Paediatric cervical spine injures. Nineteen years experience of a single centre.

PURPOSE: This observational study aims to describe pediatric C-spine injuries from a level 1 trauma centre through a period of 19 years. METHODS: Clinical records of pediatric trauma patients admitted to a level 1 trauma centre between 1991 and 2009 were analyzed. Patients were stratified by age into groups A (8 or less) and B (9 to 16), and in lower (C0-C2) and upper (C3-C7) spine injuries. Several variables were studied. RESULTS: Seventy-five cases of C-spine injuries (nine SCIWORA) were identified. Group A included 23 patients and group B 52. In group A, skeletal injuries at the upper C-spine were more common than injuries at the lower C-spine, whereas in group B, injuries of the lower C-spine were more frequent (p = 0.035). Motor vehicle accidents were the main cause of injury (44 %); 25.3 % of patients were surgically treated. Thirty-nine patients presented neurologic deficits, 16 of which improved. The overall mortality rate was 18.7 % and significantly higher in patients with neurological damages (p < 0.001) CONCLUSIONS: This study revealed a low incidence of cervical spine injuries in the paediatric population. As in previous reports younger children mainly sustained injuries at the upper C-spine, higher incidence of spinal injuries, and higher risk of death than older children.

Assessing quality of life in severe obesity: development and psychometric properties of the ORWELL-R.

PURPOSE: Several health-related quality-of-life (HRQoL) dimensions are affected by obesity. Our goal was to characterize the psychometric properties of the ORWELL-R, a new obesity-related quality-of-life instrument for assessing the "individual experience of overweightness". METHODS: This psychometric assessment included two different samples: one multicenter clinical sample, used for assessing internal consistency, construct validity and temporal reliability; and a community sample (collected through a cross-sectional mailing survey design), used for additional construct validity assessment and model fit confirmation. RESULTS: Overall, 946 persons participated (188 from the clinical sample; 758 from community sample). An alpha coefficient of 0.925 (clinical sample) and 0.934 (community sample) was found. Three subscales were identified (53.2 % of variance): Body environment experience (alpha = 0.875), Illness perception and distress (alpha = 0.864), Physical symptoms (alpha = 0.674). Adequate test-retest reliability has been confirmed (ICC: 0.78 for the overall score). ORWELL-R scores were worse in the clinical sample. Worst HRQoL, as measured by higher ORWELL-R scores, was associated with BMI increases. ORWELL-R scores were associated with IWQOL-Lite and lower scores in happiness. CONCLUSIONS: ORWELL-R shows good internal consistency and adequate test-retest reliability. Good construct validity was also observed (for convergent and discriminant validity) and confirmed through confirmatory factor analysis (in both clinical and community samples). Presented data sustain ORWELL-R as a reliable and useful instrument to assess obesity-related QoL, in both research and clinical contexts.

New intracanal formulations containing doxycycline or chlorhexidine against Enterococcus faecalis.

The present study aims to evaluate the antimicrobial effect of two new intracanal preparations against E. faecalis. Thirty single-rooted human canine teeth were used. The crowns were removed and the roots were instrumented using a conventional technique. Three groups of ten teeth each were infected with 108 CFU/ ml of E. faecalis for 21 days. The root canals were flled with new intracanal medications containing 3% doxycycline hydrochloride (DX) or 2% chlorhexidine digluconate (CHX). Ten teeth received no medication (NM)-negative control. Microbial samples were obtained 21 days after contamination: 14 days under the effect of the intracanal medications and 7 days after replacing the medications by BHI broth. The samples were homogenized, diluted, seeded on BHI agar and incubated for 48h/36°C. The number of colony forming units (CFU/ml) was obtained and analyzed statistically. All intracanal dressings significantly reduced the number of bacterial cells in the root canal after 14 days with medication. After the period with 7 days with BHI broth, the CFU counts of E. faecalis remained at low values. However, the NM group showed a significant increase of CFU in this period to similar values of the initial contamination. 3% doxycycline hydrochloride gel and 2% CHX gel were effective to eliminate E. faecalis from the root canal system.

Design and evaluation of a new nurse-led case management intervention for bariatric surgery patients.

This paper provides a new management about the treatment of obesity, that have a growing incidence worldwide. A management centered on the patients' needs during the bariatric surgery is necessary. In this context, patient monitoring and follow-up by a case manager, who guides the provision of specialized care focused on patient's adaptation to the new reality, can prove to be essential to achieve better outcomes. This study, guided by the Design Science Research Methodology (DSRM), will have as main objective to design a new intervention (Case-managing program) aimed at patients undergoing bariatric surgery. As secondary objectives, we intend to analyze the influence of the new intervention in the perioperative period and impact on several clinical and humanistic endpoints. In the evaluation phase, an experimental, controlled, and randomized study (RCT) will be developed, with an intervention group (IG) and a control group (CG). The CG will receive the usual care and the IG, will receive the intervention for an expected period of one year. This project aims to be the first study to investigate the effect of a long-term specialized case-management intervention (face-to-face and e-health) in patients who are candidates for bariatric surgery during all the perioperative periods. This method presents: • The results will be reported the patients related outcomes measures for bariatric surgery • The results are expected to provide an overview of the most effective case management interventions for long-term better results on bariatric surgery • Allowing researchers to design and propose a new case management for bariatric surgery.

Nurse-led intervention for the management of bariatric surgery patients: A systematic review.

The prevalence of obesity has become a global health concern, and severe obesity is associated with various chronic diseases and decreased quality of life. Bariatric surgery has shown success in treating obesity. Nevertheless, some patients experience weight regain and unsatisfactory outcomes. Multidisciplinary interventions have been shown to improve postoperative outcomes. Case managers, often specialized nurses, play a crucial role in patient support and coordination of care. However, the diverse design of case-managing interventions hinders the assessment of their success. Thus, the aim of this review is to identify the most successful structural characteristics of case-managing interventions, with or without the support of e-Health, in the process of perioperative management of bariatric surgery patients. A systematic literature review was conducted following the PRISMA guidelines. PubMed, MEDLINE, EBSCOhost, and CINAHL databases were searched for relevant studies published in the last 10 years. Eligible studies included randomized controlled trials, controlled clinical studies, case studies, or observational studies that evaluated perioperative care in bariatric surgery. The PICO framework was used to frame the search strategy. The initial search yielded 225 articles, of which 10 studies met the inclusion criteria. Nurse-led case-managing interventions with a multidisciplinary approach showed positive results in weight loss, physical activity, and quality of life. Patient-centered care models were found to promote adherence to treatment and patient satisfaction. E-Health technologies improved quality of life but not weight loss. The duration of behavioral interventions and the long-term outcomes after surgery remained unclear. Nurse-led case-management interventions, with a focus on behavioral change and multidisciplinary approaches, show promise in improving outcomes in bariatric surgery patients. Patient-centered care models and longer term interventions may contribute to sustained weight loss and better postoperative outcomes. Further research is needed to determine the optimal duration of interventions and the long-term effects on weight maintenance.

A dataset on skeletal muscle mass index, body composition and strength to determinate sarcopenia in bariatric patients.

Bariatric surgery is the treatment for severe obesity, with proven efficacy in reducing weight. Weight loss associated with bariatric surgery is greatly associated with a significant reduction of skeletal muscle and bone mineral mass, which leads us to induce that after bariatric surgery, patients incur an increased risk of sarcopenia. Prophylactic programs that prevent sarcopenia in bariatric surgery patients seems to be one of the crucial points for the long-term surgical success of bariatric and metabolic surgery. This article presents a initial data set of skeletal muscle mass index, body composition and strength to determinate sarcopenia in bariatric patients. The data were collected in a Central Hospital and in the University. In total, is necessary to recruit 46 patients waiting for bariatric surgery, between 18 and 60 years, men, and woman, without contradiction for exercise. The patients are randomized in two groups, for exercise group and control group. The evaluation is made on five points of timeline, before the surgery, after the surgery, after de exercise program, six months, and twelve months after the exercise program.

Effects of physical exercise in sarcopenia on patients undergoing bariatric surgery: A protocol for a randomized clinical trial.

Severe obesity is a chronic disease and bariatric surgery is the treatment with more proven efficacy in reducing weight. After surgery, the weight loss is greatly associated with a significant reduction of skeletal muscle and bone mineral mass, with an increased risk of sarcopenia for these patients. Prophylactic programs that prevent sarcopenia in bariatric surgery patients seems to be one of the crucial points for the long-term surgical success of bariatric and metabolic surgery. This article aims to describe a protocol using supervised exercise applied after bariatric surgery on skeletal muscle mass index, body composition and strength to determinate sarcopenia in bariatric patients. A RCT will be conducted with 46 patients. Baseline measures will be compared with measures after de exercise program, in five different chronologic times. Participants will be randomly allocated to: 1) combined exercise group or 2) control group. The intervention will be 16 weeks for a combined exercise, started 1 month after surgery. The present study is expected to generate significant information about the role of exercise in patients undergoing bariatric surgery.

The impact of exercise on prevention of sarcopenia after bariatric surgery: The study protocol of the EXPOBAR randomized controlled trial.

Introduction: Bariatric surgery is one of the treatments for severe obesity, with proven efficacy in reducing weight and diseases associated with obesity. Weight loss associated with bariatric surgery is greatly associated with a significant reduction of skeletal muscle and bone mineral mass, which leads us to induce that after bariatric surgery, patients incur an increased risk of sarcopenia. The need for prophylactic programs that prevent sarcopenia in bariatric surgery patients seems to be one of the crucial points for the long-term surgical success of bariatric and metabolic surgery. The aim of this randomized clinical trial will be to study the effects of a 16-week supervised exercise intervention program on the prevention of sarcopenia, in patients undergoing bariatric surgery. As a secondary purpose, it is also intended to characterize metabolic risk factors, physical fitness, and quality of life in post-bariatric surgery patients. Method: A total of 45 patients on the waiting list for bariatric surgery and who have subsequently perfurgery, will be include on EXPOBAR (EXercise POst BARiatric) and randomized into 2 groups, experimental and control. The intervention starts one month after surgery, for a total of 16 weeks. Parameters of body composition, metabolic risk, quality of life, physical activity, physical fitness, and sedentary behavior will be determined. For each participant, outcomes are measured at five different time points: before the surgery, before the exercise program, after the exercise program, six and twelve months after de exercise program. Results: This study will provide the effects of a physical exercise on sarcopenia, in patients after bariatric surgery. Trial registration: The trial was registered at Clinicaltrials.gov NCT03497546.

Highlighted Advances in Therapies for Difficult-To-Treat Brain Tumours Such as Glioblastoma.

Glioblastoma multiforme (GBM) remains a challenging disease, as it is the most common and deadly brain tumour in adults and has no curative solution and an overall short survival time. This incurability and short survival time means that, despite its rarity (average incidence of 3.2 per 100,000 persons), there has been an increased effort to try to treat this disease. Standard of care in newly diagnosed glioblastoma is maximal tumour resection followed by initial concomitant radiotherapy and temozolomide (TMZ) and then further chemotherapy with TMZ. Imaging techniques are key not only to diagnose the extent of the affected tissue but also for surgery planning and even for intraoperative use. Eligible patients may combine TMZ with tumour treating fields (TTF) therapy, which delivers low-intensity and intermediate-frequency electric fields to arrest tumour growth. Nonetheless, the blood-brain barrier (BBB) and systemic side effects are obstacles to successful chemotherapy in GBM; thus, more targeted, custom therapies such as immunotherapy and nanotechnological drug delivery systems have been undergoing research with varying degrees of success. This review proposes an overview of the pathophysiology, possible treatments, and the most (not all) representative examples of the latest advancements.

Nanoparticle-Based Treatment in Glioblastoma.

Glioblastoma (GB) is a malignant glioma associated with a mean overall survival of 12 to 18 months, even with optimal treatment, due to its high relapse rate and treatment resistance. The standardized first-line treatment consists of surgery, which allows for diagnosis and cytoreduction, followed by stereotactic fractionated radiotherapy and chemotherapy. Treatment failure can result from the poor passage of drugs through the blood-brain barrier (BBB). The development of novel and more effective therapeutic approaches is paramount to increasing the life expectancy of GB patients. Nanoparticle-based treatments include epitopes that are designed to interact with specialized transport systems, ultimately allowing the crossing of the BBB, increasing therapeutic efficacy, and reducing systemic toxicity and drug degradation. Polymeric nanoparticles have shown promising results in terms of precisely directing drugs to the brain with minimal systemic side effects. Various methods of drug delivery that pass through the BBB, such as the stereotactic injection of nanoparticles, are being actively tested in vitro and in vivo in animal models. A significant variety of pre-clinical studies with polymeric nanoparticles for the treatment of GB are being conducted, with only a few nanoparticle-based drug delivery systems to date having entered clinical trials. Pre-clinical studies are key to testing the safety and efficacy of these novel anticancer therapies and will hopefully facilitate the testing of the clinical validity of this promising treatment method. Here we review the recent literature concerning the most frequently reported types of nanoparticles for the treatment of GB.

Evaluation of the reactivity of sera from patients with systemic lupus erythematosus against the human MCP1.

This study evaluates metaphase chromosome protein 1 (MCP1), a nuclear antigen, as a diagnostic marker for systemic lupus erythematosus (SLE). Reactivity of sera from 114 Portuguese patients with autoimmune rheumatic disease or from healthy blood donors (HBD), against MCP1, produced in bacteria (bact-MCP1) or in its native form (native-MCP1), was determined by immunoblotting. Predictive and discriminative power of MCP1 reactivity for SLE diagnosis in disease-control groups was evaluated by logistic regression, its diagnostic value determined by receiver-operating characteristic analysis and compared with similar analysis of antinuclear antibody and double-stranded DNA (dsDNA). We demonstrated that native-MCP1, in contrast to bact-MCP1, reacts with SLE sera with significant predictive and discriminative power versus other autoimmune diseases (odds ratio [OR] ≤3.537 and ≥3.265; area under the receiver-operating characteristic curve [AUC] ≤0.643 and ≥0.636) or versus HBD (OR = 5.006; AUC = 0.671), showing a good diagnostic power with high specificity (82.1% versus HBD) and low sensitivity for SLE, similar to those of dsDNA. The reactivity of SLE sera with native-MCP1 was shown to be dependent on the presence of phosphorylated residues. Native-MCP1 was shown to have diagnostic value as a specific marker for SLE diagnosis and, therefore, is a suitable substrate for a new antibody test. The widely reported importance of phosphorylated epitopes as targets for autoantibodies in SLE could also be confirmed for native-MCP1.

The Portuguese version of the Personal and Social Performance Scale (PSP): reliability, validity, and relationship with cognitive measures in hospitalized and community schizophrenia patients.

PURPOSE: Deficits in social functioning are a core feature of schizophrenia and are influenced by both symptomatic and neurocognitive variables. In the present study we aimed to determine the reliability and validity of the Portuguese version of the Personal and Social Performance (PSP) scale, and possible correlations with measures of cognitive functioning. METHODS: One-hundred and four community and inpatients with schizophrenia were assessed using measures of social functioning and symptom severity alongside measures of executive function, processing speed, and verbal memory. RESULTS: Convergent validity with the GAF in the four domains of the PSP varied from 0.357 to 0.899. Reliability was found to be satisfactory, with a Cronbach's alpha coefficient of 0.789. Inter-rater reliability in the four domains of the PSP varied from 0.430 to 0.954. Low-functioning patients (PSP < 70) were older, had longer duration of illness, were more symptomatic and had worse cognitive performances, as compared with high-functioning patients (PSP ≥ 70). In a regression model, deficits in social functioning were strongly predicted both by symptomatic and neurocognitive variables; these together accounted for up to 62% of the variance. CONCLUSIONS: The present study supports the reliability and validity of the Portuguese language version of the PSP and further supports the original measure. The co-administration of brief cognitive assessments with measures of functioning may lead to more focused interventions, possibly improving outcomes in this group.

The Long-Term Association between Physical Activity and Weight Regain, Metabolic Risk Factors, Quality of Life and Sleep after Bariatric Surgery.

Bariatric surgery is currently regarded as a safe and effective long-term procedure for the treatment of obesity and related comorbidities. We analyzed the association between physical activity (PA), weight regain, metabolic risk factors and quality of life in patients submitted to bariatric surgery. This study also aimed to preliminarily assess how physical activity and weight regain may be associated with sleep quality and sedentary behavior. This was an observational study, with retrospective data collection and a cross-sectional survey. Retrospective clinical data were collected from a sample of 84 individuals who had undergone bariatric gastric bypass surgery at least five years prior to the study period in an Integrated Responsibility Center for Obesity and Metabolic Diseases Surgery. The survey, developed from validated questionnaires and applied in telephone interviews, focused on health data, associated comorbidities, quality of life, physical activity, sedentary behavior and sleep. Descriptive and comparative statistics were performed with a 95% confidence level. Bariatric surgery induced a significant weight loss in the first year after surgery. Our analysis also revealed that lower levels of PA were associated with weight regain. Quality of life as well as sleep quality were inversely related to weight regain, as well as sedentary behavior in general. Primary and secondary outcomes of bariatric surgery can be better achieved if the practice of PA could be maintained for consecutive years.

Arthroscopic Treatment of Freiberg Disease - Case Report.

Freiberg disease is a rare condition whose diagnosis requires a high clinical suspicion. Avascular necrosis of the metatarsal head progresses with articular collapse, leading to forefoot pain and limitation of the daily activities. Several surgical techniques have been described to address the disease, and since it is usually diagnosed in later-stages, most of them include joint-destructive procedures. The use of arthroscopy on the small joint of the foot has arisen in the last few years, but its application in Freiberg disease is still scant. Joint-preserving procedures have been advocated for cases of early-stage disease, aiming to relieve symptoms while preventing the progression of the disease. In the present report, we describe a successful treatment of a 12-year-old patient with early-stage Freiberg disease using core decompression and bone marrow graft through a minimally-invasive approach assisted by arthroscopy.

Normal ultrasound anatomy and common anatomical variants of the thyroid gland plus adjacent structures - A pictorial review.

BACKGROUND: High-resolution ultrasound is considered the best imaging technique for evaluating the thyroid gland, as it is accessible, non-invasive, and highly sensitive concerning the detection and characterization of thyroid nodules. However, a background knowledge of the normal ultrasound anatomy of the thyroid gland, adjacent structures, and its anatomical variants is crucial to avoid misdiagnosis in daily practice. Through this pictorial review, we intend to.

Cyberbullying: its nature and impact in secondary school pupils.

BACKGROUND: Cyberbullying describes bullying using mobile phones and the internet. Most previous studies have focused on the prevalence of text message and email bullying. METHODS: Two surveys with pupils aged 11-16 years: (1) 92 pupils from 14 schools, supplemented by focus groups; (2) 533 pupils from 5 schools, to assess the generalisability of findings from the first study, and investigate relationships of cyberbullying to general internet use. Both studies differentiated cyberbullying inside and outside of school, and 7 media of cyberbullying. RESULTS: Both studies found cyberbullying less frequent than traditional bullying, but appreciable, and reported more outside of school than inside. Phone call and text message bullying were most prevalent, with instant messaging bullying in the second study; their impact was perceived as comparable to traditional bullying. Mobile phone/video clip bullying, while rarer, was perceived to have more negative impact. Age and gender differences varied between the two studies. Study 1 found that most cyberbullying was done by one or a few students, usually from the same year group. It often just lasted about a week, but sometimes much longer. The second study found that being a cybervictim, but not a cyberbully, correlated with internet use; many cybervictims were traditional 'bully-victims'. Pupils recommended blocking/avoiding messages, and telling someone, as the best coping strategies; but many cybervictims had told nobody about it. CONCLUSIONS: Cyberbullying is an important new kind of bullying, with some different characteristics from traditional bullying. Much happens outside school. Implications for research and practical action are discussed.

Laparoscopic resolution of intussusception after Roux-en-Y gastric bypass.

INTRODUCTION: Roux-en-Y gastric bypass (RYGB) has been the most common surgical operation used to treat obesity and its inherent co-morbidities. Intussusception with bowel obstruction after RYGB is a rare complication and its physiopathology remains unclear. The diagnosis is generally based on typical image of computed tomography (CT) scan and a surgical exploration is generally recommended. CASE PRESENTATION: A 54-year-old female patient with history of a gastric bypass six years before, presented herself on the emergency department with acute onset of abdominal pain, nausea, and nonbilious vomiting. Her vital signs were stable. On abdominal evaluation a mass in the left flank was identified. The CT scan showed a small bowel intussusception. MANAGEMENT: Laparoscopic surgical exploration was performed and the diagnosis confirmed: retrograde jejunojejunal intussusception without vascular impairment. Reduction of the intussusception was possible without the need for bowel resection. A laparoscopic "second look" was made on the following day, revealing no signs of ischemia. There were no postoperative complications and the patient was discharged home on postoperative day 8. DISCUSSION: Intussusception after a RYGB is rare and the diagnosis is generally based on CT scan exam. Surgical exploration should be performed as soon as possible to prevent bowel ischemia and the need for resection.

Arthroscopic reduction and fixation of a lateral inverted osteochondral fracture of the talus ('LIFT').

Some ankle sprains hide important lesions beyond the classic lateral ligament complex injuries. The lateral inverted osteochondral fracture of the talus (LIFT) represents a rare osteochondral lesion, whose diagnosis relies on a high clinical suspicion followed by correct image study interpretation. We present a successful arthroscopic fixation of a LIFT lesion in a 45-year-old active man. At 8 months follow-up, the patient was pain free and able to return to his daily activities without limitation. The imagiological study showed osteochondral fragment consolidation with no signs of hardware failure. This midterm results reassemble the need for early diagnosis and correct treatment to achieve a good outcome in these complex and rare osteochondral lesions.

Adult Supratentorial Extraventricular Anaplastic Ependymoma: Therapeutic Approach and Clinical Review.

We report a 69-year-old patient with left paresthesia and hemiparesis. Magnetic resonance imaging revealed a right frontoparietal cystic tumor. A subtotal surgical resection was performed, and an Ommaya reservoir was left in place. The pathological diagnosis was supratentorial extraventricular anaplastic ependymoma. Radiation therapy was administered, and Ommaya reservoir drainages were performed. Four months after, her clinical status deteriorated after a reservoir drainage and image revealed an acute hemorrhage. An additional resection was carried out, and chemotherapy was undergone. One month later the tumor relapsed and the patient died 18 months after initial diagnosis. Some poor prognostic factors have been suggested in the literature: Young age, incomplete tumor resection - eloquent area location, histological anaplasia, supratentorial, and extraventricular locations. Ommaya reservoirs may be used in cystic lesions as a temporary measure only. Surgery is the mainstay of therapy with adjuvant radiotherapy and/or chemotherapy.

Long-Term Outcomes of the Calcaneo-Stop Procedure in the Treatment of Flexible Flatfoot in Children: A Retrospective Study.

INTRODUCTION: Flexible flatfoot is common amongst children, although treatment is rarely indicated. The calcaneo-stop procedure has been reported to be effective in short-term studies. We aim to evaluate the long-term outcomes of the calcaneo-stop procedure in the treatment of flexible flatfoot in children. MATERIAL AND METHODS: Twenty-six calcaneo-stop procedures performed between 1995 and 2006 on 13 patients were evaluated clinically and using photopodoscopy, and the FAOS questionnaire was applied for both feet. RESULTS: Of the 26 feet evaluated, 22 presented with heel valgus, 13 had forefoot supination and 11 had abnormal footprints. Median FAOS questionnaire score was 97.22 for 'Pain', 92.86 for 'Other symptoms', 98.53 for 'Function in daily living', 100 for 'Function in sports and recreation' and 93.75 for 'Foot and ankle-related quality of life'. DISCUSSION: The calcaneo-stop procedure is the least invasive and most simple surgical treatment for symptomatic flexible flatfoot in children. Short-term studies report excellent clinical and radiographic results. The authors report alterations in clinical parameters in a large proportion of patients. These findings can be due to biomechanical alterations in the years following removal of the screw. Patient foot and ankle-related satisfaction data is promising, although hard to evaluate given the absence of preoperative data. CONCLUSION: Larger, prospective, controlled studies are required to better evaluate the long-term success of this procedure.

Introdução: O pé plano flexível é comum entre as crianças, embora o tratamento seja raramente indicado. O procedimento calcaneostop tem sido reportado como eficaz em estudos a curto prazo. O objetivo deste trabalho é avaliar os resultados a longo prazo do procedimento calcaneo-stop no tratamento do pé plano flexível em crianças. Material e Métodos: Vinte e seis procedimentos calcaneo-stop, realizados entre 1995 e 2006, de 13 doentes, foram avaliados clinicamente e usando fotopodoscopia, e o questionário FAOS foi aplicado para ambos os pés. Resultados: Dos 26 pés avaliados, 22 apresentaram calcanhar valgo, 13 tinham supinação do antepé e 11 tinham pegadas consideradas anormais. As medianas das pontuações do questionário FAOS foram 97,22 para o parâmetro 'Dor', 92,86 para 'Sintomas', 98,53 para 'Funcionalidade, vida diária', 100 para 'Funcionalidade, desporto e atividades de lazer' e 93,75 para 'Qualidade de vida'. Discussão: O procedimento de calcaneo-stop é o tratamento cirúrgico menos invasivo e mais simples para o pé plano flexível sintomático em crianças. Estudos com avaliação a curto prazo relatam excelentes resultados clínicos e radiográficos. Os autores deste estudo reportam alterações nos parâmetros clínicos de uma grande proporção de pacientes. Esses achados podem ser devidos a alterações biomecânicas nos anos seguintes à remoção do parafuso. Os dados relativos à satisfação do paciente em relação ao pé e tornozelo são razoáveis, embora difíceis de avaliar, dada a ausência de dados pré-operatórios. Conclusão: São necessários estudos com mais casos, prospetivos, randomizados e com ocultação, para melhor avaliar o sucesso a longo prazo deste procedimento.