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Browsing by Author "Amorim, Rosa"

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  • After pediatric stroke, it’s time to enable!
    Publication . Jorge, Ines Santos; Vouga, Luis Afonso; Castro, João Paulo; Amorim, Rosa; Palhau, Lurdes
    Introduction: Although rare, pediatric stroke is more common than one may think. Deficits may not be evident in the short term but emerge months or years later, when psychomotor development, educational, and social requirements increase. Aims: To characterize the pediatric population with stroke followed at the Physical and Rehabilitation Medicine (PRM) consultation in a tertiary center and compare it with data in the literature and review the evidence on pediatric stroke rehabilitation care. Material and Methods: This was a retrospective study focusing on the first observation of stroke patients followed at a pediatric PRM consultation over 12 months. Gender, age, type of stroke, vascular territory, risk factors, functionality, event recurrence, and mortality were assessed. A bibliographic search was conducted on PubMed and Medline using the keywords ‘stroke’, ‘pediatric’, ‘perinatal’, ‘neuroplasticity’, ‘functionality’, and ‘rehabilitation’. Inclusion criteria comprised meta-analysis, systematic review, and review type of studies, written in Portuguese and English languages, and focusing human studies. Results: The study included 42 patients, 25 of whom were male (60%). Perinatal stroke was reported in 33 patients (13 in the prenatal period and 20 up to 28 days of life). Ischemic stroke was reported in 35 cases (83%), with the middle cerebral artery being the most affected vascular territory in 29 cases (69%). Fifty percent of patients had known risk factors, specifically prematurity in 21%. Fifty to 75% of patients had high functionality levels. No stroke recurrence or deaths were reported during the study period. Rehabilitation care should be implemented as soon as possible. Evidence-based guidance is still lacking for this population. Conclusions: Stroke, although uncommon in the pediatric population, is a major cause of morbidity and mortality. Diagnosis is challenging, as symptoms are often subtle and mimic other more frequent diseases in this age group. Timely referral to the physiatrist allows integration of the child into a rehabilitation program, optimizing neuroplasticity and improving participation in several activities.
    2021-09Journal article Open access Show more
  • Estimating the Glomerular Filtration Rate in Pediatric Patients With Neurogenic Bladder: A Comparison Between Creatinine- and Cystatin C-Equations
    Publication . Menezes, Catarina; Costa, Teresa; Brás, Catarina; Sousa, Patrícia; Mendes, Ana; Amorim, Rosa; Faria, Maria Do Sameiro; Mota, Conceição
    Background and objective Patients with neurogenic bladder (NB) are at a higher risk of developing chronic kidney disease (CKD). Due to their lower muscle mass, the estimated glomerular filtration rate (eGFR) based on creatinine (Cr) may be overestimated and delay the diagnosis of renal failure. This study compared eGFR calculated with different equations based on Cr and/or cystatin C (CysC) in children with NB, and the differences between patients with lower muscle mass (underdeveloped lower limbs) and those with independent gait (less muscle depletion). Methods We calculated the eGFR in pediatric patients with NB and CKD stages 1 and 2 by using the following equations: Chronic Kidney Disease in Children equation for serum creatinine (CKiD-Cr), CKiD-CysC, CKiD combined-Cr/CysC, Zappitelli-CysC, and Zappitelli combined-Cr/CysC. Results We evaluated a total of 47 patients, 74.5% with CKD stage 1, with a median age of 14.1 years. Of these participants, 59.6% had lipo/myelomeningocele. The CKiD-Cr and CysC-based equations led to significantly lower calculated eGFR ​​(p<0.05), specifically CKiD-CysC (p<0.001), Zappitelli-CysC (p<0.001), CKiD-Cr/CysC (p<0.001), and Zappitelli combined-Cr/CysC (p<0.05). When CKiD-CysC was used, 68% of the patients moved to a more advanced CKD stage. In patients without independent gait, with lower muscle mass (55.3%), the median eGFR calculated using the CKiD-Cr and CKiD combined-Cr/CysC equations was significantly higher (p<0.05). However, there were no differences between the two groups when using the other CysC-based equations. Conclusion In patients with NB and poor muscle mass, the CKiD-Cr equation may overestimate renal function. CysC-based equations seem more reliable in these patients, especially in those with greater muscular atrophy.
    2023-07Journal article Open access Show more