Publications by authors named "Joana Freitas"

19 Publications

  • Page 1 of 1

Fifteen-minute consultation: An approach to the management of PIMS-TS in a district general hospital.

Arch Dis Child Educ Pract Ed 2021 Oct 25. Epub 2021 Oct 25.

General Paediatrics, Queen Elizabeth Hospital, London, UK.

The COVID-19 pandemic has caused significant disease across the globe but children seem to be much less affected than adults. Coincidentally with the first wave of the pandemic, a cluster of children with fever, hyperinflammation and shock were identified, and this was first described as paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) by the Royal College of Paediatrics and Child Health. Patients with this novel condition were transferred to tertiary centres for management, increasing the pressure in these hospitals that were already extremely busy. There are multiple challenges related to the identification of patients presenting with PIMS-TS given that they mimic multiple other well-known paediatric conditions, like Kawasaki disease and toxic shock syndrome. Investigations and admission criteria to a district general hospital (DGH) need to be well established, and clear guidance should be available for easy decision making in a busy paediatric emergency department. Furthermore, these children can deteriorate suddenly and rapidly; close monitoring is vital, and any deterioration must be taken seriously and addressed immediately. All children who present severely ill, with shock and multiorgan failure, should be retrieved to a paediatric intensive care unit. As our knowledge of the condition has developed, more patients are now managed in a DGH, with virtual multidisciplinary team involvement. This paper outlines a structured approach to management of children presenting with suspected PIMS-TS in a DGH.
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http://dx.doi.org/10.1136/archdischild-2021-321921DOI Listing
October 2021

Asymptomatic pituitary apoplexy induced by corticotropin-releasing hormone in a 14 year-old girl with Cushing's disease.

J Pediatr Endocrinol Metab 2021 Jun 5;34(6):799-803. Epub 2021 Apr 5.

Paediatric Endocrinology Unit, Centro Hospitalar e Universitário do Porto, Porto, Portugal.

Objectives: Pituitary apoplexy is a rare complication of Cushing's disease (CD), especially in the paediatric age and even more rarely it can occur following anterior pituitary stimulation tests.

Case Presentation: We report a case of a 14-year-old girl who was admitted to our Hospital for evaluation of a possible Cushing's syndrome (CS). Her symptoms and initial laboratory tests were suggestive of CD. Magnetic resonance imaging (MRI) revealed a microadenoma of the pituitary gland. As part of her evaluation she was submitted to a corticotropin-releasing hormone (CRH) stimulation test. Two and a half months later the patient was re-evaluated and presented with both clinical improvement of CS, biochemical resolution of hypercortisolism and tumour size reduction in the MRI, also evidencing a haemorrhagic component favouring the diagnosis of pituitary apoplexy after CRH stimulation test. The patient denied any episodes of severe headache, nausea, vomiting or visual changes.

Conclusions: To our knowledge, the authors report the first case of a pituitary apoplexy after a CRH stimulation test in the paediatric age.
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http://dx.doi.org/10.1515/jpem-2020-0499DOI Listing
June 2021

Electromagnetic Rod in Lower Limb Lengthening: A Technical Note for Shaft Osteotomy.

Strategies Trauma Limb Reconstr 2019 Sep-Dec;14(3):139-141

Department of Orthopaedic and Traumatology, Centro Hospitalar de São João, Porto, Portugal.

Purpose: Long bone lengthening procedures are paramount in the treatment of limb length discrepancies. We witnessed a revolution in the treatment paradigm of this pathology with the development of expandable intramedullary rods. Endomedular nailing might be technically demanding and some steps are critical for success. The aim of authors is to describe a technical note of the PRECICE system that may ease femoral nailing and fixation: the nail can be advanced through the femur and proximal and distal fixation performed previous to complete femoral osteotomy.

Materials And Methods: The authors present a case series of XX patients in which the limb lengthening has been performed with partial osteotomy with Gigli saw, nail advancement, proximal and distal fixation, and osteotomy completion at the end of the procedure.

Results: After 18 consecutive limb (femoral) lengthening operations with this technical variation in PRECICE, nail patients presented no significant lower limb length discrepancy. There were no records of rotational deformities, nonunion, or infection. Material failure was not reported.

Conclusion: This technical note is another positive variable that can help to ease the procedure, minimise possible complications, and confirm magnetic expandable nails as the gold standard technique in limb lengthening procedures and it might be applied to other nailing systems for limb lengthening procedures.

How To Cite This Article: Lopes M, Nunes B, Couto A, Electromagnetic Rod in Lower Limb Lengthening: A Technical Note for Shaft Osteotomy. Strategies Trauma Limb Reconstr 2019;14(3):139-141.
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http://dx.doi.org/10.5005/jp-journals-10080-1444DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368354PMC
August 2020

Hyperinsulinaemic Hypoglycaemia and Polycystic Kidney Disease - A Rare Case Concerning Gene Pleiotropy.

Eur Endocrinol 2020 Apr 4;16(1):66-68. Epub 2020 Feb 4.

Paediatric Endocrinology Unit, Northern Maternal and Child Centre, Porto University Hospital Centre, Porto, Portugal.

Co-occurrence of hyperinsulinaemic hypoglycaemia and polycystic kidney disease (HIPKD) has been recently described. It is caused by a non-coding variant in the promoter region for phosphomannomutase 2 (), c.-167G>T, both in homozygous or compound heterozygous variants with deleterious coding. Although has been associated with congenital disorder of glycosylation, patients do not present with this phenotype and have normal carbohydrate-deficient transferring testing. The authors present a rare case where specific study was performed as a result of clinical suspicions. The patient was a 6-year-old female followed at our clinic due to congenital hyperinsulinism since she was 1 month old. She also presented with bilateral polycystic kidneys, detected in prenatal set, and simple hepatic cysts, for which she was treated with diazoxide and captopril. Initial metabolic and genetic studies were normal. gene sequence study revealed the promotor variant c.-167G>T in compound heterozygosity with the previously described pathogenic variant c.422G>A (p.Arg141His), confirming the diagnosis of HIPKD. This is a notable case as it highlights the importance of keeping this diagnostic hypothesis in mind and serves as a reminder to perform proper clinical and genetic investigation. A correct, and early, diagnosis will avoid unnecessary additional investigations and will allow appropriate genetic counselling for this autosomal recessive disorder.
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http://dx.doi.org/10.17925/EE.2020.16.1.66DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308104PMC
April 2020

Development and validation of a complex intervention: A physical exercise programme aimed at delaying the functional decline in frail older adults.

Nurs Open 2020 01 30;7(1):274-284. Epub 2019 Sep 30.

The Health Sciences Research Unit: Nursing Nursing School of Coimbra (ESEnfC), collaborator of the Joanna Briggs Institute (JBI) Coimbra Portugal.

Aim: To develop and validate a physical exercise programme aimed at delaying the functional decline in frail older adults.

Design: The revised guideline of Criteria for Reporting the Development and Evaluation of Complex Interventions in health care was followed.

Methods: The physical exercise programme was designed and validated by exercise specialists to be implemented by healthcare professionals. The physical exercise programme underwent three stages of development, piloting and evaluation. It includes a portfolio of exercises in different support materials (posters, e-book and website). A testing intervention was delivered to the target population.

Results: The Criteria for Reporting the Development and Evaluation of Complex Interventions in health care process has the potential to help practitioners in developing and planning complex interventions, such as an exercise programme. Its components can be adjusted to the context and to the characteristics of the target population. A study protocol and a pilot study will be developed to test the effectiveness of the physical exercise programme on delaying the functional decline of frail older adults.
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http://dx.doi.org/10.1002/nop2.388DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6917945PMC
January 2020

Effectiveness of a Combined Intervention on Psychological and Physical Capacities of Frail Older Adults: A Cluster Randomized Controlled Trial.

Int J Environ Res Public Health 2019 08 28;16(17). Epub 2019 Aug 28.

Nursing, Nursing School of Coimbra, The Health Sciences Research Unit, 3046-851 Coimbra, Portugal.

Background: Older adults experience physical and psychological declines affecting independency. Adapted and structured combined interventions composed of cognitive stimulation and physical exercise contribute to comorbidities' reduction. Multicenter single-blinded two-arm cluster randomized controlled trial conducted to assess effectiveness of a combined intervention (CI), composed of a cognitive stimulation program (CSP) and a physical exercise program (PEP), on psychological and physical capacities of frail older adults as to on their activities of daily living. Were recruited 50 subjects from two elderly end-user organizations. Of these, 44 (65.9% females, mean age of 80.5 ± 8.47 years) were considered eligible, being randomly allocated in experimental (EG) or control group (CG). Data collected at baseline and post-intervention. EG received CI three times a week during 12 weeks. CG received standard care. Non-parametric measures were considered. At baseline, groups were equivalent for study outcomes. The comparison of pre- and post-intervention data revealed that subjects receiving CI reduced depressive symptomatology and risk of fall based on gait and balance, and improved gait speed. Simultaneously, in the CG a significant decline on activities of daily living was observed. Significant results were found among biomechanical parameters of gait (BPG). EG' effect size revealed to be small (0.2 ≤ < 0.5). CG' effect size was also small; but for activities of daily living there was an evident decrease. The CI is effective on managing older adults' psychological and physical capacities.
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http://dx.doi.org/10.3390/ijerph16173125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6747215PMC
August 2019

Prenatal Diagnosis and Management of a Fetal Goiter Hypothyroidism due to Dyshormonogenesis.

Case Rep Endocrinol 2018 19;2018:9564737. Epub 2018 Dec 19.

Pediatric Endocrinology Unit, Department of Pediatrics, Centro Materno Infantil do Norte-Centro Hospitalar Universitário do Porto, Oporto, Portugal.

Fetal goiter is a rare disorder not expected to be found during a healthy woman's pregnancy. It can be a prenatal manifestation of congenital hypothyroidism due to thyroid dyshormonogenesis and it can lead to serious perinatal complications. A vascularized fetal neck mass was detected at 29 weeks' gestation of a healthy primigravida. Magnetic resonance was suggestive of goiter causing airway deviation without polyhydramnios. Maternal thyroid function was normal and thyroid antibodies were negative. Two intra-amniotic levothyroxine infusions were performed at 32 and 33 weeks. Serial imaging control showed no progression of the mass. Elective caesarean section was performed at 38 weeks. The male newborn was admitted to the intensive care unit due to cardiorespiratory insufficiency with pulmonary hypertension. Hormonal assays revealed primary congenital hypothyroidism and ultrasonography confirmed diffuse goiter. Levothyroxine was started. Currently, he is 6 years old with adequate growth and normal psychomotor development. Genetic study found a heterozygous mutation in the TPO gene.
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http://dx.doi.org/10.1155/2018/9564737DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313984PMC
December 2018

Pyogenic Sacroiliitis in a Pediatric Patient: A Rare Case of Infection by .

J Am Acad Orthop Surg Glob Res Rev 2018 Jul 9;2(7):e052. Epub 2018 Jul 9.

Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal (Dr. Nogueira, Dr. Pereira, Dr. Alves, and Dr. Lopes), and Centro Hospitalar São João, Porto, Portugal (Dr. Couto, Dr. Freitas, Dr. Alegrete, and Dr. Costa).

This is a case report of pyogenic sacroiliitis in a pediatric patient caused by . The patient is a 16-year-old boy who presented to an emergency department with sudden onset of back pain radiating to the left lower extremity. The diagnosis was confounded by the presence of isthmic spondylolisthesis. Plain radiography demonstrated mild isthmic spondylolisthesis but no radiographic signs of tumor, trauma, infection, arthritis, or other developmental problems. The C-reactive protein level was 23 mg/L. Over the next 24 hours, the patient developed fever, and the C-reactive protein level increased to 233 mg/L. Sacroiliitis and an iliopsoas abscess were identified on MRI. Blood cultures grew . The patient responded to antibiotic treatment and needle aspiration under CT guidance. Sacroiliitis is an uncommon condition and, to our knowledge, there is only one other case report of its being caused by . The previous report was in an adult.
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http://dx.doi.org/10.5435/JAAOSGlobal-D-17-00052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145553PMC
July 2018

Two consecutive limb lengthenings with the same PRECICE nail: a technical note.

Strategies Trauma Limb Reconstr 2018 Nov 19;13(3):199-204. Epub 2018 Sep 19.

Orthopaedic and Traumatology, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.

Purpose: The most significant advance in our time about limb lengthening is the magnetic lengthening nail, as the first reports appeared to show good results with accurate lengthening rates and good regenerate bone formation. The described complication rate is generally low. They avoid external fixation elements, and are activated transcutaneously, so the patient's pain and discomfort are reduced and the rehabilitation is faster and more effective. The aim of authors is to describe a special technical issue of the PRECICE system: the nail can be extended inside the patient limb (after the osteotomy), but it also can be retracted inside the limb after achieving the bone union.

Methods: The authors present a case in which the limb lengthening has been performed in consecutive lengthening periods using the same nail. The nail was extended and retracted by altering the settings on the external remote control as well as accurately setting the rate of distraction.

Results: After two consecutive femoral lengthening with the same PRECICE nail, the patient no longer has a significant lower limb length discrepancy and patient satisfaction was high. During this clinical case, we were not confronted with any type of complications.

Conclusion: This technique utilizes the principles and advantages of lengthening over an magnetic lengthening nail, avoids the necessity of nail removal and minimizes the complication rates and the overall time for complete recovery.

Level Of Evidence: Level IV.
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http://dx.doi.org/10.1007/s11751-018-0317-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6249150PMC
November 2018

Late screw perforation of external iliac artery following acetabular revision. A simple solution for a rare complication.

Rev Bras Ortop 2017 May-Jun;52(3):359-362. Epub 2016 Jul 19.

Centro Hospitalar São João, Porto, Portugal.

Vascular lesions, although quite rare, are one of the most devastating complications in the context of a hip prosthesis. Therefore, the correct diagnosis is crucial to prevent irreversible damage to the patient. The authors present the case of a 70-year-old Caucasian woman with an ischemic lower limb as consequence of a late perforation of external iliac artery due to an acetabular screw. The issue was resolved by simply cutting part of the screw, avoiding other surgical options that would be much more aggressive for the patient. Careful clinical evaluation allowed for a correct diagnosis and a timely creative treatment, preventing further consequences to the patient.
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http://dx.doi.org/10.1016/j.rboe.2016.05.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5496997PMC
July 2016

High-fat diet-induced obesity Rat model: a comparison between Wistar and Sprague-Dawley Rat.

Adipocyte 2016 Jan-Mar;5(1):11-21. Epub 2015 Jul 15.

Departamento de Bioquímica; Faculdade de Medicina; Universidade do Porto; Porto, Portugal; CINTESIS; Centro de Investigação em Tecnologias e Sistemas de Informação em Saúde; Porto, Portugal.

In the past decades, obesity and associated metabolic complications have reached epidemic proportions. For the study of these pathologies, a number of animal models have been developed. However, a direct comparison between Wistar and Sprague-Dawley (SD) Rat as models of high-fat (HF) diet-induced obesity has not been adequately evaluated so far. Wistar and SD rats were assigned for 2 experimental groups for 17 weeks: standard (St) and high-fat (HF) diet groups. To assess some of the features of the metabolic syndrome, oral glucose tolerance tests, systolic blood pressure measurements and blood biochemical analysis were performed throughout the study. The gut microbiota composition of the animals of each group was evaluated at the end of the study by real-time PCR. HF diet increased weight gain, body fat mass, mesenteric adipocyte's size, adiponectin and leptin plasma levels and decreased oral glucose tolerance in both Wistar and SD rats. However, the majority of these effects were more pronounced or earlier detected in Wistar rats. The gut microbiota of SD rats was less abundant in Bacteroides and Prevotella but richer in Bifidobacterium and Lactobacillus comparatively to the gut microbiota of Wistar rats. Nevertheless, the modulation of the gut microbiota by HF diet was similar in both strains, except for Clostridium leptum that was only reduced in Wistar rats fed with HF diet. In conclusion, both Wistar and SD Rat can be used as models of HF diet-induced obesity although the metabolic effects caused by HF diet seemed to be more pronounced in Wistar Rat. Differences in the gut microbial ecology may account for the worsened metabolic scenario observed in Wistar Rat.
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http://dx.doi.org/10.1080/21623945.2015.1061723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4836488PMC
May 2016

The Tumorigenic Roles of the Cellular REDOX Regulatory Systems.

Oxid Med Cell Longev 2016 22;2016:8413032. Epub 2015 Nov 22.

Centre for Biomedical Research (CBMR), University of Algarve, Campus of Gambelas, Building 8, Room 2.22, 8055-139 Faro, Portugal.

The cellular REDOX regulatory systems play a central role in maintaining REDOX homeostasis that is crucial for cell integrity, survival, and proliferation. To date, a substantial amount of data has demonstrated that cancer cells typically undergo increasing oxidative stress as the tumor develops, upregulating these important antioxidant systems in order to survive, proliferate, and metastasize under these extreme oxidative stress conditions. Since a large number of chemotherapeutic agents currently used in the clinic rely on the induction of ROS overload or change of ROS quality to kill the tumor, the cancer cell REDOX adaptation represents a significant obstacle to conventional chemotherapy. In this review we will first examine the different factors that contribute to the enhanced oxidative stress generally observed within the tumor microenvironment. We will then make a comprehensive assessment of the current literature regarding the main antioxidant proteins and systems that have been shown to be positively associated with tumor progression and chemoresistance. Finally we will make an analysis of commonly used chemotherapeutic drugs that induce ROS. The current knowledge of cancer cell REDOX adaptation raises the issue of developing novel and more effective therapies for these tumors that are usually resistant to conventional ROS inducing chemotherapy.
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http://dx.doi.org/10.1155/2016/8413032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4670861PMC
September 2016

Effect of chronic consumption of blackberry extract on high-fat induced obesity in rats and its correlation with metabolic and brain outcomes.

Food Funct 2016 Jan;7(1):127-39

Departamento de Bioquímica, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. and Centro de Investigação em Tecnologias e Sistemas de Informação em Saúde (CINTESIS), Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.

Flavonoids have been presented as potential protectors against metabolic and cognitive dysfunction. However, mechanisms underlying these 'claims' have not been sufficiently explored. To analyse the effect of long-term supplementation with blackberry extract (BE) in the context of a high-fat or a standard diet, Wistar rats were divided into 4 groups (n = 6) fed with a standard or a high-fat diet, with or without BE supplementation at 25 mg per kg body weight per day. A high-fat diet significantly impaired glucose tolerance and increased body weight, caloric ingestion, very-low-density lipoprotein, triglycerides and cholesterol. Furthermore, it was observed that a high-fat diet increased dopamine content in the prefrontal cortex and decreased brain derived neurotrophic factor (BDNF) levels both in the prefrontal cortex and in plasma. BE supplementation only affected some of these aspects. BE slightly improved glucose metabolism and significantly decreased levels of lactate, independent of diet. BE decreased levels of BDNF and also interacted with the dopaminergic system, increasing dopamine turnover in the striatum, and reverting dopamine content induced by a high-fat diet in the prefrontal cortex. This study shows that, despite some particular benefits of anthocyanin supplementation, some long-term effects may not be desirable and further studies are needed to optimize ingestion conditions.
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http://dx.doi.org/10.1039/c5fo00925aDOI Listing
January 2016

Evaluation of lipoic acid topical application on rats skin wound healing.

Acta Cir Bras 2013 Oct;28(10):708-15

Purpose: To evaluate the effects of lipoic acid (thioctic acid) topical application on wound healing on rats skin, and the consequences of lipoic acid nanoencapsulation on this process.

Methods: The model used was the healing activity on wounds induced by surgical incision on rats skin (n = 44). The parameters analyzed (11 days) were wound healing rate and histology (vascular proliferation, polymorphonuclear or mononuclear cells, and collagen synthesis or reepithelialization), after application of free lipoic acid or lipoic acid- loaded nanocapsules. The antioxidant activity of these formulations was evaluated by lipid peroxidation test.

Results: It was demonstrated for the first time that the topical application of lipoic acid improves wound healing. On the seventh day after surgery, the animals treated with lipoic acid showed increased healing rate (60.7 ± 8.4%) compared to the negative control group (43.0 ± 17.4%), as so improvement of histological parameters. The nanoencapsulation reverted the pro-oxidant activity presented in vitro by lipoic acid, whereas diminished wound repair.

Conclusions: The topical application of lipoic acid produced an increase in the skin wound healing, which may be related to its pro-oxidant activity. On the other hand, the nanoencapsulation of the lipoic acid reversed the pro-oxidant activity, although presented minor healing activity.
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http://dx.doi.org/10.1590/s0102-86502013001000004DOI Listing
October 2013

CT and MRI lower extremity torsional profile studies: measurement reproducibility.

J Child Orthop 2012 Oct 23;6(5):391-6. Epub 2012 Aug 23.

Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, 3030 Children's Way, Suite 410, San Diego, CA 92123 USA.

Background: Assessment of lower extremity (LE) torsional profile using computed tomography (CT) imaging is a well-recognized imaging method that supplements the clinical examination. Magnetic resonance imaging (MRI) is another advanced imaging modality that can be used as an alternative, since there are many growing concerns of radiation exposure with traditional CT studies, particularly in the skeletally immature population.

Methods: Sixty-two patients between the ages of 7 and 19 years were included. Thirty-four had CT and 28 had MRI for assessment of LE torsional profile. All patients had clinical evidence of torsional malalignment. CT and MR images were randomized and de-identified. Two observers measured femoral anteversion and tibial torsion based on previously published methodologies. This exercise was repeated 2 weeks later and the data were tabulated and statistical analysis was performed. Radiation exposure for the patients studied by CT was estimated.

Results: The mean age of the patients was 14.4 years (range 9.5-18.9 years) and 13.8 years (range 7.3-18.9 years) for the CT and MRI groups, respectively. Inter-observer reliability for both CT and MRI studies were excellent. The intra-class correlation coefficient (ICC) for femoral anteversion and tibial torsion studied by CT and MRI for both observers at both times were excellent. The radiation exposure for CT examination averaged 0.3-0.5 mSv, compared to none with the MRI method.

Conclusions: MRI provides a reproducible method for assessing the torsional profile in children and adolescents using similar anatomic landmarks for measurements as those used on CT torsional profile. In circumstances where MRI methods are readily available (and affordable), the CT torsional profile can be replaced with MRI methods, in the current era of growing concerns of radiation hazards and increasing awareness about radiation safety.

Level Of Evidence: Diagnostic Level III.
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http://dx.doi.org/10.1007/s11832-012-0434-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3468734PMC
October 2012

EOS imaging of the human pelvis: reliability, validity, and controlled comparison with radiography.

J Bone Joint Surg Am 2013 May;95(9):e58

Department of Orthopedic Surgery, Rady Children's Hospital San Diego, 3030 Children's Way, San Diego, CA 92123, USA.

Background: The EOS technique represents a unique imaging modality combining low radiation exposure with high image quality. As its applications for pelvic imaging may increase with time, we performed a pilot study to evaluate the validity and reliability of this technique for the assessment of gross pelvic and acetabular morphology.

Methods: Consecutive conventional and EOS radiographs of a human cadaveric pelvis were made in 5° intervals of sagittal tilt and axial rotation (range, -15° to 15° for each). Six measurements were made on each image: (1) the vertical distance between the sacrococcygeal joint and the upper border of the pubic symphysis, (2) the horizontal distance between the midpoints of these structures, (3) the distance between the anterior superior iliac spines, (4) the distance between the facets of S1, (5) the Sharp angle, and (6) the Tönnis angle. Coxa profunda and crossover signs were also evaluated. The findings of the two imaging techniques were correlated with each other and with true linear measurements made on the cadaveric pelvis. All measurements were performed by two independent observers, and one observer repeated all measurements to assess reproducibility. Both observers were blinded to the true linear measurements made on the pelvis.

Results: There was a strong correlation between the results of the conventional and EOS radiography (Pearson correlation coefficient, 0.644 to 0.998), and both modalities had high intraobserver and interobserver reproducibility (intraclass correlation coefficient, 0.795 to 1.000). Intraobserver and interobserver agreement on the presence of coxa profunda were both 100%. Intraobserver agreement (96.2%) and interobserver agreement (92.3%) on the presence of the crossover sign were marginally lower. Linear measurements differed significantly between the two modalities because of distortion caused by magnification effects in the conventional radiographic imaging (p < 0.05).

Conclusions: The EOS imaging technique proved reliable for the assessment of gross pelvic and acetabular morphology, and it may be an alternative to current radiography for primary imaging in the pediatric population and potentially in adults as well. This study did not evaluate the ability of EOS imaging to detect subtle radiographic anatomic abnormalities.
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http://dx.doi.org/10.2106/JBJS.K.01591DOI Listing
May 2013

Acetabular version on magnetic resonance imaging: analysis of two different measuring techniques.

Hip Int 2012 Nov-Dec;22(6):672-6

Department of Orthopaedics, Rady Children's Hospital, San Diego, CA, USA.

Background: Both increased anteversion and retroversion of the acetabulum can lead to clinical problems. Although computed tomography (CT) is the gold standard in acetabular version imaging, magnetic resonance imaging (MRI) is becoming increasingly popular. We conducted this retrospective study to answer the following questions: 1) can the bony landmarks necessary to outline and measure acetabular version on MRI be consistently and reproducibly identified; 2) are soft-tissue (labral) landmarks comparable to bony landmarks for the measurement of acetabular version?

Methods: Twenty-nine MRI torsional profile examinations were studied. A total of 232 readings (116 each for right and left sided acetabulae) were involved. Acetabular anteversion angle (AAA) was measured using two different methods (i.e. bony acetabulum landmarks and labrum), by two investigators, at two separate times.

Results: Mean age was 13 years, 8 months with a range of 14 years. There were 12 male patients and 17 female. It was possible to consistently identify bony and labral landmarks in all MR images. AAA measurements using both methods were consistent and reproducible. When comparing the two methods to each other we found them to be in excellent agreement with an ICC of 0.943 (95% confidence interval, 0.927 to 0.956), 37% of all readings were in perfect agreement and 97% were within 5 degrees. The mean difference in measurement between methods was 1.34 degrees.

Conclusion: Measurement of acetabular version using MRI remains consistent independent of the method used (bone versus labrum). MRI can provide adequate information for calculating acetabular version.
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http://dx.doi.org/10.5301/HIP.2012.10435DOI Listing
May 2013

[Vitamin D measurement in Portuguese patients with fragility fractures].

Acta Reumatol Port 2010 Jul-Sep;35(3):352-7

Serviços de Reumatologia do Hospital de São João e da Faculdade de Medicina da Universidade do Porto, Porto, Portugal.

Objectives: Osteoporosis is a «silent epidemic», resulting from a combination of many possible causal and risk factors, which prevalence depend on particular features of the population. The authors propose to characterize some of these elements, with special attention to vitamin D (vitD) levels, in a Portuguese population at risk, selected on the basis of a history of prior fragility fracture.

Methods: Participants were selected from the computerized list of discharges from all hospitalized patients in a Central Hospital in Oporto, between the dates 1/1/2002 and 31/12/2004, with the diagnosis of low-impact fracture of the wrist. They were invited to a reassessment of their risk of fracture, after 5 to 7 years from that event. For each one, a protocol was completed, focusing on clinical, epidemiological, laboratorial, radiological and densitometric parameters.

Results: In this population, as expected, there was a high rate of osteoporosis risk factors, which may explain the also high rate of subsequent osteoporotic fractures. Among others, early menopause, low intake of calcium and protein, levels of vitD generally inadequate and low frequency of osteopo-rosis treatment were noticed.

Discussion: The widespread insufficiency of vitD, described in other populations, mostly from the Northern countries, was also found here, supporting the suspicion that also in Portugal low vitD levels could be prevalent, despite the supposed regular sun exposure. These and other observations in this series, to be proven in directed studies, should, meanwhile, raise the levels of awareness of the community, but particularly health professionals and policymakers of public health, in a matter with a strong impact on individual and collective health in the country.
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February 2011

[Pertussis keeps on killing].

Rev Port Pneumol 2010 Mar-Apr;16(2):315-20

Serviço de Pediatria, CHMA, EPE - Unidade de Famalicão.

Pertussis, or whooping cough, is a highly infectious respiratory disease, endemic all over the world, caused by bacteria Bordetella pertussis. The authors describe the case of a 36 day old infant, brought to the emergency room due to respiratory distress and cyanosing cough, admitted with suspected pertussis infection complicated by bacterial pneumonia, having begun large spectrum antibiotics. Labs showed hyperleukocytosis and thrombocytosis. She was transferred to an Intensive Care Unit because of a worsened state, dying 20 hours after admission with pulmonary hypertension and haemorrhage. Pertussis was diagnosed by PCR. Over the last few years, there has been an increase in the number of cases of pertussis. Adolescents and adults have become an under-recognized but significant source of infection, particularly to small unvaccinated infants. The authors underline the importance of recognizing pertussis, so that even in its atypical presentation, one can suspect, treat, report and prevent a disease that is not, and is not expected to be, eradicated any time soon. New vaccination strategies are necessary, to avoid this disease, which can be fatal to the most vulnerable.
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http://dx.doi.org/10.1016/s0873-2159(15)30029-5DOI Listing
August 2010
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