Search

Pulses are nutrient-dense foods that have for a long time been empirically known to have beneficial effects in human health. In the last decade, several studies have gathered evidence of the metabolic benefits of pulse intake. However, it remains unclear at what amounts these effects may be attained. This study aimed to systematically review the scientific outputs of the last two decades regarding health benefits of pulse consumption and the amounts necessary for positive outcomes to be achieved. A PubMed search including keywords [(“dietary pulses”, “pulses”, “legumes”, “grain legumes”, “bean”, “chickpea”, “pea”, “lentil”, “cowpea”, “faba bean”, “lupin”) and (“inflammation”, “inflammatory markers”, “C-reactive protein”, “blood lipids”, “cholesterol”, “cardiometabolic health”, “cardiovascular disease”, “diabetes”, “glycaemia”, “insulin”, “HOMA-IR”, “body weight”, “body fat”, “obesity”, “overweight”, “metabolome”, “metabolic profile”, “metabolomics”, “biomarkers”, “microbiome”, “microbiota”, “gut”)] was performed. Only English written papers referring to human dietary interventions, longer than one day, focusing on whole pulses intake, were included. Most of the twenty eligible publications reported improvements in blood lipid profile, blood pressure, inflammation biomarkers, as well as, in body composition, resulting from pulse daily amounts of 150 g (minimum-maximum: 54-360 g/day; cooked). Concerns regarding methodological approaches are evident and the biochemical mechanisms underlying such effects require further investigation. This work was supported by National Funds from FCT through projects UID/Multi/50016/2019 and CICECO-Aveiro Institute of Materials, FCT Ref. UID/CTM/50011/2019 and POCI-01-0145-FEDER-007679, financed by national funds through the FCT/MCTES. Transition paths to sustainable legume-based systems in Europe (TRUE), has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No. 727973. H. Ferreira would like to acknowledge FCT for doctoral grant ref. SFRH/BDE/132240/2017.

Introduction: The malnutrition in children under 5 years is a serious public health problem in the developing countries such as Mozambique. The stunting can affect cognitive and physical development and compromise the school performance. Method: A cross sectional study was carried out which used the secondary data from a survey conducted by National Health Institute of Mozambique, in districts of Angonia, Tsangano, Magoe and Changara in Tete Province, Mozambique. The polynomial regression model and the hierarchical approach were used to examine the association between social economic factors and malnutrition in children measured by stunting (low height for age) and underweight (low weight for age). Results: The prevalence of moderate and severe stunting was 39.8%, and prevalence of moderate and severe underweight was 19.6%. In the basic level, the households that had 1 durable goods possession were associated to 1.46 times greater than the mild underweight, OR = 1.46 (C.I. 95% 1.02 - 2.11). In the intermediate level, lack of latrine increased 2.01 times greater than the moderate and severe underweight in children, OR = 2.01 (C.I. 95% 1.09 - 3.70); In the immediate level, the child deworming had 1.91 times greater than the moderate and severe stunting, OR = 1.91 (C.I.95% 1.04 - 3.52) and children who did not breastfeed had 2.42 times greater than the moderate and severe stunting, OR = 2.42 (C.I. 1.49 - 3.43). Conclusion: In the countries where the weak health system and the inadequate children food are frequent, the prevalence of undernutrition in children remains very high.

Introdução: Há alimentos transgénicos (modificados geneticamente) a serem cultivados, comercializados e consumidos em Portugal. É importante que os médicos se mantenham ao corrente quanto aos impactos de tais alimentos na saúde. Este trabalho propõe-se identificar a opinião, conhecimento e necessidades de formação dos médicos face aos alimentos transgénicos. Material e Métodos: Foi aplicado um inquérito a 278 médicos. Resultados: Em relação à opinião, 85,8% apresentam uma posição neutra, 12,5 % negativa e uma minoria (1,7%) positiva. No entanto, 79,8% têm um nível de conhecimento baixo, 17,7% médio e 2,5% alto. De referir que 91,4% consideram útil existir algum tipo de formação durante a educação universitária e 65,1% destacaram ser muito útil ao longo da vida profissional a existência de formação continuada sobre esta temática. Emergiram dois perfis de médicos: um grupo (83%), interessado em saber mais sobre alimentos transgénicos e outro grupo (17%), desinteressado. Discussão: Os médicos são considerados fontes de referência fiável a quem a população opta por recorrer para obter informação sobre saúde, o que sugere a necessidade de se manter um conhecimento suficiente e atualizado sobre este tema. Conclusão: Este estudo é pioneiro no que se refere ao posicionamento de médicos portugueses relativamente a estes alimentos. Os resultados apontam para uma necessidade de formação específica., Introduction: Transgenic (genetically modified) foods are being grown, sold and eaten in Portugal. As such it is important that physicians stay up to date on any negative health consequences of such foods. This study aimed to identify their opinion, knowledge and training needs regarding transgenic foods. Material and Methods: A total of 278 physicians responded to a survey. Results: In terms of opinion, 85.8% of physicians had a neutral position, 12.5% had a negative view and a minority (1.7%) was positive. However, 79.8% had a low level of knowledge, 17.7% had an average level of knowledge and only 2.5% showed a high level of knowledge regarding the subject. It should be noted that 91.4% of physicians consider that it is useful to carry out some kind of training during their university education and 65.1% said that it would be very useful during the professional life to have continuing education concerning the issue. Most physicians (83%) could be grouped together according to their interest in learning more. The other group (17%) showed lack of interest. Discussion: Physicians are considered reliable sources, to whom the general population can turn to in order to access valuable health information, which suggests the need to stay up-to-date regarding transgenic foods. Conclusion: This is a pioneering study on Portuguese physicians and transgenic foods. Results point to a need for specific training concerning this issue.

HIGHLIGHTS: Associations between FA supplementation in pregnancy and effects on offspring's NTDs, allergy/respiratory problems, cancer and behaviour problems as been studied. There is growing concern about the effects of excessive FA supplementation, whether in terms of doses or times of exposure. FA supplementation in the periconceptional period is protective against NTDs while in later periods it could be deleterious. A daily dose of 0.4 mg FA in the periconceptional period seems to be effective and safe. ABSTRACT: Maternal folic acid (FA) supplementation is one of the most popular nutritional interventions during pregnancy for its protective effect against neural tube defects (NTDs). The purposes of this review are: (a) to gather the current evidence regarding supplementation of maternal diet with FA and (b) to problematize the available literature in terms of dosages, critical temporal windows, and its potential benefits and risks. The expression (pregnancy OR fetus OR offspring OR mother) AND (“folic acid” AND supplementation) was searched on PubMed database, filtering for articles published from 2005 to 2014. Publications referring to FA supplementation during the periconceptional period or pregnancy in which there was a conclusion about the effects of isolated FA supplementation on pregnant woman, pregnancy or offspring were included. Of the initial 1182 papers, 109 fulfilled the inclusion criteria. The majority of the publications reported FA supplementation outcomes on offspring's health, with emphasis in NTDs, allergy/respiratory problems, cancer and behaviour problems. Some inconsistency is observed on the impact of FA supplementation on different outcomes, except for NTDs. It is also visible an increased concern about the impact of excessive supplementation, either in terms of doses or exposure's duration. In conclusion, there is a growing interest in FA supplementation issues. The protective effect of FA supplementation over NTDs has been confirmed, being the periconceptional period a critical window, and it is frequently suggested that allergy/respiratory outcomes arise from (excessive) FA supplementation particularly later in pregnancy. Further research on critical doses and time of exposure should be conducted.

Objective The purpose of this study is to examine the association of the clock drawing test (CDT) with incident dementia, cardiovascular events and mortality in very elderly hypertensive patients. Method All participants were hypertensive and aged 80 years and over. The CDT was administered at baseline and annually thereafter. Data on incident cardiovascular, fatal events and dementia were collected over follow-up. Results There were 3845 participants recruited and followed up for a mean of 2.1 years. Of these, 2701 completed a CDT with 2259 available at baseline. Of this group, 6.6% had a cardiovascular event, 6.1% died, and 10% were diagnosed with dementia. There was no relationship between baseline CDT score and subsequent cardiovascular events or mortality. For incident dementia, the hazard ratio was 0.88 (95% confidence intervals 0.83–0.94) suggesting that better performance on the baseline CDT was associated with a lower risk of dementia. Conclusion These results provide tentative support for the CDT alongside other cognitive screening tools in a hypertensive elderly population. Copyright © 2014 John Wiley & Sons, Ltd.

Purpose To evaluate prospectively if the impaction of a bone dowel in the tibial tunnel prevents the tunnels from enlarging beyond their original diameter. Methods Seventeen patients underwent arthroscopically assisted ACL reconstruction with hamstring autologous graft. All patients underwent CT of the knee on the day of surgery, at 3months and 12months post-op. Results On the day of surgery, the median cross-sectional areas of the tunnels were 77.0 and 79.0mm 2 , respectively at 15mm and 20mm from the tip of the posterior wall of the tunnel. At 3months, the median cross-sectional areas of the tunnels were 70.0 and 65.0mm 2 , at 15mm and 20mm. At 12months post-op, the median cross-sectional areas of the tunnels were 69.0 and 69.0mm 2 . The median enlargement of the tunnels between 3months and 12months post-op was 0.0mm 2 at 15mm and −2.0mm 2 at 20mm. Conclusions The impaction of an autologous bone dowel in the tibial tunnel during hamstring ACL reconstruction keeps the tunnels from enlarging beyond their original diameter, and there is no further enlargement of the tunnels after 3months post-op.

Introdução: Tem havido baixa adesão ao padrão da dieta mediterrânica na população portuguesa. Nesta perspectiva, procedemos à revisão crítica do estado de nutrição das mulheres em idade fértil, grávidas e recém-nascidos, em Portugal. Material e Métodos: Realizámos uma revisão narrativa crítica de estudos recentes com qualidade e inquéritos nacionais oficiais, que tivessem avaliado a dieta e estado de nutrição de mulheres em idade fértil e de grávidas portuguesas e sua influência no estado de nutrição dos respetivos fetos e recém-nascidos. Resultados: Foram selecionados e analisados cinco estudos ecológicos multinacionais que incluíram Portugal, dois inquéritos oficiais nacionais sobre disponibilidade de alimentos, sete estudos nacionais sobre dieta e estado de nutrição de mulheres em idade fértil e grávidas e cinco estudos nacionais sobre a influência de fatores nutricionais maternos no crescimento dos fetos. A prevalência de excesso de peso/obesidade em mulheres em idade fértil e grávidas aumentou substancialmente associada à diminuição da adesão à dieta mediterrânica. As variações no consumo de energia e macronutrientes na gravidez parecem não ter impacto significativo no estado de nutrição dos fetos. Pelo contrário, o excesso de peso/obesidade pré-concecional associa-se a aumento de adiposidade ao nascer e o excessivo aumento de peso na gravidez associa-se ao excesso ponderal na infância. Os fatores potencialmente relacio-nados com a baixa adesão à dieta mediterrânica, merecendo futura investigação, incluem políticas agrícolas da União Europeia que promoveram a produção de grupos alimentares não tipicamente mediterrânicos a baixo preço e a pouca capacidade financeira referida pela população portuguesa para aquisição de alimentos de qualidade.Conclusão: A recuperação dos hábitos dietéticos mediterrânicos tradicionais deve ser incluída em estratégias de prevenção e trata-mento do excesso de peso/obesidade em Portugal, especialmente em mulheres em idade fértil., Introduction: Portuguese population is drifting away from the Mediterranean diet-like pattern. In this context, the current nutritional status of women of childbearing age and of pregnant Portuguese women and their growing fetuses is critically reviewed. Material and Methods: A narrative critical review was performed on recent published high quality studies assessing diet and nutritional status of women of childbearing age and pregnant women and its influence on the nutritional status of their offspring. Results: Data from five multinational ecological studies that included Portugal, two national official surveys on food availability, seven national studies on the diet and nutritional status of women of childbearing age and pregnant women, and five national studies on the effect of nutritional maternal factors on their growing fetuses were selected and analyzed. The prevalence of overweight/obesity has dramatically increased in Portuguese women of childbearing age and pregnant women, associated with the described trend of low adherence to Mediterranean diet. Variations in energy and macronutrients intakes during pregnancy seem to have no significantly impact on the nutritional status of growing fetuses. On contrary, pre-pregnancy overweight/obesity has been associated with increased offspring adiposity at birth, and an excessive gestational weight gain may be associated with offspring’s overweight status in childhood. Factors potentially contributing to low adherence to the Mediterranean diet, deserving further investigation, include European Union agriculture policies that have implemented the production of non-Mediterranean food groups at low cost, and insufficient financial capacity to afford foods of quality reported by Portuguese population. Conclusion: Retrieving traditional Mediterranean dietary habits should be incorporated into strategies for prevention and treatment of overweight/obesity in Portugal, especially in women of childbearing age.

Background Underuse of medication considered beneficial is particularly common in elderly patients. A new Screening Tool to Alert Doctors to the Right Treatment (START) has been published to identify potential prescribing omissions. Objective To quantify and characterize potential prescribing omissions of cardiovascular risk management therapy using START criteria. Setting This study was conducted in the Stroke Unit of the university teaching hospital of Cova da Beira Hospital Centre, Covilha, located in the Eastern Central Region of Portugal. Method During 6 months, the medical files of all elderly patients (age ≥ 65 years) admitted with acute cardiovascular disease were reviewed and the START criteria applied to the information of medication, at admission and at the time of discharge from the hospital Stroke Unit. Main outcome measure Potential prescribing omissions of cardiovascular and endocrine pharmacological therapy were identified and the difference in the potential prescribing omissions between admission and discharge from hospital Stroke Unit was also evaluated. Results At the time of admission to the Stroke Unit, 101 potential prescribing omissions were found in 68.1 % (n = 91) of elderly (average 1.11 omissions per patient), of which 84.2 % (n = 85) were corrected at the time of discharge. In 14 patients, 16 omissions found at admission were not corrected during hospitalization, and in 5 patients 5 new omissions were detected. Conclusion Prescribing omissions of beneficial drugs are highly prevalent in acutely ill admitted to a Stroke Unit. START criteria represent a simple, evidence-based and easy-to-use tool to screen underuse of cardiovascular risk management therapy in elderly patients.

Two different approaches for drilling the femoral tunnel are commonly used in single-bundle anterior cruciate ligament (ACL) reconstruction: creating the femoral tunnel through the tibial tunnel or drilling the tunnel through a low anteromedial arthroscopy portal. When using a transtibial drilling technique, the location of the femoral tunnel is restricted by the angulation of the tibial tunnel in the coronal plane and may lead to a high placement of the femoral tunnel in the intercondylar notch. However, some authors refer that the femoral tunnel can be positioned correctly in the center of the femoral ACL footprint by means of a transtibial technique if the tibial tunnel forms an angle between 60 degrees and 65 degrees to the medial joint line of the tibia in the coronal plane. The purpose of this study was to evaluate prospectively with CT scans whether a femoral tunnel drilled through a tibial tunnel at an angle of 60 degrees-65 degrees in the coronal plane is created between the AM and PL bundles in the lateral femoral condyle. Our results showed that the median difference of the distance between the center of the femoral tunnel and the center of the AM and PL bundles along the Blumensaat's line was 6 and 5%, respectively. In the height of the femoral condyle, the median difference of the distance between the center of the femoral tunnel and the center of the AM and PL bundles was 0 and 31%, respectively. In conclusion, when drilling the femoral tunnel via a transtibial technique with the tibial tunnel angled 60 degrees-65 degrees in the coronal plane, the center of the femoral tunnel is created in the AM bundle footprint in the height of the femoral condyle.

Tunnel enlargement after anterior cruciate ligament (ACL) reconstruction may compromise revision surgery. The cause of this tunnel enlargement is not yet fully understood, but it is thought to be multifactorial, with biomechanical and biological factors playing a role. Tunnel enlargement has been described particularly in patients who underwent ACL reconstruction with hamstring tendons with extracortical fixation devices. The purpose of our study was to evaluate prospectively with magnetic resonance imaging (MRI) the changes in femoral tunnel diameter following arthroscopic anatomic ACL reconstruction with hamstring tendons. At 3-month post-op, all tunnels had enlarged compared to the diameter of the drill and most tunnels enlarged more in the midsection than at the aperture. In the posterolateral tunnels, the entrance increased 16% in diameter and the middle of the tunnel increased 30% in diameter. In the anteromedial femoral tunnels, the tunnels enlarged 14% at the aperture and 35% in the midsection. All femoral tunnels enlarged and most of them enlarged in a fusiform manner. The biological factors explain better our findings than the mechanical theory, although mechanical factors may play a role and the cortical bone at the entrance of the tunnel may modify the way tunnels respond to mechanical stress.

ObjectiveTo assess maternal diet and nutritional adequacy prior to conception and during pregnancy.DesignFollow-up of a cohort of pregnant women with collection of questionnaire data throughout pregnancy and after delivery.SettingAntenatal clinics at two public hospitals in Porto, Portugal.SubjectsTwo hundred and forty-nine pregnant women who reported a gestational age below 13 weeks at the time they attended their first antenatal visit.ResultsIntakes of energy and macronutrients were within recommended levels for most women. Pregnancy was accompanied by increases in the dietary intake of vitamins A and E, riboflavin, folate, Ca and Mg, but declines in the intake of alcohol and caffeine. The micronutrients with higher inadequacy prevalences prior to pregnancy were vitamin E (83 %), folate (58 %) and Mg (19 %). These three micronutrients, together with Fe, were also those with the highest inadequacy prevalences during pregnancy (91 %, 88 %, 73 % and 21 %, respectively, for folate, Fe, vitamin E and Mg). Ninety-seven per cent of the women reported taking supplements of folic acid during the first trimester, but the median gestational age at initiation was 6·5 (interquartile range 5, 9) weeks. Self-reported prevalences of Fe and Mg supplementation were high, and increased throughout pregnancy.ConclusionThe study identified low dietary intakes of vitamin E, folate and Mg both in the preconceptional period and during pregnancy, and low intake of Fe during pregnancy only. The low dietary intake of folate and the late initiation of supplementation indicate that current national guidelines are unlikely to be effective in preventing neural tube defects.

The world population is aging and disorders that are more prevalent in the elderly are of increasing importance. Hypertension falls into this category and has been linked to many adverse outcomes from stroke to mortality and dementia. Antihypertensive treatment has been shown to be successful in younger age groups but in those aged 80 years and over its benefits are not yet proven, and the risks and benefits of hypertension and antihypertensive treatment are unclear. Given this, it is useful to examine hypertension in the very elderly, the epidemiology, the likely impact of hypertension in this population, both physical and mental, and the as yet unclear issue of treatment. An ongoing, randomized, controlled trial in this age group will aid resolution of these issues and our understanding of this very elderly group.

Isolated systolic hypertension, an elevation in systolic but not diastolic pressure, is the most prevalent type of hypertension in those aged 50 or over, occurring either de novo or as a development after a long period of systolic-diastolic hypertension with or without treatment. The increase in blood pressure with age is mostly associated with structural changes in the arteries and especially with large artery stiffness. It is known from various studies that rising blood pressure is associated with increased cardiovascular risk. In the elderly, the most powerful predictor of risk is increased pulse pressure due to decreased diastolic and increased systolic blood pressure. All evidence indicates that treating the elderly hypertensive patient will reduce the risk of cardiovascular events. However, there is no evidence yet for the very elderly. This population is particularly susceptible to side effects of treatments and the reduction of blood pressure, although reducing the risk of cardiovascular events such as stroke, may result in increased mortality.

Introdução: Os linfomas não Hodgkin constituem um grupo variável de neoplasias do sistema linforreticular que por vezes podem ser difíceis de diagnosticar. Neste caso clínico apresenta-se um tipo raro de linfoma, com forma de apresentação rara, em que o médico de família teve um papel importante no diagnóstico. Descrição de caso: Homem de 73 anos que inicialmente se apresenta com tumefação supra-orbitária e queixas de sensação de pressão ocular, sem outros sintomas. É avaliado por oftalmologia, sendo considerado que as tumefações resultariam de tecido adiposo. Após agravamento de tumefação orbitária, surgimento de edema dos lábios e adenopatias cervicais suspeitou-se de doença linfoproliferativa. O utente é referenciado para consulta de medicina interna e chega-se ao diagnóstico de linfoma de células do Manto, após excisão e análise histológica de adenopatia. Comentário: Este caso clínico ilustra a dificuldade no diagnóstico que pode acarretar um linfoma não Hodgkin, dada a sua grande variabilidade de apresentações. O acompanhamento do doente ao longo das várias consultas foi essencial para se colocar a hipótese de diagnóstico de doença linfoproliferativa. Introduction: The non-Hodgkin's lymphomas are a diverse group of neoplasms of the lymphoreticular system. The diagnosis is often difficult. In this case report we present a rare type of lymphoma, with a rare form of presentation, in which the family doctor had an important role to play in collating clinical information to make the diagnosis. Case report: A 73-year-old man initially presented with supraorbital swelling and a complaint of pressure in the eye, without other symptoms. An ophthalmologist evaluated the patient and considered that the swelling arose from adipose tissue. After worsening of the orbital swelling and the appearance of swelling of the lips and cervical adenopathy, a lymphoproliferative disease was suspected. The patient was sent for an internal medicine consultation and the diagnosis of mantle cell lymphoma was made after excisional biopsy of a lymph node. Comment: This case shows some of the difficulty encountered in diagnosing a non-Hodgkin's lymphoma, given great variability in their presentations. Close follow-up of the patient during numerous consultations was essential to make the diagnosis of a lymphoproliferative disease. info:eu-repo/semantics/publishedVersion

To compare CT-guided and MRI-guided patient-specific instrumentation in total knee arthroplasty (TKA).Forty-four patients underwent primary TKA using either CT-guided or MR-guided Signature™ patient-specific instrumentation. They were prospectively assigned into two groups: 23 patients into the MR-guided instrumentation (group A) and 21 patients into the CT-guided patient-specific instrumentation (group B). All patients underwent computed tomography of the operated knee in the first week after the surgery to measure the components rotation.The femoral component rotation was 0.0° (0.0, 1.0) in group A and 0.0° (-2.0, 1.0) in group B. The tibial component rotation was -16.0° (-19.0, -14.0) in group A and -15.0° (-18.0, -8.0) in group B. In both components, there were no significant differences between the two groups. The difference between the tibial component rotation and the neutral tibial rotation was similar in both groups [2.0° (-1.4, 4.0) in group A and 3.0° (-0.5, 5.0) in group B], but the dispersion around the median was different between the two groups, with the amplitude of the difference between tibial rotation and neutral position 9° (-3.0, 6.0) in group A and 27° (-9.0, 18.0) in group B.MRI may be more accurate than CT using the Signature™ system when planning the surgical guides for TKA, with fewer patients with malrotation of the tibial component.II.

To compare the femoral and tibial components rotational alignment in total knee arthroplasty (TKA) performed either with conventional or with patient-specific instrumentation.Forty-five patients underwent primary TKA and were prospectively randomized into two groups: 22 patients into the conventional instrumentation group (group A) and 23 patients into the Signature™ patient-specific instrumentation group (group B). All patients underwent computed tomography of the operated knee in the first week after surgery to measure the components rotation.The femoral component rotation was 0.0° (-0.25, 1.0) in group A, and 0.0° (0.0, 1.0) in group B. The tibial component rotation was -16.0° (-18.5, 11.8) in group A, and -16.0° (-19.0, -14.0) in group B. There were no significant differences between the two groups in tibial and femoral components rotation. The difference between the tibial component rotation and the neutral tibial rotation was similar in both groups [2.0° (-0.5, 6.3) in group A and 2.0° (-1.0, 4.0) in group B], but the dispersion around the median was different between the two groups. The amplitude of the difference between tibial rotation and neutral position was 27° (-13, 14) in group A and 9° (-3, 6) in group B.There is a smaller chance of internal malrotation of the tibial component with the Signature™ patient-specific instrumentation system, with less dispersion and amplitude of the tibial component rotation around the neutral position.II.

To assess by magnetic resonance imaging (MRI) if adult non-cultivated bone marrow stem cells accelerate tendon-to-bone healing in the femoral tunnel, after hamstring anterior cruciate ligament (ACL) reconstruction. Forty-three patients underwent ACL reconstruction and were prospectively randomized into two groups: 20 patients in the experimental group (group A) with adult non-cultivated bone marrow stem cells and 23 patients in the control group (group B) without adult non-cultivated bone marrow stem cells. All patients underwent MRI of the knee at three months after surgery to evaluate the signal-to-noise ratio of the interzone. There was no difference in the signal-to-noise ratio of the interzone on MRI between the experimental and the control group. Adult non-cultivated bone marrow stem cells do not seem to accelerate graft-to-bone healing in ACL reconstruction. The clinical relevance of this finding is that adult non-cultivated bone marrow stem cells apparently have a limited role in ACL reconstruction. II.

The purpose of this study was to compare the transtibial reconstruction technique of the anterior cruciate ligament (ACL) with the anteromedial (AM) portal technique in their ability to place the femoral and tibial tunnels within the ACL footprints.Forty patients were sequentially enrolled in two different surgical techniques, 20 patients in the transtibial and 20 patients in the AM portal technique. All patients underwent computed tomography scan of the operated knee. The center of the femoral tunnel aperture on the lateral femoral condyle was measured according to the quadrant method. On the tibial side, the center of the tibial tunnel was measured in the sagittal plane. These measurements were compared with the center of the normal AM and PL bundles.There were no differences in the center of the femoral tunnels on the Blumensaat's line between the two groups (mean 23.5% (4.2) for the transtibial technique and 26.0% (4.3) for the AM portal technique (P = n.s.). In the height of the femoral condyle, the center of the tunnels was significantly lower in the AM portal technique group [mean 34.7% (3.8) vs. 24.0% (7.9) (P0.001)]. In the tibia, the center of the tunnel in the sagittal plane was significantly posterior in the transtibial technique (mean 55.4% (4.9) vs. 44.4% (3.7) (P0.001).The AM portal technique places the femoral and tibial tunnels more centrally in the ACL footprint when compared with the transtibial technique.II.

Background: depression is common in elderly people and may be associated with increased cardiovascular risk and incident dementia. Method: participants in the Hypertension in the Very Elderly Trial (HYVET) completed a depression screening instrument, the Geriatric Depression Score (GDS), at baseline and annually. We examined the association of GDS score with incident stroke, mortality and dementia using Cox proportional hazards models (hazard ratios, HR and 95% confidence intervals, CI) adjusted for treatment group and other potential confounders. Results: 2,656 HYVET participants completed the GDS. The mean follow-up was 2.1 years. A GDS score ≥6 was associated with increased risks of all-cause (HR 1.8, 95% CI 1.4–2.3) and cardiovascular mortality (HR 2.10, 95% CI 1.5–3.0), all stroke (HR 1.8, 95% CI 1.2–2.8) and all cardiovascular events (HR 1.6, 95% CI 1.2–2.1). Risk of incident dementia also tended to be increased (HR 1.28, 95% CI 0.95–1.73). Each additional GDS point at baseline also gave rise to a significantly increased risk of fatal and non-fatal cardiovascular events, all-cause mortality and dementia. Conclusion: there was a strong association between baseline depression scores and later fatal and non-fatal cardiovascular endpoints over a mean follow-up of 2 years in a hypertensive very elderly group. The mechanism of this association warrants further study.

This study aimed to evaluate the validity and reproducibility of a semi-quantitative food frequency questionnaire (FFQ) to estimate nutrient intake among Portuguese pregnant women. A sample of 101 pregnant women completed a 3-day food diary (FD) in each pregnancy trimester (reference method) and an interviewer-administered FFQ in the immediate post-partum period. Ranking women according to their usual intake showed that, on average, 65% were classified into the same +/-1 quintile and 2.4% into opposite quintiles by the two methods. Energy-adjusted and de-attenuated correlation coefficients ranged from 0.20 (protein) to 0.58 (riboflavin). Similar results were obtained when the FFQ was compared to each trimester-specific FD. To assess the FFQ reproducibility, 70 women in their third pregnancy trimester were interviewed twice within a 2-week interval. The level of agreement was high, with > or = 75% of the participants being classified into the same +/-1 quintile by the two administrations for 13 of the 15 nutrients examined. A review of the published literature revealed that this is the first FFQ to take the whole pregnancy as its reference time window. Our findings showed that a single administration of this FFQ in the immediate post-partum period is a valid tool to rank Portuguese pregnant women according to their intakes.

Background/Aims: The Clock Drawing Test (CDT) is used in clinical practice for the screening of cognitive disorders. This systematic review aims to present and discuss the CDT scoring methods available in the literature, in order to find differences in administration and utility of the CDT. Methods: A literature search was carried out in Medline (1966 to June 2008), Psychinfo (1967 to June 2008) and EMBASE (1980 to June 2008). Results: All studies showed good interrater and test-retest reliabilities. The correlation with other standard screening tests was statistically significant in most studies, but the results were influenced by age, education and language. In studies that included patients with mild or questionable dementia, the CDT had a low sensitivity and variable specificity. Conclusion: The CDT has the characteristics of a good screening method for moderate and severe dementia. However, the scoring method used and potential confounders need to be taken into consideration.

Aim To relate eating behaviours at 6 months of age with weight for gestational age at birth. Methods Study subjects belong to a population-based birth cohort assembled in Porto, Portugal (Generation XXI, n=8666). A sub-cohort of 1562 newborns was re-evaluated at 6 months and 1227 singletons presented data on variables of interest. Data were gathered by trained interviewers. Mother answered a questionnaire on socio-demographic, clinical and behavioural characteristics. Small for gestational age (SGA) and large for gestational age (LGA) were defined as 90th percentile, respectively, of sex-specific Kramer growth charts. OR and 95% CIs were obtained from unconditional logistic regression, after adjustment for sex, mother9s age, education and pre-pregnancy body mass index, maternal smoking during pregnancy, and breastfeeding. Results Approximately 15% of children were SGA and 4% were LGA. Compared to adequate for gestational age children, SGA had more frequently mothers reporting difficulties in feeding at 6 months (OR=1.52, 95% CI 1.01 to 2.31) and eating small quantities each time (OR=1.78, 95% CI 1.27 to 2.49). LGA children had also more feeding difficulties (OR=2.26, 95% CI 1.10 to 4.63) and a higher probability of refusing solid foods (OR=2.21, 95% CI 1.02 to 4.80). No associations were found neither with eating slowly, being angry at the meals9 end, choke with food and spitting up milk, nor a later weaning or inclusion of fruits and vegetables as first foods. Conclusions Both SGA and LGA children presented more feeding difficulties at 6 months of age, and LGA was associated with neophobia to solid foods.

OBJECTIVE: This article describes the rationale and methodology for the monitoring of ambulatory blood pressure and arterial compliance in hypertensive patients aged 80 years and above. This is a side project of the Hypertension in the Very Elderly Trial. METHODS: The hypertension in the Very Elderly Trial is a multicentre, double-blind, randomized, placebo-controlled trial aiming to investigate the effect of active treatment on cardiovascular and other outcomes in hypertensive patients aged 80 years or more. Patients are randomized to placebo or active treatment starting with the diuretic indapamide and adding the angiotensin-converting enzyme inhibitor perindopril if required. This study has completed a pilot trial and the main trial is now underway. Six hundred patients will have two ABPM recordings, the first at baseline and the second a year after randomization. Arterial compliance is measured using the Q wave (electrocardiogram) to Korotkoff diastole sound interval. RESULTS: Baseline characteristics for the first 50 patients recruited are presented. CONCLUSION: This side project will allow the investigation of 24-h ambulatory measures of blood pressure and arterial compliance as predictors of cerebrovascular and cardiovascular events in the very elderly. The project will also allow the investigation of the blood pressure and vascular compliance profiles in the very elderly and their changes with posture. The association between these measurements and mortality and morbidity in this age group will be addressed. ispartof: Blood pressure monitoring vol:11 issue:1 pages:3-8 ispartof: location:England status: published