Joana Gomes - Academia.edu (original) (raw)

Papers by Joana Gomes

Hiccups are sudden and involuntary contractions of the diaphragm and intercostal muscles, which c... more Hiccups are sudden and involuntary contractions of the diaphragm and intercostal muscles, which causes sudden inspiration followed by abrupt closure of the glottis, generating a characteristic sound. There is a large panoply of pharmacological and non-pharmacological interventions that have been attempted to treat persistent or intractable hiccups. However none of the interventions showed sustained and consensual scientific evidence. Some studies have suggested favorable effects of acupuncture on eliminating persistent hiccups. In this article we report a clinical case in which acupuncture was used to eliminate persistent hiccups following brainstem stroke.

International Journal of Family & Community Medicine, 2018

The purpose of our study was to investigate the prevalence of bladder dysfunction symptoms in a d... more The purpose of our study was to investigate the prevalence of bladder dysfunction symptoms in a diabetic population, its relation to other diabetes complications, duration and type of diabetes, comparing to a healthy population. We also evaluated the disease impact in quality of life.

British Journal of Sports Medicine, 2017

Background Acrobatic Gymnastics is a competitive discipline where gymnasts work together, perform... more Background Acrobatic Gymnastics is a competitive discipline where gymnasts work together, perform acrobatic moves, dance and tumbling. Objective Investigate the prevalence of musculoskeletal (MS) disorders in former gymnasts. Design Survey of MS disorders (past and present), sent to former gymnasts. Setting This study included former gymnasts. Participants Retired gymnasts of national teams (n=200) and clubs (n=390) from all over the world (16 countries, 4 continents); 612 responders, 590 included according to the inclusion criteria. Interventions The survey included questions on country, gender, position, years of practice, hours of training/week and competition level, as well as medical information: reason for stopping practice (medical/nonmedical, specify the problem), injuries during practice years, present impact in daily life. Main Outcome Measurements Proportion (%) who stopped practicing as a consequence of a serious MS injury. Proportion (%) having any current MS disorder. Pre-specified analysis of relationship between training hours/week, competition level, position and % with current MS disorders in the present. Results Of 590 gymnasts, 294 (50%) reported having suffered a training injury, while 166 (28%) reported still having current medical problems as result of these. A total of 131 gymnasts (22%) reported having stopped practicing because of a medical problem and 121 (21%) reported having a current MS disorder. The most common injury was a traumatic fracture (n=125), most commonly affecting the knee (n=74) and ankle/foot (n=73). As a consequence of the training period, the most common current problems were spine pathology (n=43) and tendinopathies(n=38). Concerning actual symptoms, 402 (68%) reported low back pain, 320 (54%) knee and 219 (37%) shoulder disorders. Conclusions This is the first study of former gymnasts, allowing us to evaluate the impact of training on the future life quality of the athletes, to identify the most frequent injuries, as well as those with the greatest impact. This may lead to improvements in the treatment of acute injuries, as well as to monitor the level and quality of training, to prevent and also to rehabilitate injuries.

British Journal of Sports Medicine, 2016

Myositis ossificans (MO) is a condition characterised by non-neoplastic heterotopic proliferation... more Myositis ossificans (MO) is a condition characterised by non-neoplastic heterotopic proliferation of bone in soft tissue and skeletal muscle. It is benign and usually self-limited. The traumatic form is the most common, corresponding to 60-75% of cases, and occurs as a complication of large haematomas (20% of them). In athletes, causes of MO are contusions, strains or repeated micro-injuries by overuse. The bone will usually grow 2 to 4 weeks after the injury and becomes mature within 3 to 6 months. Symptoms of MO include pain in the muscle, and a restricted range of motion(ROM), particularly if the ossification occurs near a joint. An X-ray can confirm the diagnosis. Resolution with conservative treatment is seen in almost all cases, despite heterotrophic bone exostosis. Whenever a painful mass persists, surgical excision can be considered. J.C.,18-year-old female, gymnast of a national team, who practices 25 hours per week. Two weeks before the World Championship, after an intense training session, she developed an exuberant swelling on the cubital fossa and brachial region, restricted ROM (loss of 70° on elbow extension), without history of trauma during that session. Magnetic resonance imaging (MRI) demonstrated an increased volume of the brachial muscle body, with interstitial oedema, and an area corresponding to an intramuscular haematoma measuring 4 cm long and 1.4 cm thick, with changes suggesting interstitial partial rupture. Haematoma aspiration was not performed, no NSAIDs were given and she started a 3 day rehabilitation program that included immobilisation of the muscles in slight tension with compression, ice and elevation. Thereafter, manual therapy, stretching, strengthening (progressive eccentric training) and proprioceptive retraining were done, with gym routine to maintain flexibility, strength and aerobic conditioning. 15days after the lesion, she competed in the World Championship, although still having a 10° restriction on elbow extension and a painful isometric contraction of brachial muscle (Figure 1) After the competition, she re-started the previous rehabilitation program, with progressive complexity evolution during 30days. 45days after the lesion, the athlete recovered full range of motion, normal muscle function, returning to her previous gymnastic activity without pain, but a large mass still remained in the brachial muscle. Ultrasound and MRI revealed a MO of brachial muscle measuring 2.3cm transverse, 2.5cm anteroposterior and 6cm longitudinal diameter (Fig 2). As she had no functional limitations or pain, she continued to train and started conservative treatment of MO with extracorporeal-shock-wave-therapy(ESWT) and a program of supervised exercises and stretching. MO is a condition related to some risk factors, such as the severity of the initial injury, localised tenderness and swelling, re-injury during the recovery, delay in treatment over 72hours, improper management of the muscle haematoma, precocious return to competition. In this specific clinical case, the aspiration of the haematoma was not performed. Despite the correct approach of the injury, the athlete returned to activity too early, which may have contributed to the development of MO. If MO develops, the graded restoration of flexibility and strength with minimal pain becomes the goal of rehabilitation.

A transitória associada à gravidez foi descrita pela primeira vez em 1955 e foram apresentados 2 ... more A transitória associada à gravidez foi descrita pela primeira vez em 1955 e foram apresentados 2 casos desta patologia em 1959. É uma patologia pouco frequente, não havendo estimativas da sua incidência; no entanto, acredita-se que pode estar sub-diagnosticada1. É geralmente uma patologia autolimitada, que ocorre em mulheres no terceiro trimestre da gravidez ou no pós-parto imediato, especialmente em primigestas, caracterizando-se pelo aparecimento súbito de dor severa e incapacitante, afetando frequentemente o membro inferior, com maior incidência a articulação coxofemoral1,2. Surge geralmente uma coxalgia exuberante e rapidamente progressiva (incapacitando a marcha), podendo o atingimento ser bilateral entre 25 a 30% dos casos, sem outras alterações do sistema musculoesquelético ou neurológico3-5. Diferentes fatores de risco têm sido associados, mas a etiologia permanece desconhecida. Pensa-se estar associada a alterações neurovasculares, mecânicas (flexão excessiva da cabeça e co...

Hiccups are sudden and involuntary contractions of the diaphragm and intercostal muscles, which c... more Hiccups are sudden and involuntary contractions of the diaphragm and intercostal muscles, which causes sudden inspiration followed by abrupt closure of the glottis, generating a characteristic sound. There is a large panoply of pharmacological and non-pharmacological interventions that have been attempted to treat persistent or intractable hiccups. However none of the interventions showed sustained and consensual scientific evidence. Some studies have suggested favorable effects of acupuncture on eliminating persistent hiccups. In this article we report a clinical case in which acupuncture was used to eliminate persistent hiccups following brainstem stroke.

International Journal of Family & Community Medicine, 2018

The purpose of our study was to investigate the prevalence of bladder dysfunction symptoms in a d... more The purpose of our study was to investigate the prevalence of bladder dysfunction symptoms in a diabetic population, its relation to other diabetes complications, duration and type of diabetes, comparing to a healthy population. We also evaluated the disease impact in quality of life.

British Journal of Sports Medicine, 2017

Background Acrobatic Gymnastics is a competitive discipline where gymnasts work together, perform... more Background Acrobatic Gymnastics is a competitive discipline where gymnasts work together, perform acrobatic moves, dance and tumbling. Objective Investigate the prevalence of musculoskeletal (MS) disorders in former gymnasts. Design Survey of MS disorders (past and present), sent to former gymnasts. Setting This study included former gymnasts. Participants Retired gymnasts of national teams (n=200) and clubs (n=390) from all over the world (16 countries, 4 continents); 612 responders, 590 included according to the inclusion criteria. Interventions The survey included questions on country, gender, position, years of practice, hours of training/week and competition level, as well as medical information: reason for stopping practice (medical/nonmedical, specify the problem), injuries during practice years, present impact in daily life. Main Outcome Measurements Proportion (%) who stopped practicing as a consequence of a serious MS injury. Proportion (%) having any current MS disorder. Pre-specified analysis of relationship between training hours/week, competition level, position and % with current MS disorders in the present. Results Of 590 gymnasts, 294 (50%) reported having suffered a training injury, while 166 (28%) reported still having current medical problems as result of these. A total of 131 gymnasts (22%) reported having stopped practicing because of a medical problem and 121 (21%) reported having a current MS disorder. The most common injury was a traumatic fracture (n=125), most commonly affecting the knee (n=74) and ankle/foot (n=73). As a consequence of the training period, the most common current problems were spine pathology (n=43) and tendinopathies(n=38). Concerning actual symptoms, 402 (68%) reported low back pain, 320 (54%) knee and 219 (37%) shoulder disorders. Conclusions This is the first study of former gymnasts, allowing us to evaluate the impact of training on the future life quality of the athletes, to identify the most frequent injuries, as well as those with the greatest impact. This may lead to improvements in the treatment of acute injuries, as well as to monitor the level and quality of training, to prevent and also to rehabilitate injuries.

British Journal of Sports Medicine, 2016

Myositis ossificans (MO) is a condition characterised by non-neoplastic heterotopic proliferation... more Myositis ossificans (MO) is a condition characterised by non-neoplastic heterotopic proliferation of bone in soft tissue and skeletal muscle. It is benign and usually self-limited. The traumatic form is the most common, corresponding to 60-75% of cases, and occurs as a complication of large haematomas (20% of them). In athletes, causes of MO are contusions, strains or repeated micro-injuries by overuse. The bone will usually grow 2 to 4 weeks after the injury and becomes mature within 3 to 6 months. Symptoms of MO include pain in the muscle, and a restricted range of motion(ROM), particularly if the ossification occurs near a joint. An X-ray can confirm the diagnosis. Resolution with conservative treatment is seen in almost all cases, despite heterotrophic bone exostosis. Whenever a painful mass persists, surgical excision can be considered. J.C.,18-year-old female, gymnast of a national team, who practices 25 hours per week. Two weeks before the World Championship, after an intense training session, she developed an exuberant swelling on the cubital fossa and brachial region, restricted ROM (loss of 70° on elbow extension), without history of trauma during that session. Magnetic resonance imaging (MRI) demonstrated an increased volume of the brachial muscle body, with interstitial oedema, and an area corresponding to an intramuscular haematoma measuring 4 cm long and 1.4 cm thick, with changes suggesting interstitial partial rupture. Haematoma aspiration was not performed, no NSAIDs were given and she started a 3 day rehabilitation program that included immobilisation of the muscles in slight tension with compression, ice and elevation. Thereafter, manual therapy, stretching, strengthening (progressive eccentric training) and proprioceptive retraining were done, with gym routine to maintain flexibility, strength and aerobic conditioning. 15days after the lesion, she competed in the World Championship, although still having a 10° restriction on elbow extension and a painful isometric contraction of brachial muscle (Figure 1) After the competition, she re-started the previous rehabilitation program, with progressive complexity evolution during 30days. 45days after the lesion, the athlete recovered full range of motion, normal muscle function, returning to her previous gymnastic activity without pain, but a large mass still remained in the brachial muscle. Ultrasound and MRI revealed a MO of brachial muscle measuring 2.3cm transverse, 2.5cm anteroposterior and 6cm longitudinal diameter (Fig 2). As she had no functional limitations or pain, she continued to train and started conservative treatment of MO with extracorporeal-shock-wave-therapy(ESWT) and a program of supervised exercises and stretching. MO is a condition related to some risk factors, such as the severity of the initial injury, localised tenderness and swelling, re-injury during the recovery, delay in treatment over 72hours, improper management of the muscle haematoma, precocious return to competition. In this specific clinical case, the aspiration of the haematoma was not performed. Despite the correct approach of the injury, the athlete returned to activity too early, which may have contributed to the development of MO. If MO develops, the graded restoration of flexibility and strength with minimal pain becomes the goal of rehabilitation.

A transitória associada à gravidez foi descrita pela primeira vez em 1955 e foram apresentados 2 ... more A transitória associada à gravidez foi descrita pela primeira vez em 1955 e foram apresentados 2 casos desta patologia em 1959. É uma patologia pouco frequente, não havendo estimativas da sua incidência; no entanto, acredita-se que pode estar sub-diagnosticada1. É geralmente uma patologia autolimitada, que ocorre em mulheres no terceiro trimestre da gravidez ou no pós-parto imediato, especialmente em primigestas, caracterizando-se pelo aparecimento súbito de dor severa e incapacitante, afetando frequentemente o membro inferior, com maior incidência a articulação coxofemoral1,2. Surge geralmente uma coxalgia exuberante e rapidamente progressiva (incapacitando a marcha), podendo o atingimento ser bilateral entre 25 a 30% dos casos, sem outras alterações do sistema musculoesquelético ou neurológico3-5. Diferentes fatores de risco têm sido associados, mas a etiologia permanece desconhecida. Pensa-se estar associada a alterações neurovasculares, mecânicas (flexão excessiva da cabeça e co...