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Master's thesis by Ana Curto

The city of Tomar was a burial site for centuries and for many peoples, including Romans and Arab... more The city of Tomar was a burial site for centuries and for many
peoples, including Romans and Arabs. The osteological sample studied is part of the skeletons buried at Santa Maria dos Olivais in Medieval/Modern Age. The sample in question is composed of 28 individuals, 25 adults and 3 sub-adults belonging to primary burials, the ossuaries associated with these burials weren’t analyzed in this study. Of the 25 adult individuals studied 11 are male, 9 female and in 5 it wasn’t possible to make a reliable sexual diagnosis. These individuals have a higher robustness in the right side, all the males are robust and the females not robust.
The paleopathological study of this sample revealed very interesting data, including degenerative pathology, both articular and nonarticular, in the upper limbs, indicating an intensive manual labor. There were also 13 cases of traumatic injuries, especially in males, signs of infectious pathology in 6
individuals, 8 cases of osteochondritis dissecans, cardiovascular disorders in the tibia and endocranium in 5 of the analyzed individuals and neoplasms in 4. There were also 6 pathologies of uncertain etiology and a case of Legg-Calve-Perthes disease.

Papers by Ana Curto

International Journal of Paleopathology, 2016

Maduromycosis, commonly called Madura foot, is na infectious pathology caused by fungi or bacteri... more Maduromycosis, commonly called Madura foot, is na infectious pathology caused by fungi or bacteria, and it is native of the tropical, subtropical and equatorial areas. This paper presents a well preserved male skeleton, between 23 and 57 years old from a medieval necropolis (13th-15th centuries) in Estremoz, Portugal. The left foot of this individual showed marked alterations on the morphology of the calcaneus and cuboid that are ankylosed, which led to arthrosis of the calcaneous and talus. The five metatarsals have bone destruction and irregular subperiosteal new bone formation with multiple lytic foci and progressive osteoporosis with very little reactive bone formation. After a careful differential diagnosis, taking into consideration various pathological conditions, it was concluded that this is a possible case of maduromycosis.This study suggests that in the past this pathology could have been present in Europe, particularly in the Mediterranean region, and especially when the climatic conditions were conducive. This could be one of the first cases of maduromycosis infection published in na archaeological context.

There is a bidirectional interaction across nutrition, infection and immunity. While good nutriti... more There is a bidirectional interaction across nutrition, infection and immunity. While good nutrition increases the immune system's response, immune deficits following malnutrition early in life have been shown to persist for weeks and even years. This study combines osteological and archaeometric analysis providing significant novel perspectives on the synergy between diet and health exploring stable isotope analysis. It is intended to assess whether stable isotope analysis can be used as a tool to study the impact of diet on the individuals' susceptibility to pathogens. This study will help understanding the physiological mechanisms of stress and disease prior to the advent of modern medicine and antibiotics, as well as improve dietary isotope data interpretation. The samples under study were recovered from Santa Maria do Olival, Tomar, Portugal (11th - 17th centuries). Stable isotope analyses were performed to 66 skeletons, 33 individuals without macroscopic indicators of p...

Maduromycosis, commonly called Madura foot, is an infectious pathology caused by fungi or bacteri... more Maduromycosis, commonly called Madura foot, is an infectious pathology caused by fungi or bacteria, and it is native of the tropical, subtropical and equatorial areas. This paper presents a well preserved male skeleton, between 23 and 57 years old from a medieval necropolis (13th–15th centuries) in Estremoz,
Portugal.The left foot of this individual showed marked alterations on the morphology of the calcaneus and cuboid that are ankylosed, which led to arthrosis of the calcaneous and talus. The five metatarsals have bone destruction and irregular subperiosteal new bone formation with multiple lytic foci and progressive osteoporosis with very little reactive bone formation. After a careful differential diagnosis, taking into
consideration various pathological conditions,it was concluded that this is a possible case of maduromycosis. This study suggests that in the past this pathology could have been present in Europe, particularly in the Mediterranean region, and especially when the climatic conditions were conducive. This could be one of the first cases of maduromycosis infection published in an archaeological context.

ABSTRACT. The Legg-Calvé-Perthes’ disease (LCPD) is an idiopathic avascular necrosis of the femor... more ABSTRACT. The Legg-Calvé-Perthes’ disease (LCPD) is an idiopathic avascular necrosis of the femoral head, related with a disruption of the blood supply, probably initiated with a trauma. It passes through four stages: the onset of avascular necrosis; subchondral fracture; revascularization and regeneration; and healing. This condition usually appears between 5 and 9 years old and boys are more affected than girls. Besides most cases have been sporadic, some factors, as genetic predisposition and environmental influences have been implicated in the etiology of LCPD. In this study we report a possible case of LCPD in a medieval/modern male adult from an excavation in Tomar, Portugal. In this individual not only we observed the usually features found in LCPD, like the femoral head in a form of mushroom and a slight disto-mesial rotation of the tibia, but also osteoarthritis in the calcaneus and astralagus, probably related to the changes in the femur. We also observed the presence of new bone in the last four thoracic vertebrae, at the right side it looks like melted candle wax down the front of the T9, T10 and T11 and in the T12 it was observed a total filling of the disc space with new bone. It was also noted high levels of changes in the enthesis and bone forming in some bones. This person shows an apparently tendency to ossify soft tissues and would have a very limited movement being heavily dependent on others.

Posters by Ana Curto

A slipped capital femoral epiphysis case study from medieval Estremoz, Slipped capital femoral ep... more A slipped capital femoral epiphysis case study from medieval Estremoz, Slipped capital femoral epiphysis is the result of a fracture at the growth plate of the femoral head. In this study we describe an adult male skeleton from a medieval necropolis in Estremoz, Portugal, in which we observed a misalignment of the left femoral head leading to the shortening of the neck. This condition resulted in an enlargement of the femoral head and probably leads to osteoarthritis in both the femoral head and the acetabulum.

Treponemal infections become apparent in four clinically different syndromes (syphilis, bejel, ya... more Treponemal infections become apparent in four clinically different syndromes (syphilis, bejel, yaws and pinta) and it can be difficult to differentiate them, with the exception of pinta which doesn't cause pathological changes in the human skeleton. The geographic distribution of these syndromes tends to be limited to specific climatic conditions, except for syphilis. Venereal syphilis can affect the bone during the tertiary stage of the disease, between 2 to 10 years following infection .

O indivíduo em estudo (SMOL-388) provem da necrópole medieval/moderna de Santa Maria do Olival (T... more O indivíduo em estudo (SMOL-388) provem da necrópole medieval/moderna de Santa Maria do Olival (Tomar) e foi diagnosticado como sendo um adulto do sexo masculino. As lesões neste indivíduo encontram-se na coluna vertebral, que apresenta fusão intra-articular das apófises articulares vertebrais e fusão costo-vertebral. Observa-se também calcificação e ossificação nos locais tendinosos das vértebras e erosão na articulação sacro-ilíaca. A extensão da anquilose vertebral terá conduzido a uma movimentação reduzida.

O esqueleto SMOL-362, diagnosticado como um indivíduo adulto maduro do sexo masculino, foi exumad... more O esqueleto SMOL-362, diagnosticado como um indivíduo adulto maduro do sexo masculino, foi exumado da necrópole medieval/moderna de Santa Maria dos Olivais, Tomar. Este indivíduo apresenta diversas lesões no esqueleto pós-craniano incluindo lesões traumáticas, infeciosas e degenerativas articulares e não articulares. Estas lesões indicam que o indivíduo em estudo teria uma atividade física muito intensa e que sobreviveu a várias lesões traumáticas.

Conference Presentations by Ana Curto

Talipes equinovarus é uma deformidade genética/congénita, rara na paleopatologia Portugue... more Talipes equinovarus é uma deformidade genética/congénita, rara na paleopatologia Portuguesa, cuja etiologia multifactorial é mal conhecida. A necrópole de onde provém o caso em estudo localiza-se em Estremoz, Portugal,
e terá sido utilizada do século XIII ao século XVIII. Foram recuperados 66 indivíduos, dos quais 60 adultos (19 femininos, 39 masculinos). Este estudo visa apresentar as alterações patológicas nos ossos do pé direito num adulto (RMPE-75), com 40 a 50 anos de idade à morte, ao qual se atribuiu o sexo masculino. O navicular, o cubóide, o cuneiforme lateral e o intermédio apresentam alterações nas facetas anteriores, modificando a articulação com os metatársicos. Porém, os locais mais afetados são as extremidades distais dos metatársicos, que se encontram aduzidas, alterando a posição das facetas articulares, que apresentam artrose mais severa do que no pé esquerdo. Observou-se
osteocondrite dissecante na superfície articular proximal do segundo metatársico e na superfície articular posterior do calcâneo. Sendo a osteocondrite dissecante causada pela interrupção no fornecimento sanguíneo ao tecido ósseo é possível que as deformações nos ossos do pé a tenham potenciado.

The city of Tomar was a burial site for centuries and for many peoples, including Romans and Arab... more The city of Tomar was a burial site for centuries and for many
peoples, including Romans and Arabs. The osteological sample studied is part of the skeletons buried at Santa Maria dos Olivais in Medieval/Modern Age. The sample in question is composed of 28 individuals, 25 adults and 3 sub-adults belonging to primary burials, the ossuaries associated with these burials weren’t analyzed in this study. Of the 25 adult individuals studied 11 are male, 9 female and in 5 it wasn’t possible to make a reliable sexual diagnosis. These individuals have a higher robustness in the right side, all the males are robust and the females not robust.
The paleopathological study of this sample revealed very interesting data, including degenerative pathology, both articular and nonarticular, in the upper limbs, indicating an intensive manual labor. There were also 13 cases of traumatic injuries, especially in males, signs of infectious pathology in 6
individuals, 8 cases of osteochondritis dissecans, cardiovascular disorders in the tibia and endocranium in 5 of the analyzed individuals and neoplasms in 4. There were also 6 pathologies of uncertain etiology and a case of Legg-Calve-Perthes disease.

International Journal of Paleopathology, 2016

Maduromycosis, commonly called Madura foot, is na infectious pathology caused by fungi or bacteri... more Maduromycosis, commonly called Madura foot, is na infectious pathology caused by fungi or bacteria, and it is native of the tropical, subtropical and equatorial areas. This paper presents a well preserved male skeleton, between 23 and 57 years old from a medieval necropolis (13th-15th centuries) in Estremoz, Portugal. The left foot of this individual showed marked alterations on the morphology of the calcaneus and cuboid that are ankylosed, which led to arthrosis of the calcaneous and talus. The five metatarsals have bone destruction and irregular subperiosteal new bone formation with multiple lytic foci and progressive osteoporosis with very little reactive bone formation. After a careful differential diagnosis, taking into consideration various pathological conditions, it was concluded that this is a possible case of maduromycosis.This study suggests that in the past this pathology could have been present in Europe, particularly in the Mediterranean region, and especially when the climatic conditions were conducive. This could be one of the first cases of maduromycosis infection published in na archaeological context.

There is a bidirectional interaction across nutrition, infection and immunity. While good nutriti... more There is a bidirectional interaction across nutrition, infection and immunity. While good nutrition increases the immune system's response, immune deficits following malnutrition early in life have been shown to persist for weeks and even years. This study combines osteological and archaeometric analysis providing significant novel perspectives on the synergy between diet and health exploring stable isotope analysis. It is intended to assess whether stable isotope analysis can be used as a tool to study the impact of diet on the individuals' susceptibility to pathogens. This study will help understanding the physiological mechanisms of stress and disease prior to the advent of modern medicine and antibiotics, as well as improve dietary isotope data interpretation. The samples under study were recovered from Santa Maria do Olival, Tomar, Portugal (11th - 17th centuries). Stable isotope analyses were performed to 66 skeletons, 33 individuals without macroscopic indicators of p...

Maduromycosis, commonly called Madura foot, is an infectious pathology caused by fungi or bacteri... more Maduromycosis, commonly called Madura foot, is an infectious pathology caused by fungi or bacteria, and it is native of the tropical, subtropical and equatorial areas. This paper presents a well preserved male skeleton, between 23 and 57 years old from a medieval necropolis (13th–15th centuries) in Estremoz,
Portugal.The left foot of this individual showed marked alterations on the morphology of the calcaneus and cuboid that are ankylosed, which led to arthrosis of the calcaneous and talus. The five metatarsals have bone destruction and irregular subperiosteal new bone formation with multiple lytic foci and progressive osteoporosis with very little reactive bone formation. After a careful differential diagnosis, taking into
consideration various pathological conditions,it was concluded that this is a possible case of maduromycosis. This study suggests that in the past this pathology could have been present in Europe, particularly in the Mediterranean region, and especially when the climatic conditions were conducive. This could be one of the first cases of maduromycosis infection published in an archaeological context.

ABSTRACT. The Legg-Calvé-Perthes’ disease (LCPD) is an idiopathic avascular necrosis of the femor... more ABSTRACT. The Legg-Calvé-Perthes’ disease (LCPD) is an idiopathic avascular necrosis of the femoral head, related with a disruption of the blood supply, probably initiated with a trauma. It passes through four stages: the onset of avascular necrosis; subchondral fracture; revascularization and regeneration; and healing. This condition usually appears between 5 and 9 years old and boys are more affected than girls. Besides most cases have been sporadic, some factors, as genetic predisposition and environmental influences have been implicated in the etiology of LCPD. In this study we report a possible case of LCPD in a medieval/modern male adult from an excavation in Tomar, Portugal. In this individual not only we observed the usually features found in LCPD, like the femoral head in a form of mushroom and a slight disto-mesial rotation of the tibia, but also osteoarthritis in the calcaneus and astralagus, probably related to the changes in the femur. We also observed the presence of new bone in the last four thoracic vertebrae, at the right side it looks like melted candle wax down the front of the T9, T10 and T11 and in the T12 it was observed a total filling of the disc space with new bone. It was also noted high levels of changes in the enthesis and bone forming in some bones. This person shows an apparently tendency to ossify soft tissues and would have a very limited movement being heavily dependent on others.

A slipped capital femoral epiphysis case study from medieval Estremoz, Slipped capital femoral ep... more A slipped capital femoral epiphysis case study from medieval Estremoz, Slipped capital femoral epiphysis is the result of a fracture at the growth plate of the femoral head. In this study we describe an adult male skeleton from a medieval necropolis in Estremoz, Portugal, in which we observed a misalignment of the left femoral head leading to the shortening of the neck. This condition resulted in an enlargement of the femoral head and probably leads to osteoarthritis in both the femoral head and the acetabulum.

Treponemal infections become apparent in four clinically different syndromes (syphilis, bejel, ya... more Treponemal infections become apparent in four clinically different syndromes (syphilis, bejel, yaws and pinta) and it can be difficult to differentiate them, with the exception of pinta which doesn't cause pathological changes in the human skeleton. The geographic distribution of these syndromes tends to be limited to specific climatic conditions, except for syphilis. Venereal syphilis can affect the bone during the tertiary stage of the disease, between 2 to 10 years following infection .

O indivíduo em estudo (SMOL-388) provem da necrópole medieval/moderna de Santa Maria do Olival (T... more O indivíduo em estudo (SMOL-388) provem da necrópole medieval/moderna de Santa Maria do Olival (Tomar) e foi diagnosticado como sendo um adulto do sexo masculino. As lesões neste indivíduo encontram-se na coluna vertebral, que apresenta fusão intra-articular das apófises articulares vertebrais e fusão costo-vertebral. Observa-se também calcificação e ossificação nos locais tendinosos das vértebras e erosão na articulação sacro-ilíaca. A extensão da anquilose vertebral terá conduzido a uma movimentação reduzida.

O esqueleto SMOL-362, diagnosticado como um indivíduo adulto maduro do sexo masculino, foi exumad... more O esqueleto SMOL-362, diagnosticado como um indivíduo adulto maduro do sexo masculino, foi exumado da necrópole medieval/moderna de Santa Maria dos Olivais, Tomar. Este indivíduo apresenta diversas lesões no esqueleto pós-craniano incluindo lesões traumáticas, infeciosas e degenerativas articulares e não articulares. Estas lesões indicam que o indivíduo em estudo teria uma atividade física muito intensa e que sobreviveu a várias lesões traumáticas.

Talipes equinovarus é uma deformidade genética/congénita, rara na paleopatologia Portugue... more Talipes equinovarus é uma deformidade genética/congénita, rara na paleopatologia Portuguesa, cuja etiologia multifactorial é mal conhecida. A necrópole de onde provém o caso em estudo localiza-se em Estremoz, Portugal,
e terá sido utilizada do século XIII ao século XVIII. Foram recuperados 66 indivíduos, dos quais 60 adultos (19 femininos, 39 masculinos). Este estudo visa apresentar as alterações patológicas nos ossos do pé direito num adulto (RMPE-75), com 40 a 50 anos de idade à morte, ao qual se atribuiu o sexo masculino. O navicular, o cubóide, o cuneiforme lateral e o intermédio apresentam alterações nas facetas anteriores, modificando a articulação com os metatársicos. Porém, os locais mais afetados são as extremidades distais dos metatársicos, que se encontram aduzidas, alterando a posição das facetas articulares, que apresentam artrose mais severa do que no pé esquerdo. Observou-se
osteocondrite dissecante na superfície articular proximal do segundo metatársico e na superfície articular posterior do calcâneo. Sendo a osteocondrite dissecante causada pela interrupção no fornecimento sanguíneo ao tecido ósseo é possível que as deformações nos ossos do pé a tenham potenciado.