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Biomedical subjects

A L Santos

Publications and source records attributed to A L Santos.

At least 19 recordsLinked to original sources
PubMed1997

[Coronary disease in the postmenopausal woman. The experience of an intensive care unit over 10 years].

OBJECTIVES: Analysis of the characteristics of acute myocardial infarction in female patients admitted to a coronary care unit during a 10 year period. DESIGN: Retrospective analysis of computerized data collected during a 10-year period in every patient with acute myocardial infarction admitted between 1986 and 1995. SETTING: A coronary care unit of a central hospital. PATIENTS AND METHODS: Data on 2439 patients were analyzed in what concerns gender, age and hospital mortality. In the restricted group of 655 patients admitted between 1993 and 1995 the prevalence of the following risk factors was assessed: arterial hypertension, dyslipidemia, smoking and diabetes mellitus. RESULTS: During a 10-year period, 1918 male (M) and 521 female (F) patients were admitted, originating a 3.5 to 1 M:F ratio. The M:F relation decreased from decade to decade from 11:1 in patients under 50 years old to 1.8:1 in patients over 70 years old. Hospital mortality was 25.9% in female patients and 12.0% in male patients (p < 0.001). Mortality was similar in males and females until 60 years of age; significant differences were found only in the seventh decade of life (25% in females vs. 12% in males, p < 0.001) and in patients over 70 years old (36% in females vs. 24% in males, p < 0.005). Hypertension was significantly move prevalent in females (66% in females vs 46% in males, p < 0.001) as well as diabetes mellitus (31% in females vs. 20% in males). Similarly, a previous history of dyslipidemia was more frequently found in females than in males, but the difference was not significant (24% vs. 19%, respectively). On the contrary, smoking was significantly less frequent in female patients (11% in female patients vs. 44% in male patients, p < 0.001). CONCLUSIONS: The probability of the occurrence of acute myocardial infarction is very low in premenopausal women. The M:F ratio decreases with aging. The risk of death progressively increases with age, and it is significantly higher in females in relation to males after the age of 60 years. Women, besides being older, have a higher prevalence of coronary artery disease risk factors, namely hypertension, diabetes mellitus and dyslipidemia.

Adult↗
PubMed1996

Rapid epidemiologic assessment of breastfeeding practices: probit analysis of current status data.

We describe the use of probit analysis to estimate breastfeeding indicators from current status epidemiological data. A health centre-based sample of 2411 children aged 0-1 year was investigated in Santo Andre, a large town in the Metropolitan Area of Sao Paulo, southeastern Brazil. Mothers were interviewed during routine pediatric consultations and asked about their current infant feeding practices. Probit regressions were calculated by a public-domain microcomputer programme written by one of us. The median duration of total (i.e. exclusive plus partial) breastfeeding in this children's sample, estimated as 108.8 days (95 per cent confidence interval: 95.5-123.2 days), is close to that recently reported in the city of Sao Paulo and nearby towns. However, the median duration of exclusive breastfeeding (28.9 days, 95 per cent CI: 17.9-38.3 days) is rather short when compared to recent estimates from this same region. Despite the nationwide efforts for promotion of exclusive breastfeeding, only 14 per cent (95 per cent CI: 12.3-17 per cent) of the infants were still being exclusively breastfed by 120 days of age. Therefore, a key feature of breastfeeding practices in this population sample, namely, the early introduction of supplementary foods, was identified by using simplified methods of data collection and analysis. This communication suggests that probit analysis of current status data may be further explored as a method for rapid epidemiologic assessment of breastfeeding practices.

Brazil↗
PubMed1995

[Severe poisoning by organophosphate compounds. An analysis of mortality and of the value of serum cholinesterase in monitoring the clinical course].

Ingestion of organophosphate (OP) compounds usually results in severe poisoning. We undertook a retrospective study of 52 consecutive patients admitted with severe OP poisoning to determine the value of serum cholinesterase (SChE) in monitoring clinical course. Considering survivors and non-survivors, we evaluate clinical and laboratory baseline characteristics, severity scores (APACHE II, SAPS II), atropine rate (mg/h), SChE evolution at 24, 72 and 120 h and final SChE (SChE at the day of discharge or death). Mortality in the ICU was 28.9% (n = 15). In both groups SChE showed a trend to increase. In survivors, SChE recovery was statistically significant for SChE 24h-SChE 72 h, SChE 24 h-SChE 120 h and SChE initial-SChE 120 h (p = 0.008, p = 0.00003, p = 0.0002 respectively). In this group a simultaneous decrease in atropine requirements was registered. In non-survivors, the rate of atropine remained unchanged up to 120 h. Three groups could be defined in non-survivors according to their final SChE and day of death. Non-survivors-1 (death in the first 24h; 2 patients) and non-survivors-2 (death after the first 24 h; 5 patients) had a final SChE below 10% of normal SChE activity and statistically different from survivors' final SChE. Non-survivors-3 (8 patients) had a final SChE similar to the survivors and death was due to sepsis and multiple organ failure (MOF). We conclude that SChE is useful in OP poisoning diagnosis and also in monitoring clinical course. SChE recovery above 10% of normal seems to correlate with good prognosis. Sepsis and MOF were important determinants of mortality.

Acute Disease↗
PubMed1994

[The evaluation of the hemodynamic effects of captopril one year after a myocardial infarct].

In the present study, the authors evaluate the haemodynamic effects of continuous captopril therapy during one-year after a first anterior myocardial infarction (MI). Haemodynamic measurements are made during the first 48 hours after de MI and repeated one year later. Patients are divided in two groups: The first group had therapy with acetylsalicylic acid (ASA) and isosorbide dinitrate (ISDNI) and the second group had therapy with ASA, ISDNI and captopril. From their results the authors conclude that captopril helps peripheral resistances elevations, and that this is one of the mechanisms by which it can have a favourable effect after an anterior MI.

Adult↗
PubMed1993

[Unstable angina. An evaluation of a diagnostic and therapeutic methodology].

The authors describe the diagnostic and therapeutic management of 55 patients with the diagnosis of unstable angina admitted at a medical intensive care unit. According to Braunwald classification, 52 patients had primary angina and the remaining three had post-infarction angina. Risk stratification was based on non invasive procedures such as 2D echocardiogram and exercise test after clinical stabilization. Coronary angiography was performed in all patients. Most of the patients needed revascularization: 62% by percutaneous transluminal coronary angioplasty (PTCA) and 13% were submitted to coronary artery by-pass graft (CABG). None of the patients died during hospitalization.

Adult↗
PubMed1993

[Risk stratification in non-Q-wave myocardial infarct].

There was been some controversy about non-Q wave myocardial infarction, its evolution and prognosis. The most recent studies showed that, in spite of the low immediate mortality in non-Q wave myocardial infarction, the long-term risk of ischaemia, reinfarction or sudden death is equal or even greater than in the Q-Wave myocardial infarction. In order to define an adequate ischaemic risk stratification strategy in the post non-Q wave myocardial infarction without complications, the authors studied 21 patients who were submitted to treadmill exercise test and coronary angiography within 30 days after the acute event. Of the 17 patients with positive stress testing, 14 showed significant relationship between ischaemic area detected in the stress testing and the anatomic localization and severity of the lesions in the coronary angiography (chi 2 = 14,875; p < 0.006). Revascularization therapy (PTCA or bypass surgery) was very high in this group of patients (47.6%). From the date obtained the authors conclude that it is not necessary to use invasive studies in every patient that has suffered from non-Q wave myocardial infarction without complications, since the stress testing showed high sensitivity (94.4%), specificity (75%) and high predictive value (100%) in the ischaemic risk stratification.

Chi-Square Distribution↗
PubMed1989

[Automatic processing of clinical information related to 2334 myocardial infarcts consecutively hospitalized at a coronary care unit].

OBJECTIVE: Brief description of a clinical information system and its application to 2334 cases of acute myocardial infarction. DESIGN: To evaluate the influence on intra-hospital prognosis of 22 clinical characteristics observed in patients on the acute phase of myocardial infarction admitted to a coronary care unit. SETTING: Coronary care unit. PATIENTS: 2334 cases of myocardial infarction admitted sequentially to a coronary care unit. MATERIAL AND METHODS: A locally developed computerized information system was used. Software was organized in a modular way in order to turn available simplicity, flexibility and expandibility which are requisites of an automatic information system operating in a coronary unit. Following characteristics were evaluated: age and sex; previous myocardial infarction, angina, hypertension, diabetes, tabagism and hyperlipidemia; electrocardiographic localization of the infarction; ventricular dysfunction as evaluated by Killip classes; supraventricular and ventricular dysrhythmias; auriculo ventricular and intraventricular blocks; epistenocardic pericarditis; intra-hospital extension of the infarction; transient episode of hypertension and post-infarction angina. Statistical association between these characteristics and intra-hospital mortality was evaluated. Statistical significance was considered with a p less than 0.05. RESULTS: Statistical significant differences were found between surviving and non-surviving patients in the following characteristics: age and sex; previous history of myocardial infarction, angina and diabetes; Killip classes distribution; electrocardiographic localization of the infarction; intra-hospital extension of the infarction; auriculoventricular block, left and right bundle branch block; supraventricular and ventricular dysrhythmias. Patients with a previous history of tabagism and hyperlipidemia had a lesser mortality and were younger than the patients without these characteristics. Patients with transient episodes of hypertension and epistenocardic pericarditis had a lesser hospital mortality. CONCLUSIONS: Local development of a computerized information system turned available clinical information of 2334 patients sequentially admitted to a coronary care unit. A worse intra-hospital prognosis was present in the following groups of patients: older patients and females; patients with a previous history of infarction, angina and diabetes; anterior myocardial infarction, left ventricular dysfunction as evaluated by Killip classes, ventricular and supraventricular dysrhythmias, auriculoventricular and intraventricular blocks, transient episodes of hypertension and extension of the infarction. Patients with a previous history of tabagism and hyperlipidemia had a lesser mortality; however, there patients were younger than other. Patients with transient episodes of hypertension on first hours of infarction and those who had epistenocardic pericarditis had a lesser mortality.

Adult↗
PubMed1989

[Heart insufficiency in acute myocardial infarct. Long-term prognostic implications. Study of 213 cases of myocardial infarct].

OBJECTIVE: To evaluate intra-hospital and first year prognosis of the acute myocardial infarction. DESIGN: Univariate analysis of hospital and late mortalities in 21 characteristics on the evolution of the acute phase of myocardial infarction of patients sequentially admitted in a coronary care unit. SETTING: Coronary care unit and out patient clinic of a school hospital. PATIENTS: A group of 213 patients with acute myocardial infarction admitted sequentially in a coronary care unit was studied. MATERIAL AND METHODS: Making use of a computerized information system the following characteristics f the patients were prospectively studied: age, sex, previous history of myocardial infarction, angor, diabetes, hypertension and tabacism, presence of left ventricular dysfunction electrocardiographic localization of the infarction, presence of angor in the acute phase of the infarction, epistenocardic pericarditis, hypertensive reaction, hypotension, sinus tachycardia, sinus bradycardia, supraventricular disrhythmias, ventricular disrhythmias, A-V block, complete right bundle branch block, complete left bundle block and peak of CPK values. Univariate analysis was made between each one of these characteristics and hospitalar and one year mortalities. RESULTS: Statistically significant differences were obtained in the hospitalar mortality in the following characteristics: age (p less than 0.001), sex (p less than 0.03), previous history of diabetes (p less than 0.05) and tabagism (p less than 0.005), left ventricular disfunction (p less than 0.0005), hypotension (p less than 0.005), sinus tachycardia (p less than 0.0005), sinus bradycardia (p less than 0.024), A. V. block (p less than 0.004), and peak of CPK (p less than 0.05). Statistically significant differences were found in one year mortality in the following characteristics: age (p less than 0.001), left ventricular disfunction (p less than 0.02), sinus tachycardia (p = 0.0116) and peak of CPK (p less than 0.05). CONCLUSION: Influence in the hospitalar mortality was demonstrated by the following characteristics of the patients with myocardial infarction: age, sex, previous history of diabetes and tabagism, left ventricular disfunction, infarct size expressed by the peak values of CPK, sinus tachycardia, sinus bradycardia, hypotensive reaction in the acute phase of the myocardial infarction and A-V block. Mortality in the late phase infarction was influenced by age, left ventricular dysfunction, sinus tachycardia and peak values of CPK.

Adult↗
PubMed1975

Surgical mortality in the elderly.

Surgical mortality rates were reviewed for the four-year period 1970-1973, in a series of 2,186 operations. The majority of these operations were performed in patients aged 70 or older; of these, 116 were performed in patients of the 90+ age group. Predictably, the surgical mortality in the older groups was higher than in the younger groups. However, the overall mortality for patients aged 70 or older was 4.9 per cent as compared with 8 to 21 per cent for series reported in the literature. Gastrointestinal, biliary, and chest procedures carried a much higher mortality than did the other major categories. Minor surgical operations in the elderly should be approached with caution since they may be associated with a significant mortality rate. Nevertheless, elderly patients should not be denied surgical intervention, major or minor, on the basis of age alone when the operation can make their remaining years more comfortable.

Age Factors↗