi.org/10.1080/00365521.2017.1342137DOI Listing
October 2017

Acute Alithiasic Cholecystitis and Human Herpes Virus Type-6 Infection: First Case.

Case Rep Pediatr 2016 20;2016:9130673. Epub 2016 Apr 20.

Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057 Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Department of Pediatric Surgery, Hospital de Braga, Sete Fontes, São Victor, 4710-243 Braga, Portugal.

A three-year-old male child presented with erythematous maculopapular nonpruritic generalized rash, poor feeding, vomiting, and cramping generalized abdominal pain. He was previously healthy and there was no family history of immunologic or other diseases. On examination he was afebrile, hemodynamically stable, with painful palpation of the right upper quadrant and positive Murphy's sign. Laboratory tests revealed elevated inflammatory markers, elevated aminotransferase activity, and features of cholestasis. Abdominal ultrasound showed gallbladder wall thickening of 8 mm with a positive sonographic Murphy's sign, without gallstones or pericholecystic fluid. Acute Alithiasic Cholecystitis (AAC) was diagnosed. Tests for underlying infectious causes were negative except positive blood specimen for Human Herpes Virus Type-6 (HHV-6) by polymerase chain reaction. With supportive therapy the child became progressively less symptomatic with gradual improvement. The child was discharged on the sixth day, asymptomatic and with improved analytic values. Two months later he had IgM negative and IgG positive antibodies (1/160) for HHV-6, which confirmed the diagnosis of previous infection. In a six-month follow-up period he remains asymptomatic. To the best of our knowledge, this represents the first case of AAC associated with HHV-6 infection.
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http://dx.doi.org/10.1155/2016/9130673DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855020PMC
May 2016

Acute Alithiasic Cholecystitis and Human Herpes Virus Type-6 Infection: First Case.

Case Rep Pediatr 2016 20;2016:9130673. Epub 2016 Apr 20.

Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057 Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Department of Pediatric Surgery, Hospital de Braga, Sete Fontes, São Victor, 4710-243 Braga, Portugal.

A three-year-old male child presented with erythematous maculopapular nonpruritic generalized rash, poor feeding, vomiting, and cramping generalized abdominal pain. He was previously healthy and there was no family history of immunologic or other diseases. On examination he was afebrile, hemodynamically stable, with painful palpation of the right upper quadrant and positive Murphy's sign. Laboratory tests revealed elevated inflammatory markers, elevated aminotransferase activity, and features of cholestasis. Abdominal ultrasound showed gallbladder wall thickening of 8 mm with a positive sonographic Murphy's sign, without gallstones or pericholecystic fluid. Acute Alithiasic Cholecystitis (AAC) was diagnosed. Tests for underlying infectious causes were negative except positive blood specimen for Human Herpes Virus Type-6 (HHV-6) by polymerase chain reaction. With supportive therapy the child became progressively less symptomatic with gradual improvement. The child was discharged on the sixth day, asymptomatic and with improved analytic values. Two months later he had IgM negative and IgG positive antibodies (1/160) for HHV-6, which confirmed the diagnosis of previous infection. In a six-month follow-up period he remains asymptomatic. To the best of our knowledge, this represents the first case of AAC associated with HHV-6 infection.
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http://dx.doi.org/10.1155/2016/9130673DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855020PMC
May 2016

Oral manifestations of Crohn's disease.

BMJ Case Rep 2015 Oct 28;2015. Epub 2015 Oct 28.

Department of Medicine and Oral Surgery, Instituto Superior de Ciências da Saúde Norte, CESPU, Paredes, Portugal.

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http://dx.doi.org/10.1136/bcr-2015-212300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636709PMC
October 2015

Opinions on a car smoking ban: a needed guide for public health decision-makers.

Gac Sanit 2016 Jan-Feb;30(1):86-7. Epub 2015 Sep 26.

Serviço de Pediatria, Hospital de Braga; Instituto de Ciências da Vida e da Saúde (ICVS); Escola de Ciências da Saúde da Universidade do Minho e Laboratório associado ICVS/3B's, Braga/Guimarães, Portugal.

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http://dx.doi.org/10.1016/j.gaceta.2015.08.001DOI Listing
August 2017

Children's exposure to second hand smoke at home: a cross-sectional study in Portugal.

Rev Port Pneumol (2006) 2015 Jul-Aug;21(4):178-84. Epub 2015 Jan 20.

Instituto de Educação, Universidade do Minho, Campus de Gualtar, Braga, Portugal.

Second-hand tobacco smoke (SHS) is a major indoor pollutant that causes serious health problems for all exposed, especially children. Children are often exposed to SHS at home, due to parental or other households' or guests' smoking. This study describes Portuguese children's exposure to SHS at home (total and by Portuguese main regions). In 2010/2011, a questionnaire was applied to a sample of Portuguese children in the 4th grade (N=3187, mean age 9.05±0.7 years, 51.1% male). Descriptive analysis, chi-square tests and crude odds ratios were performed. Of the participants, 62.9% of those with smoking parents and 19.2% of those with non-smoking parents were exposed to SHS at their home. Parental smoking varied significantly among regions and was significantly associated with children's exposure to SHS at home. Children's exposure to SHS at home was high, especially if their parents smoke. Children living in Lisbon Region presented the highest SHS exposure rate. The association of SHS exposure with geographic regions suggests the influence of social and contextual factors on smoking behaviour and on tobacco control effectiveness. Our findings highlight the need to effectively prevent children's SHS exposure at their home and to develop tailored tobacco control measures by region.
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http://dx.doi.org/10.1016/j.rppnen.2014.09.003DOI Listing
April 2016

Portuguese children's exposure to second-hand tobacco smoke in the family car.

Gac Sanit 2015 Mar-Apr;29(2):131-4. Epub 2014 Dec 6.

Instituto de Educação, Universidade do Minho, Campus de Gualtar, Braga, Portugal.

Objectives: To assess the prevalence of children's exposure to second-hand smoke in the family car; to compare exposure among children with smoking and non-smoking parents.

Methods: In 2011, a self-administered questionnaire was applied to a 4th grade Portuguese children national sample (N=3187, mean age 9.5 ± 0.7, 51.1% boys). Prevalence rates and chi-square tests were computed.

Results: Of the participants, 52.0% reported having, at least, one smoking parent. Overall exposure in the car was 28.9% (95% CI 27.3-30.5). Children's exposure among those reporting smoking parents was 46.9% (95% CI 44.4-49.4); and 8.6% (95% CI 7.1-10.1) among those reporting non-smoking parents (p<.001). Therefore, children with smoking parents were 5.44 times more likely to be exposed.

Conclusions: Children's exposure to second-hand smoke in the family car is frequent, especially if one or both parents smoke. This highlights the need for effective tobacco control measures to prevent this severe health hazard.
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http://dx.doi.org/10.1016/j.gaceta.2014.10.011DOI Listing
January 2017

Acute pancreatitis in children: a tertiary hospital report.

Scand J Gastroenterol 2014 May 26;49(5):642-7. Epub 2014 Mar 26.

Gastroenterology, Hepatology and Nutrition Unit, Pediatrics Department, Hospital de Braga , Braga , Portugal.

Introduction: The incidence of acute pancreatitis (AP) in children has increased significantly in the past two decades.

Objective: All cases of AP, acute recurrent pancreatitis (ARP), and chronic pancreatitis examined between May 2002 and May 2012 at Hospital de Braga, Portugal, were reviewed.

Material And Methods: Patients were identified by searching the hospital's electronic discharge records for the International Classification of Disease, Ninth Revision (ICD-9) code 577.0 (acute pancreatitis). ARP was considered as two or more episodes of AP per year or more than three episodes over a lifetime with intervening return to baseline. The following data were analyzed: demographic information, clinical, laboratory and imaging test results, etiology of pancreatitis, medical and surgical management, length of hospitalization, and outcome. The clinical and laboratory factors used in the pediatric acute pancreatitis severity score system and computed tomography severity index (CTSI) score were compared between patients with mild and severe disease.

Results: A total of 37 patients, 31 episodes of AP and 6 patients with ARP, were documented. The most prevalent etiologies were biliary stones/sludge (24.3%) and trauma (16.2%). Admission elevated white blood cell count (p=0.011), 48-h trough calcium (p=0.007), and 48-h rise in blood urea nitrogen (p=0.025) correlated significantly with disease severity. CTSI on admission had a score below 4 in three patients with severe disease.

Conclusion: This Portuguese pediatric pancreatitis report highlights the multiple and complex etiology of this disease. Better pediatric scoring systems and management algorithms are needed.
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http://dx.doi.org/10.3109/00365521.2014.882403DOI Listing
May 2014

The relationship between weight status and psychopathology in adolescence: the role of social support.

J Health Psychol 2014 Jul 12;19(7):907-17. Epub 2013 Apr 12.

University of Minho, Portugal Braga Hospital, Portugal ICVS/3B's-PT Government Associate Laboratory, Portugal.

This study evaluated the differences between normal-weight and overweight adolescents in psychopathology, social support and emotional competences, and the role of social support in the relationship between psychopathology and weight. We examined a clinical group of 83 overweight/obese adolescents, a community group of 82 overweight/obese adolescents, and 205 adolescents with normal weight. No differences were found in psychopathology and emotional skills. Compared to healthy peers, however, the overweight/obese community group was less satisfied with their friendships, and the clinical group was less satisfied with their intimate support and social activities. Social support mediates the relationship between weight and psychopathology.
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http://dx.doi.org/10.1177/1359105313482162DOI Listing
July 2014

Chediak-Higashi syndrome: pathognomonic feature.

Lancet 2013 Nov 29;382(9903):1514. Epub 2013 Mar 29.

Paediatrics Department, Hospital de Braga, Braga, Portugal; Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal. Electronic address:

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http://dx.doi.org/10.1016/S0140-6736(13)60020-3DOI Listing
November 2013

Peutz-Jeghers syndrome: capsule endoscopy to stage disease.

Lancet 2013 Feb 5;381(9864):e5. Epub 2012 Oct 5.

Gastroenterology, Hepatology and Nutrition Unit, Department of Pediatrics, Braga Hospital, Braga, Portugal.

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http://dx.doi.org/10.1016/S0140-6736(12)60830-7DOI Listing
February 2013

[Evaluation of the performance of three spacers].

Acta Med Port 2012 Jan-Feb;25(1):4-9. Epub 2012 May 25.

Departamento de Engenharia Mecânica, Universidade do Minho, Guimarães, Portugal.

Introduction: Several aspects are known to influence the drug distribution within the low respiratory tract, with particular emphasis on those related to the inhalation device. The aim of this work was to assess the performance of three spacers in the drug release, and also the quantity of active agent deposited inside these devices.

Materials And Methods: In order to evaluate the behaviour of particles in suspension delivered through the Ventilan®HFA inhaler coupled to three different spacers (Volumatic®, AeroChamber MAX® and NebuChamber®) the Multistage Liquid Impinger (MSLI) was used, according to the Portuguese Pharmacopoeia. The mass of salbutamol sulphate deposited on the different impinger compartments and inside the spacer was determined by spectrophotometry, with the purpose of determining the percentage of cumulative mass for each spacer, and then the fine particle fraction. The results were compared statistically using a one-way analysis of variance (one-way ANOVA) with a Bonferroni post-hoc test.

Results: About 40 to 50% of salbutamol sulphate was found deposited in the body of the three spacers. This deposition was slightly lower for NebuChamber® (average ± standard deviation of 43.8 % ± 11.6 %), in relation to Volumatic® (p=0.351) or AeroChamber MAX® (p=0.115). The fine particle fraction reached values of 28.2 ± 4.1%, 29.6 ± 2.4% and 30.9 ± 6.7% for Volumatic®, AeroChamber MAX® and NebuChamber®, respectively.

Conclusion: The spacers showed to have similar efficiencies in the delivery of salbutamol sulphate in the last stages, and there was no relation between the results and the spacers characteristics such as volume, shape and material. Therefore, Volumatic® appears to be perfect for hospital use, since its big volume does not constitute a disadvantage, and its lower cost, when compared to the remaining two spacers, represents an advantage of utmost importance for public hospitals.
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December 2012

A novel de novo deletion of chromosome 7 [46,XX,del(7)(p14.2 p15.1)] in a child with feeding problems.

Gene 2012 Jul 29;503(1):152-4. Epub 2012 Apr 29.

Pediatric Gastroenterology Unit, Braga Hospital, Portugal.

The phenotype and severity of symptoms associated with deletions on chromosome 7 are directly proportional to the size of the deleted segment. Distal and interstitial deletions have been described in 40 cases. In this report the authors aim to report a child with a novel de novo interstitial deletion on chromosome 7, with the following karyotype: 46,XX,del(7)(p14.2 p15.1). We described a female, born at 38 weeks with intrauterine growth restriction and feeding problems with episodes of cyanosis after feedings and failure to thrive. Physical examination showed low implantation of ears, hypertelorism, oblique palpebral fissures, retrognathia, and palate ogived, with insertion anomalies of the toes, poor facial expression and mild axial hypotonia. Transfontanelar ultrasound, magnetic resonance imaging, bronchofibroscopy and metabolic studies were normal. She was hospitalized until the 32nd day of life. She started speech therapy and presented improvements in swallowing. The percutaneous endoscopic gastrostomy was removed at 36 months. She had recurrent urinary tract infection with normal dimercaptosuccinic acid but with a vesicoureteral reflux (grade III). Imagiological studies revealed a bilateral osteonecrosis of femoral epiphysis (Legg-Calvé-Perthes disease). Currently (6years-old), she is being normally fed (body mass index=15.8kg/m(2)). Her weight is 16.4kg (3rd centile) and length is 105cm (3rd to 5th centiles). She has a mild delay of psychomotor development impairment and some speech problems. This is the first case report of a patient with this de novo small interstitial deletion on chromosome 7. This rare chromosomal abnormality was associated with severe feeding problems in the first years of life.
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http://dx.doi.org/10.1016/j.gene.2012.04.046DOI Listing
July 2012

Development of new spacer device geometry: a CFD study (part I).

Comput Methods Biomech Biomed Engin 2012 24;15(8):825-33. Epub 2011 May 24.

Mechanical Engineering Department, School of Engineering, University of Minho, 4800-058, Guimarães, Portugal.

Asthma is a widespread disease, affecting more than 300 million individuals. The treatment in children is based upon an administration of a pressurised metered-dose inhaler added with a spacer. The efficiency of drug delivery to the patient is strongly affected by the transient airflow pattern inside the spacer device. This paper presents a computational fluid dynamics (CFD) analysis of airflow inside a commercially available spacer device with wide application. This study, carried out in Fluent™, was the basis of an optimisation procedure developed to improve the geometry of the spacer and develop a more efficient product. The results show that an appropriate control of the boundary layer development, by changing the spacer shape, reduces the length of the recirculation zones and improves the flow. It can be concluded that CFD is a powerful technique that can be successfully applied to optimise the geometry of such medical devices.
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http://dx.doi.org/10.1080/10255842.2011.563359DOI Listing
December 2012

Immune disease expressed in liver and platelets in an adolescent: a case report.

Ital J Pediatr 2010 Jun 11;36:42. Epub 2010 Jun 11.

Adolescents Unit and Gastrenterology, Hepatology and Nutrition Unit, Pediatrics Department, Braga Hospital, and Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal.

We report a case of a 15-year-old boy with autoimmune hepatitis lacking common serologic markers and normal gammaglobulinemia associated with immune thrombocytopenia and family history of psoriasis. He presented to our department with a 4-year history of a cervical posterior lymphadenopathy and recent petechiae. Previous laboratory results 6 months before already showed hepatocellular injury. After exclusion of other causes, the diagnosis of autoimmune hepatitis was made based on clinical grounds, associated immune disorder and histological features of liver biopsy.The authors alert for this atypical presentation of autoimmune hepatitis and associated immune thrombocytopenia.
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http://dx.doi.org/10.1186/1824-7288-36-42DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892502PMC
June 2010

Second hand smoke (SHS) exposure in children. An evaluation of a preventative measure.

Rev Port Pneumol 2010 Jan-Feb;16(1):57-72

Departamento de Metodologias da Educação, do Instituto de Educação e Psicologia da Universidade do Minho.

Aims: To evaluate the effectiveness of the preventative programme "Smoke-free Homes" undertaken in 4th year children and their parents or guardians, aiming to reduce children's exposure to second hand smoke (SHS) in the home.

Material And Methods: This was a pre- and post-test pre-experimental study, in students from 32 Braga district primary schools 2007/08. A self-administered and structured questionnaire was given out to 795 students in the classroom before and after the programme. In analysing data, we used the chi-squared test for the categorical variables.

Results: The rate of children exposed to regular or occasional SHS due to living with at least one smoker dropped from 42.2% to 32.6% (p=0.001). The percentage of students, children of smokers who stated that their father smoked regularly or occasionally at home, dropped from 68.0% pre-test to 51.6% posttest (p=0.000). No significant reduction was seen in mothers.

Conclusion: Based on the data, we can conclude that the "Smoke-free Homes" programme was effective in preventing smoking in the home, and therefore reducing the rate of children exposed to SHS by about 10%. However, it appears that about a third of children are still exposed, which highlights the need for further measures in this area. Healthcare professionals, particularly those working in Paediatrics, should advise parents to quit smoking, especially in the home.
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April 2010

[Prevalence and smoking trends in Portugal and Europe].

Acta Med Port 2009 Jul-Aug;22(4):335-48. Epub 2009 Aug 10.

Instituto de Educação e Psicologia, Universidade do Minho, Braga.

Unlabelled: Tobacco smoking is the cause of more than half million deaths/year in the European Union (EU). Monitoring smoking prevalence is an important tool to evaluate the epidemic and its evolution and to assess the effectiveness of preventive measures. The comparison between countries may help us identify good control practices.

Objective: To describe the current state and evolution of the smoking epidemic in several EU countries, and to characterize the Portuguese situation in comparison with those countries.

Methods: To characterize smoking habits and their evolution in the population over 15 years old, several Eurobarometer reports from 1995 to 2007 were used. The characterization of School Aged Children's smoking habits was based on the Health Behaviour in School-Aged Children data of 1993-4 and 2002. The Portuguese situation also used the information available from the National Health Surveys of 1987 up to 2005/06.

Results: The global prevalence of smoking in adult population in most of the European countries is over 25%. The average prevalence of male and female smokers in School-Aged Children over 15 years of age is approximately 18% if we consider both genders together. In most countries the prevalence of tobacco consumption is higher in girls when compared to boys. In Portugal, the prevalence in the population over 15 years of age has one of the lowest values among European countries (30,6 % for men and 11,6% for women). Despite these crude prevalence rates, high age-sex-specific prevalence rates were found in age groups 25-34 and 35-44 in men (39,9% e 44,6% respectively) and in women (17,6 e 21,2% respectively). In 2002, at the age of 15, the percentage of daily smoking girls in Portugal was 19.5%. This value reveals that Portugal is among the countries with higher prevalence rates of smoking among adolescent girls. Over the last decade (1996-2006), a decrease in tobacco consumption has been observed in most EU countries, both in adult population and in School-Aged Children. In Portugal, this consumption has levelled off in adult men and in youngsters aged 15, but shows a significant increase in female adults and school-aged girls.

Conclusions: Although Portugal presents low global prevalence rates in the European context, the substantial increases observed in the young adult female population are of particular concern because of its impact on women's health and the risk of pre and post-natal associated childhood exposure. These results reveal that current preventive strategies in Portugal are ineffective in reducing smoking prevalence among children and young adults.
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February 2010

G2P[4] the most prevalent rotavirus genotype in 2007 winter season in an European non-vaccinated population.

J Clin Virol 2009 May 17;45(1):76-8. Epub 2009 Apr 17.

Gastroenterology, Hepatology and Nutrition Unit, Pediatrics Department, S Marcos Hospital, Braga, Portugal.

Background: Recently, a high prevalence of G2P[4] rotavirus (RV) infection was reported from Brazil, and linked with the universal RV vaccination programme that used the G1P[8] live oral RV vaccine.

Objective: To determine the genotypes of RV co-circulating in a non-vaccinated population, in northern Portugal in the winter season of 2007.

Study Design: Prospective multicenter study of the genotypes circulating in the northwest region of Portugal during January to March 2007. Children with acute gastroenteritis, who attended the Pediatric Emergency Services of five Hospitals, were included in the study. The parents of the children completed a clinical and epidemiological data questionnaire and stool samples were collected. Stool samples positive in a RV enzyme immunoassay (EIA) were genotyped by reverse transcriptase-polymerase chain reaction.

Results: Stool samples were collected from 424 children. Two hundred and thirty-four (55.2%) stool samples were RV-positive. G2P[4] was the predominant RV type (68.6%), followed by G9P[8] (14.0%).

Conclusions: Because our population was naïve for RV vaccine, the G2P[4] predominance cannot be explained by vaccination. Rather, this high prevalence of G2P[4] may be within the normal fluctuation of RV genotypes. RV strain surveillance programmes are important for informing RV vaccination programmes.
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http://dx.doi.org/10.1016/j.jcv.2009.03.010DOI Listing
May 2009

[Congenital simple hepatic cyst: a diagnostic and management challenge].

Gastroenterol Hepatol 2009 Feb 13;32(2):92-6. Epub 2009 Feb 13.

Instituto de Ciencias de la Vida y la Salud, Universidad de Minho, Braga.

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http://dx.doi.org/10.1016/j.gastrohep.2008.09.014DOI Listing
February 2009

Serum leptin levels in overweight children and adolescents.

Br J Nutr 2009 Apr 28;101(8):1262-6. Epub 2008 Aug 28.

Gastroenterology, Hepatology and Nutrition Unit, Paediatric Department, S. Marcos Hospital, Braga, Portugal.

Leptin is an adipocyte-secreted hormone which plays a key role in energy homeostasis. Our aim was to determine the relationship between serum leptin and clinical and biochemical features in overweight children and adolescents. Overweight children and adolescents followed in this Unit with serum leptin ascertained were included. Clinical, biochemical and abdominal ultrasound data were analysed. Statistical analysis was performed by t test, chi2, Pearson's correlation and linear regression. One outlier of serum leptin was excluded to perform correlation and regression. Serum leptin was determined in 357 patients. At the first visit, the mean age was 9.5 (sd 3.2) years and mean BMI z-score was 1.72 (sd 1.34) (girls 1.71 (sd 1.16); boys 1.72 (sd 1.11)). Serum leptin levels were significantly related to: sex (mean: girls 48.0 ng/ml, boys 34.4 ng/ml; P = 0.003); Tanner stage (mean: I-II 37.0 ng/ml, III-V 45.2 ng/ml; P = 0.035); systolic blood pressure (mean: normal 41.3 ng/ml, high 44.0 ng/ml; P = 0.009); BMI z-score (r 0.136; P = 0.010); C-peptide (r 0.17; P = 0.002); insulin (r 0.34; P < 0.001); homeostasis model assessment of insulin resistance (HOMA-IR) (r 0.25; P < 0.001) and aspartate aminotransferase (r - 0.12; P = 0.023). In the multivariate analysis (with leptin as the dependent variable and sex, Tanner stage, BMI z-score, systolic blood pressure, aspartate aminotransferase, C-peptide, insulin and HOMA-IR as independent variables), sex and BMI were determinant factors. The present study in overweight children and adolescents showed that being female and greater BMI were significantly and independently associated with increased serum leptin. In this large cohort other associations with leptin described in the literature can be discharged.
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http://dx.doi.org/10.1017/S0007114508055682DOI Listing
April 2009
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