Browsing by Author "Pinto, A"
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- Bone Histomorphometry RevisitedPublication . Vidal, B; Pinto, A; Galvão, MJ; Santos, AR; Rodrigues, A; Cascão, R; Abdulghani, S; Caetano-Lopes, J; Ferreira, A; Fonseca, JE; Canhão, HBone histomorphometry is defined as a quantitative evaluation of bone micro architecture, remodelling and metabolism. Bone metabolic assessment is based on a dynamic process, which provides data on bone matrix formation rate by incorporating a tetracycline compound. In the static evaluation, samples are stained and a semi-automatic technique is applied in order to obtain bone microarchitectural parameters such as trabecular area, perimeter and width. These parameters are in 2D, but they can be extrapolated into 3D, applying a stereological formula. Histomorphometry can be applied to different areas; however, in recent decades it has been a relevant tool in monitoring the effect of drug administration in bone. The main challenge for the future will be the development of noninvasive methods that can give similar information. In the herein review paper we will discuss the general principles and main applications of bone histomorphometry.
- Complicações Hemorrágicas e/ou Tromboembólicas em Doentes sob Anticoagulação Oral Regularmente Seguidos em Consulta DiferenciadaPublication . Pelicano, NJ; Branco, LM; Pinto, A; Sá, A; Timóteo, AT; Feliciano, J; Fiarresga, A; Agapito, AF; Palma, C; Quininha, JA consulta de hipocoagulação de um hospital central contempla uma população bastante diversificada, pelo que uma melhor compreensão das características da mesma, poderá levar à melhoria da prestação de cuidados de saúde e à diminuição do número de complicações tromboembólicas (resultantes da patologia base) e hemorrágicas [resultantes da própria terapêutica anticoagulante (ACO)]. Objectivos: Avaliar as características da população que frequenta a consulta de hipocoagulação e analisar quais podem predizer um maior risco de complicações. Métodos: Utilizaram-se os dados colhidos por um médico através de um questionário colocado a doentes durante a consulta de hipocoagulação. Foram efectuados 101 questionários e avaliaram-se as características demográficas (sexo, idade, escolaridade, grau de analfabetismo), os factores de risco clássicos para doença coronária, o diagnóstico que levou ao início da ACO, a duração da ACO, a periodicidade da determinação e valores mínimos, máximos e à data do questionário de INR e as complicações desta terapêutica. Consideraram-se como complicações o aparecimento de fenómenos hemorrágicos e/ou tromboembólicos, no decurso da terapêutica hipocoagulante. Resultados: Foram estudados 101 doentes, 74 do sexo feminino (73,3%), com idade média de 6410 anos (21-85). A população analisada tinha 4,5 ± 3,5 anos de escolaridade, com 15% de analfabetismo. A maioria dos doentes iniciou ACO após colocação de prótese valvular mecânica (56,4%). Em cada doente existia em média 1 factor de risco para doença coronária. O número de meses de ACO era de 99,489 (1-360). Sessenta e seis doentes (65,3%) conheciam o motivo pelo qual iniciaram esta terapêutica. Cada doente tinha efectuado 1,20,6 determinações de INR por mês e tinha, em média, um tempo máximo sem verificação do mesmo de 6,210,4 semanas. Quarenta e cinco doentes sofreram alguma complicação tromboembólica e/ou hemorrágica no decurso da terapêutica ACO. Ocorreram 50 complicações hemorrágicas, em 41 doentes, das quais 7 motivaram internamento. Detectaram-se 7 episódios de tromboembolismo central ou periférico, em 7 doentes. Posteriormente, dividiu-se a população em dois grupos: grupo I – com complicações (GI) e grupo II – sem complicações (GII). GI – 45 doentes, idade média 63,59,1 anos (39-80) e GII – 56 doentes, idade média 64,711,3 anos (21-85). Nos doentes que iniciaram ACO por prótese mitral detectou-se um maior número de complicações (60,6% no GI e 39,4% no GII, p=0,024). Também nos doentes com INR máximo recomendado > 3 (55,2% no GI e 44,8% no GII, p=0,013) e nos que tinham sido sujeitos a terapêutica estomatológica (68,3% no GI e 31,7% no GII, p<0,001) se verificou um maior número de complicações. A duração da ACO foi o factor mais significativo para o aparecimento de complicações (GI – 138,196,5 meses, GII – 67,868,2 meses, p <0,00005). Na análise multivariada apenas a duração da ACO se manteve como factor preditivo independente. Conclusões: Na população existe uma percentagem importante de doentes com baixa escolaridade, que se poderá repercutir sobre a compreensão desta terapêutica específica, não tendo contudo, neste estudo, revelado influência significativa na taxa de complicações. O aparecimento de complicações durante a terapêutica anticoagulante é dependente da duração desta, do valor do INR máximo recomendado e da realização ou não de procedimentos estomatológicos, sendo o primeiro factor o mais significativo.
- Doença de Hodgkin em Doente VIH Positivo: Dois CasosPublication . Pinto, A; Gouveia, J; Teófilo, E; Brotas, V; Pereira, MEOs autores apresentam dois casos de febre prolongada em doente com infecção VIH. O seu estudo conduziu ao diagnóstico de Doença de Hodgkin.
- Early Feeding Practices in Infants with Phenylketonuria Across EuropePublication . Pinto, A; Adams, S; Ahring, K; Allen, H; Almeida, MF; Garcia-Arenas, D; Arslan, N; Assoun, M; Atik Altınok, Y; Barrio-Carreras, D; Belanger Quintana, A; Bernabei, SM; Bontemps, C; Boyle, F; Bruni, G; Bueno-Delgado, M; Caine, G; Carvalho, R; Chrobot, A; Chyż, K; Cochrane, B; Correia, C; Corthouts, K; Daly, A; De Leo, S; Desloovere, A; De Meyer, A; De Theux, A; Didycz, B; Dijsselhof, ME; Dokoupil, K; Drabik, J; Dunlop, C; Eberle-Pelloth, W; Eftring, K; Ekengren, J; Errekalde, I; Evans, S; Foucart, A; Fokkema, L; François, L; French, M; Forssell, E; Gingell, C; Gonçalves, C; Gökmen Özel, H; Grimsley, A; Gugelmo, G; Gyüre, E; Heller, C; Hensler, R; Jardim, I; Joost, C; Jörg-Streller, M; Jouault, C; Jung, A; Kanthe, M; Koç, N; Kok, I L; Kozanoğlu, T; Kumru, B; Lang, F; Lang, K; Liegeois, I; Liguori, A; Lilje, R; Ļubina, O; Manta-Vogli, P; Mayr, D; Meneses, C; Newby, C; Meyer, U; Mexia, S; Nicol, C; Och, U; Olivas, SM; Pedrón-Giner, C; Pereira, R; Plutowska-Hoffmann, K; Purves, J; Re Dionigi, A; Reinson, K; Robert, M; Robertson, L; Rocha, JC; Rohde, C; Rosenbaum-Fabian, S; Rossi, A; Ruiz, M; Saligova, J; Gutiérrez-Sánchez, A; Schlune, A; Schulpis, K; Serrano-Nieto, J; Skarpalezou, A; Skeath, R; Slabbert, A; Straczek, K; Giżewska, M; Terry, A; Thom, R; Tooke, A; Tuokkola, J; van Dam, E; van den Hurk, TM; van der Ploeg, EC; Vande Kerckhove, K; Van Driessche, M; van Wegberg, AJ; van Wyk, K; Vasconcelos, C; Velez García, V; Wildgoose, J; Winkler, T; Żółkowska, J; Zuvadelli, J; MacDonald, AIn infants with phenylketonuria (PKU), dietary management is based on lowering and titrating phenylalanine (Phe) intake from breast milk or standard infant formula in combination with a Phe-free infant formula in order to maintain blood Phe levels within target range. Professionals use different methods to feed infants with PKU and our survey aimed to document practices across Europe.
- Endocardite Plurivalvular com Fenómenos Embólicos Múltiplos Periféricos e Pulmonares a Propósito de um Caso ClínicoPublication . Pinto, A; Branco, LM; Pelicano, NJ; Feliciano, J; Sobrinho, G; Agapito, AF; Salomão, S; Mota Capitão, L; Quininha, JA síndrome febril indeterminada no idoso coloca sempre alguma dificuldade diagnóstica. A endocardite infecciosa, pela relativa raridade e pela atipia das suas manifestações é muitas vezes esquecida neste grupo etário, onde outras causas, nomeadamente neoplásicas, são primeiramente consideradas. Os autores apresentam um caso clínico de uma doente idosa com endocardite infecciosa subaguda mitral e tricuspide, cujo diagnóstico foi estabelecido apenas após embolização periférica. Para além de fenómenos embólicos múltiplos, esta doente teve ainda como complicação um aneurisma micótico da artéria femural esquerda a que foi operada.
- Natural Protein Intake in Children with Phenylketonuria: Prescription vs. Actual IntakesPublication . Pinto, A; Daly, A; César Rocha, J; Ashmore, C; Evans, S; Ilgaz, F; Hickson, M; MacDonald, AIn phenylketonuria (PKU), an important component of the UK dietary management system is a 50 mg phenylalanine (Phe)/1 g protein exchange system used to allocate the Phe/natural protein intakes according to individual patient tolerance. Any foods containing protein ≤ 0.5 g/100 g or fruits/vegetables containing Phe ≤ 75 mg/100 g are allowed without measurement or limit. In children with PKU, we aimed to assess the difference between the prescribed natural protein intake and their actual consumed intake, and to calculate the natural protein/Phe intake from foods given without measurement or restriction. Over a 6-month duration, three one-day diet diaries were collected every month by caregivers of children with PKU at the beginning of a follow-up study. Dietary intakes of Phe, as well as natural and total protein intakes, were calculated using Nutritics® (v5.09). Weekly blood Phe spots were collected by caregivers. The target blood Phe level was ≤360 μmol/L for ages up to 12 years and ≤600 μmol/L for ages ≥12 years. Sixteen early treated children (69% females) with PKU were recruited. The median age was 11 years (range: 9-13), and most had classical PKU (n = 14/16). A median of 18 (range 12-18) one-day diaries and 22 blood spots were analysed for each subject over 6 months. The median prescribed natural protein was 6 g/day (range: 3-27), but when calculated, the actual median intake from all foods consumed was 10 g/day (range: 4-37). The median prescribed Phe was 300 mg/day (range: 150-1350), but the actual median intake was 500 mg/day (range: 200-1850). The median difference between the prescribed and actual natural protein daily intakes was +4 g/day (range: -2.5 to +11.5), with a median percentage increase of 40% for natural protein/Phe intake (p < 0.001). The median blood Phe level was 250 μmol/L (range 20-750), with 91% of blood Phe levels within the target range. Only one patient (11 years) had less than 75% of their blood Phe levels within the target range. The UK Phe exchange system provides flexibility in the dietary management of PKU. With this method, the actual natural protein intake was 167% higher than the prescribed amount. Although this led to a variable daily protein intake, the majority of children (n = 15/16) experienced no deterioration in their metabolic control.
- Peri-Prosthetic Bone Cysts After Total Ankle Replacement. A Systematic Review and Meta-AnalysisPublication . Arcângelo, J; Guerra-Pinto, F; Pinto, A; Grenho, A; Navarro, A; Martin Oliva, XBackground: Periprosthetic cystic osteolysis is a well-known complication of total ankle replacement. Several theories have been proposed for its aetiology, based on individual biomechanical, radiological, histopathology and outcome studies. Methods: Studies that met predefined inclusion/exclusion criteria were analysed to identify literature describing the presence of peri-prosthetic ankle cystic osteolysis. Quantitative data from the selected articles were combined and statistically tested in order to analyse possible relations between ankle peri-prosthetic bone cysts and specific implant characteristics. Results: Twenty-one articles were elected, totalizing 2430 total ankle replacements, where 430 developed peri-prosthetic cystic osteolysis. A statistically significant association (P<.001) was found between the presence of bone cysts and non-anatomic implant configuration, hydroxyapatite-coating, mobile-bearing and non tibial-stemmed implants. No significant association existed between the type of constraining and the presence of cysts (P>.05). Conclusions: Non-anatomic, mobile-bearing, hydroxyapatite-coated and non tibial-stemmed total ankle replacements are positively associated with more periprosthetic bone cysts.
- A Rat Model of Diabetic Wound Infection for the Evaluation of Topical Antimicrobial TherapiesPublication . Mendes, JJ; Leandro, C; Bonaparte, D; Pinto, ADiabetes mellitus is an epidemic multisystemic chronic disease that frequently is complicated by complex wound infections. Innovative topical antimicrobial therapy agents are potentially useful for multimodal treatment of these infections. However, an appropriately standardized in vivo model is currently not available to facilitate the screening of these emerging products and their effect on wound healing. To develop such a model, we analyzed, tested, and modified published models of wound healing. We optimized various aspects of the model, including animal species, diabetes induction method, hair removal technique, splint and dressing methods, the control of unintentional bacterial infection, sampling methods for the evaluation of bacterial burden, and aspects of the microscopic and macroscopic assessment of wound healing, all while taking into consideration animal welfare and the '3Rs' principle. We thus developed a new wound infection model in rats that is optimized for testing topical antimicrobial therapy agents. This model accurately reproduces the pathophysiology of infected diabetic wound healing and includes the current standard treatment (that is, debridement). The numerous benefits of this model include the ready availability of necessary materials, simple techniques, high reproducibility, and practicality for experiments with large sample sizes. Furthermore, given its similarities to infected-wound healing and treatment in humans, our new model can serve as a valid alternative for applied research.
- Suitability and Allocation of Protein-Containing Foods According to Protein Tolerance in PKU: A 2022 UK National ConsensusPublication . Gama, MI; Adam, S; Adams, S; Allen, H; Ashmore, C; Bailey, S; Cochrane, B; Dale, C; Daly, A; De Sousa, G; Donald, S; Dunlop, C; Ellerton, C; Evans, S; Firman, S; Ford, S; Freedman, F; French, M; Gaff, L; Gribben, J; Grimsley, A; Herlihy, I; Hill, M; Khan, F; McStravick, N; Millington, C; Moran, N; Newby, C; Nguyen, P; Purves, J; Pinto, A; César Rocha, J; Skeath, R; Skelton, A; Tapley, S; Woodall, A; Young, C; MacDonald, AIntroduction: There is little practical guidance about suitable food choices for higher natural protein tolerances in patients with phenylketonuria (PKU). This is particularly important to consider with the introduction of adjunct pharmaceutical treatments that may improve protein tolerance. Aim: To develop a set of guidelines for the introduction of higher protein foods into the diets of patients with PKU who tolerate >10 g/day of protein. Methods: In January 2022, a 26-item food group questionnaire, listing a range of foods containing protein from 5 to >20 g/100 g, was sent to all British Inherited Metabolic Disease Group (BIMDG) dietitians (n = 80; 26 Inherited Metabolic Disease [IMD] centres). They were asked to consider within their IMD dietetic team when they would recommend introducing each of the 26 protein-containing food groups into a patient’s diet who tolerated >10 g to 60 g/day of protein. The patient protein tolerance for each food group that received the majority vote from IMD dietetic teams was chosen as its tolerance threshold for introduction. A virtual meeting was held using Delphi methodology in March 2022 to discuss and agree final consensus. Results: Responses were received from dietitians from 22/26 IMD centres (85%) (11 paediatric, 11 adult). For patients tolerating protein ≥15 g/day, the following foods were agreed for inclusion: gluten-free pastas, gluten-free flours, regular bread, cheese spreads, soft cheese, and lentils in brine; for protein tolerance ≥20 g/day: nuts, hard cheeses, regular flours, meat/fish, and plant-based alternative products (containing 5−10 g/100 g protein), regular pasta, seeds, eggs, dried legumes, and yeast extract spreads were added; for protein tolerance ≥30 g/day: meat/fish and plant-based alternative products (containing >10−20 g/100 g protein) were added; and for protein tolerance ≥40 g/day: meat/fish and plant-based alternatives (containing >20 g/100 g protein) were added. Conclusion: This UK consensus by IMD dietitians from 22 UK centres describes for the first time the suitability and allocation of higher protein foods according to individual patient protein tolerance. It provides valuable guidance for health professionals to enable them to standardize practice and give rational advice to patients.
- The Impact of the Quality of Nutrition and Lifestyle in the Reproductive Years of Women with PKU on the Long-Term Health of Their ChildrenPublication . Gama, MI; Pinto, A; Daly, A; César Rocha, J; MacDonald, AA woman's nutritional status before and during pregnancy can affect the health of her progeny. Phenylketonuria (PKU), a rare disorder causing high blood and brain phenylalanine (Phe) concentrations, is associated with neurocognitive disability. Lifelong treatment is mainly dietetic with a Phe-restricted diet, supplemented with a low-Phe protein substitute. Treatment adherence commonly decreases in adolescence, with some adults ceasing dietary treatment. In maternal PKU, elevated blood Phe is harmful to the fetus so a strict Phe-restricted diet must be re-established preconception, and this is particularly difficult to achieve. A woman's reproductive years introduces an opportunity to adopt healthier behaviours to prepare for successful pregnancies and positive health outcomes for both themselves and their children. Several factors can influence the health status of women with PKU. Political, socioeconomic, and individual food and lifestyle choices affect diet quality, metabolic control, and epigenetics, which then pre-condition the overall maternal health and long-term health of the child. Here, we reflect on a comprehensive approach to treatment and introduce practical recommendations to optimize the wellbeing of women with PKU and the resultant health of their children.