Biomedical subjects

A Sousa

Publications and source records attributed to A Sousa.

50 records · Page 3Linked to original sources

PubMed1991

[Assessment of the first myocardial infarctions with lead ECG --implications in the study of hospital mortality and its reduction using thrombolytic drugs].

STUDY OBJECTIVE: Correlation between mortality reduction of first Myocardial Infarction (MI) by thrombolytic therapy and MI size evaluated with the classical Electrocardiogram (ECG). DESIGN: A retrospective sequential study. SETTING: Coronary Unit patients. PATIENTS: Sequential sample of 132 patients with first MI obeying all the following criteria: 1) no previous MI; 2) age less than or equal to 70 years; 3) clinical evolution less than 12 hours; 4) no Left Bundle Branch Block in the CCU first ECG; 5) ischemic ST elevation in greater than or equal to 1 initial ECG leads. Patients were divided into Group A, with less than or equal to 3 initial ECG leads with ischemic ST elevation (n = 80), and Group B, with greater than or equal to 4 initial ECG leads with ischemic ST elevation (n = 52). Only 34 patients (25.7%) did thrombolytic therapy with IV Streptokinase (SK); 15 from Group A and 19 from Group B. MEASUREMENTS AND MAIN RESULTS: 17 patients died in MI acute phase (12.8%); 4 in Group A (5%) and 13 in Group B (24.9%). Inhospital mortality was statistically worst in Group B than in Group A (24.9% vs 5% with p less than 0.01). Creatin kinase (CK) maximal values (A = 911.5 UI; B = 1444.6 UI with p less than 0.01) and initial Heart Rate (A = 75.7; B = 86.7 with p less than 0.001) were also statistically greatest in Group B. Inhospital mortality was smaller in patients treated with SK (8.8% vs 14.3%), as in Group B (10.5% vs. 33.3%), both without statistical significance. CONCLUSIONS: Inhospital mortality and thrombolytic therapy benefit were so bigger as MI size evaluated by the number of initial ECG leads with ischemic ST elevation, by initial HR and maximal values of CK. Classical ECG can be useful by identifying patients with first MI that can more benefit with thrombolytic therapy (greater than or equal to 4 leads with ischemic ST elevation).

Aged↗

PubMed1985

Congenital aneurysm of the sinus of Valsalva. Surgical repair in an infant.

We report the case of a 5-month-old infant with cardiac failure and an unruptured aneurysm of the right coronary sinus of Valsalva. Emphasis is put on the diagnostic value of the echocardiogram. Cardiac failure was probably due to a combination of aortic regurgitation and compression of the outflow tract of the right ventricle. The surgical approach is discussed. The defect was repaired through an aortotomy. The aneurysmal sac was resected and an aortic valvuloplasty was performed. Twelve months postoperatively the patient continues to be asymptomatic; an aortic root angiogram shows only trivial aortic insufficiency.

Aortic Aneurysm↗

PubMedDate not supplied

Schistosomiasis in the Republic of São Tomé and Principe: human studies.

The only schistosome species found in stool specimens in the local population of the republic of São Tomé is Schistosoma intercalatum. An initial survey of schoolchildren showed an overall prevalence of 10.9%, with some schools reaching 29%. No S. haematobium egg was found in 782 urine specimens from the local population, although some were seen in the urine of Angolan soldiers stationed near the capital city. One village in the endemic area, San Marçal, had an S. intercalatum prevalence of 43%, with 14 persons > 40 years of age harbouring severe infections. The transmission area is restricted to the north-east of the main island, where 5 foci apparently account for most of the infections. Seven cases recorded from Principe may be explained by the fact that the children were attending school at São Tomé. Women carrying out domestic activities are more at risk of contracting the infection because of longer periods of water contact than men. The morbidity produced by the infection is restricted to splenomegaly and blood in the stools. High prevalences have been found of Ascaris lumbricoides and Trichuris trichiura, and hookworm and Stronglyloides stercoralis were also observed. Praziquantel was well tolerated and appears to be a good tool for control purposes, although reinfection in the transmission area apparently occurs rapidly. Control strategies based on chemotherapy should take into account an older age group as well as the schoolchildren. Focal mollusciciding and the introduction of washing facilities may also have a role to play in control. The possible recent introduction of the infection to the island is discussed.

Adolescent↗

PubMedDate not supplied

Study of three intragenic polymorphisms in the Machado-Joseph disease gene (MJD1) in relation to genetic instability of the (CAG)n tract.

Intergenerational instability is one of the most important features of the disease-associated trinucleotide expansions, leading to variation in size of the repeat among and within families, which manifests as variable age at onset and severity, and is probably the basis for the occurrence of anticipation. Several factors are known to affect the degree of instability, namely the type of repeated sequence, its initial size, the presence or absence of interruptions in the repetitive tract and the gender of the transmitting parent. A recent study demonstrated the effect of an intragenic polymorphism (C987GG/G987GG) in the Machado-Joseph disease causative gene, immediately downstream of the CAG repeat, on the intergenerational instability of the expanded repeat. Surprisingly, there was an effect not only of the specific allele in cis to the disease chromosome, but also of the allele on the normal chromosome, suggesting the existence of an interaction between the normal and expanded alleles that affects the fidelity of replication of the (CAG)n tract. This effect could be a direct effect of the polymorphism studied or, alternatively, this polymorphism could be in disequilibrium with some other flanking sequence which affects the instability of the repetitive (CAG)n tract. In order to confirm the previous results in a different population and to distinguish between a direct and indirect effect of the CGG/GGG polymorphism, we typed 70 parent-progeny pairs for which the variation in the (CAG)n length in the MJD1 gene was known, for three intragenic polymorphisms: C987GG/G987GG and two additional, newly described ones, TAA1118/TAC1118 and A669TG/G669TG. We also typed a control population of 125 individuals for the A669TG/G669TG, C987GG/G987GG and TAA1118/TAC1118 polymorphisms, in an attempt to identify any association between haplotype and (CAG)n length in normal chromosomes, suggestive of an instability-predisposing effect of the repeat-flanking sequences, which could have led to the origin of the MJD mutation in the human population. We confirmed the effect of the C987GG/G987GG polymorphism on intergenerational instability when present in trans. Our results suggest that this effect is restricted to a small region of the gene, immediately downstream of the CAG repeat, which includes this particular nucleotide substitution and the stop codon of the MJD1 cDNA, and is not a more widespread chromosomal effect. The lack of a significant association of any specific intragenic haplotype with larger CAG repeats in normal chromosomes, together with the absence of an effect of the intragenic haplotype in cis on the intergenerational instability of the expanded (CAG)n in MJD families does not indicate the existence of an instability-predisposing haplotype.

Alleles↗

PubMedDate not supplied

Skeletal maturity and socio-economic status in Portuguese children and youths: the Madeira growth study.

BACKGROUND: Skeletal maturity is used to evaluate biological maturity status. Information about the association between socio-economic status (SES) and skeletal maturity is limited in Portugal. AIMS: The aim of this study is to document the skeletal maturity of youths in Madeira and to evaluate variation in maturity associated with SES. SUBJECTS AND METHODS: The study involved 507 subjects (256 boys and 251 girls) from the Madeira Growth Study, a mixed-longitudinal study of five cohorts (8, 10, 12, 14 and 16 years of age) followed at yearly intervals over 3 years (1996-1998). A total of 1493 observations were made. Skeletal age was estimated from radiographs of the hand and wrist using the Tanner-Whitehouse 2 method (TW2). Social class rankings were based on method. Five social rankings were subsequently grouped into three SES categories: high, average and low. RESULTS: Median for the radius, ulna and short finger bones (RUS scores) in the total sample of boys and girls increased curvilinearly across age whereas median for the 7 (without pisiform) carpal bones (Carpal scores) increased almost linearly. The 20-bone maturity scores demonstrated distinctive trends by gender: the medians for boys increased almost linearly while the medians for girls increased curvilinearly. SES differences were minimal. Only among children aged 10-11 years were high SES boys and girls advanced in skeletal maturity. Madeira adolescents were advanced in skeletal maturity compared with Belgian reference values. CONCLUSION: The data suggests population variation in TW2 estimates of skeletal maturation. Skeletal maturity was not related to SES in youths from Madeira.

Adolescent↗

PubMedDate not supplied

Familial amyloidotic polyneuropathy in Sweden: geographical distribution, age of onset, and prevalence.

Familial amyloidotic polyneuropathy (FAP) in Swedish patients is associated with the same transthyretin mutation (TTRMet30) as in Portuguese, Japanese, Brazilian and Majorcan patients. Yet, the age of onset of FAP is much later in Sweden than in other populations. We have studied 239 cases of FAP from northern Sweden, their geographical distribution, differences in age of onset, and estimated prevalence and incidence rates. Cases and families concentrate mainly in two areas, around the towns of Skellefteå and Piteå. Mean age of onset was found to be later in the Piteå (58.8 +/- 10.8) than in the Skellefteå area (54.4 +/- 13.5). Unusually high figures were found for prevalence rates (91 x 10(-5) and 104 x 10(-5), respectively) in 1985. Mean yearly incidences were 3.1 x 10(-5) and 4.4 x 10(-5), respectively, over the period 1985-1989.

Adult↗

PubMedDate not supplied

Hemangioendothelioma: a rare vascular tumor in childhood and adolescence.

Most vascular tumors occurring in children are benign. They are recognized by their ability to form angiomatous structures. In some instances, there is no clear-cut line between a benign vascular tumor (or angioma) and a malignant vascular tumor (or angiosarcoma). The hemangioendothelioma is a rare tumor of vascular origin, involving bone or soft tissue, and represents 1% of all vascular neoplasms. Accurate diagnosis is critical in recommending the most appropriate therapy for each patient. The aim of this paper is to give a brief review of the literature of this rare entity, particularly in childhood and adolescence.

Adolescent↗

PubMedDate not supplied

Nurse, haemodialysis, patient: is our caring based within a helping relationship?

Due to our experience in haemodialysis (HD) we became interested in evaluating the quality of care given during HD treatment. In May 1994, we conducted a cross sectional survey comparing the assessment of the total interaction between nurses and haemodialysis patients in a Lisbon dialysis facility. Our purpose was to identify nurses' and patients' opinion on the total interaction established during the dialysis treatment among both groups.

Aged↗

PubMedDate not supplied

[Infection due to Mycoplasma pneumoniae: three cases with neurological complications].

INTRODUCTION: Mycoplasma pneumoniae infection has been associated with severe central nervous system diseases. The pathogenesis of these disorders is unknown and the treatment uncertain. CASE REPORTS: The authors present three cases of central nervous system diseases: acute transverse myelitis, cerebellitis and encephalomyelitis associated with M. pneumoniae infection. CONCLUSIONS: M. pneumoniae infection should be considered in all cases of severe acute central nervous system symptomatology.

Adolescent↗

PubMedDate not supplied

[Cytomegalovirus infection in kidney transplantation].

150 patients, subjected to kidney graft transplantation between January 1988 and December 1989, were studied. Mean +/- 95% CL age was 37.5 +/- 2.03 (range 12-69) years. IgG and IgM antibodies levels (ELISA) cytomegalovirus (CMV) were investigated in the donor before organ harvesting and in the kidney recipients on 1st and 21th days and then on the 3rd, 6th and 9th months after transplantation. Patients lacking either donor or 1st day studies were excluded. 133 donor (D) receptor (R) pairs were classified as group 1) D+/R+, 2) D+/R-, 3) D-/R+ e 4) D-/R-. Prevalence, severity of CMV disease and date of diagnosis were studied. Mean time +/- 95% CI of diagnosis after transplantation was 78.4 +/- 15.1 days. Seronegative receptors had a statistically significant higher prevalence of the disease as to seropositive receptors, but not a higher incidence of disease severity. One out of five patients had a serious form of disease. Hiperimmune globulin was used in 15 patients (all serious forms and 3 moderate forms of of disease). No patient died as a result of CMV infection.

Adolescent↗

PubMedDate not supplied

[Essential thrombocythemia. Therapy with interferon alfa].

A clinical case of essential thrombocythaemia is presented to demonstrate good therapeutic response to subcutaneous Alpha-2b Interferon in a dosage of 3 x 10(6) units, three times a week. Based on this case and on a literature research we propose that Alpha-2b Interferon is a legitimate alternative to alkylating agents or radioactive phosphorus (32P), showing identical efficacy and less Leukemogen effect.

Female↗

PubMedDate not supplied

[Acute renal insufficiency as presentation form of multiple myeloma].

Multiple Myeloma (MM) causes a wide range of serious clinical, alterations, including acute renal failure (ARF) often present and contributing to the global mortality of this neoplasm. ARF usually occurs well after MM is diagnosed. We describe a case of ARF in a 42 years old male patient requiring urgent hemodialysis that subsequently proved to have MM. The singularity of this case lead us to review cases of ARF admitted to the Nephrology Department between 1978 and 1990. We describe 7 patients (4 male) with ARF as presenting form of MM. Their mean +/- SD age was 60.0 +/- 10.6 (range 42-73). ARF with conserved diuresis was the presenting form in 6, 5 has systemic infection, and none was hypertensive. Replacement therapy with hemodialysis was needed in 6 patients and plasmapheresis was performed in 3. 4 patients died while admitted, 2 were discharged on chronic hemodialysis and there was recovery of renal function in 1 patient.

Acute Kidney Injury↗

PubMedDate not supplied

[Preliminary study on low-trait genital infection and cervical epithelial dysplasia in women from the Parakanä tribe of South America].

BACKGROUND: We evaluated the occurrence of low-trait genital infection and cervical epithelial dysplasia in women from a South-american indian tribe in the Brazilian Amazonia. METHODS: Cross-sectional study of women older than 10 years from two indian settlements of the Parakanã tribe: Paranatinga and Maroxewara. Demographic data and information about sexual behavior as well as obstetric/gynaecological history were recorded. Two gynecologists examined 80 patients (89.9%), and collected vaginal and cervical specimens of 69 indians for further laboratory analysis, by Gram stain and Papanicolaou method. Fourteen (20.3%) women resulted to be pregnant. RESULTS: Parakanã women begin sexual activity early, after menarche; they have multiple sexual partners; are multiparous. Some of his partners already had intercourse with women of our society. In Paranatinga, vaginal discharges were a very frequent sign and not age-related, and women presented high frequency of disturbances on lactobacilli flora, greater than among inhabitants of Maroxewara. Pap smears in 91.5% of all patients showed inflammatory pattern. When found an possible etiologic agent (61.3%), in 63.4% it was Gardnerella vaginalis, in 7.3% Trichomonas vaginalis and in 4.9% Candida sp. In 23.2% of smears cythophatic signs related to infection by human papillomavirus were identified. One case had morphological changes compatible with cervical intraepithelial neoplasia grade I, another with CIN II and, in a 48 year old indian, cervical cancer. CONCLUSIONS: Near all women had some grade of cervical disease. Measure HPV-infection prevalence among Parakanã indians with adequate methods may improve our understanding about worldwide occurrence of HPV infections. Established risk factors for cancer of the cervix and sexually transmitted diseases were common in this tribe.

Adolescent↗

PubMedDate not supplied

[The diagnostic and prognostic value of the 12-lead electrocardiogram in assessing the severity of coronary disease in the acute phase of an acute myocardial infarct].

UNLABELLED: The conventional twelve-lead electrocardiogram (ECG) still is the cheapest, most used and absolutely essential diagnostic method for the acute phase of myocardial infarction (MI) allowing risk stratification and coronary prognostic evaluation in this phase mainly by the localization of the ST segment depression and/or T wave inversion (ST/T changes) not related to the infarct area in Q-Wave MI or at any localization in case of non-Q wave MI. The etiology and pathophysiology of these ST/T changes in the setting of MI has been controversial. With the objective of determining ECG prognostic and diagnostic value, 70 patients (Pts) (59 men and 11 women, mean age 58 + 13) admitted in the acute phase of MI were studied with revision of acute phase ECG ST/T changes. All patients underwent coronary angiography and ventriculography at the moment of hospital discharge. Patients were divided into two classifications: A) MI localization: A1--Q-wave MI (anterior--20 pts, inferior--29 pts, lateral--1 pt); A2--non-Q wave--20 pts. B) Evidence of ST/T changes outside the infarct area in Q wave MI or at any localization in non-Q wave MI (group B1--with ST/T changes, group B2--without ST/T changes). We correlated the angiographically documented coronary artery disease in groups with ST/T changes and their localization. RESULTS: A1) Anterior MI group: in the 6 pts (30%) with "opposite" (inferior) ST/T changes, right coronary artery (RCA) disease was documented in 5 and in the other 14 patients the RCA did not show significant lesions. Inferior MI group: in the 24 Pts (83%) with "opposite" (precordial) ST/T changes. 23 of them had angiographic correlation (left anterior descending (LAD) and/or circumflex (CX) artery disease). Lateral MI group: one Pt with anterior wall ST/T changes and LAD and CX disease. A2) Non-Q wave group: in 13 pts (87%) the diseased vessels were correlated with the site of ST/T changes. B1) Q-Wave AMI: left main and 3-vessel disease in 2 pts, 3-vessel disease in 17 pts, 2-vessel disease in 9 pts, 1-vessel disease in 2 pts and non-significant disease in one pt. Non-Q wave MI: left main and 3-vessel disease in 1 pt, 3-vessel disease in 7 patients, 2-vessel disease in 3 pts and 1-vessel disease in 4 pts. B2) non-Q Wave MI: 3-vessel disease in 5 pts, 2-vessel disease in 7 pts, 1-vessel disease in 6 pts and non-significant disease in 1 pt. Non-Q wave MI: 2-vessel disease in 2 pts and non-significant disease in 1 pt. IN CONCLUSION: When pts were divided according to MI localization, a correlation was found between the ST/T changes outside the infarct area with CAD in 91% of Pts in the Q-Wave infarction group, with more significance in inferior and lateral MI. In the non-Q wave group, we found correlation between the a coronary lesions and the localization of ST/T changes in 87% of the pts. The pt group with ST/T changes presented, when compared with the pt group without these changes, evidence of more severe coronary artery disease (CAD): 3 vessels or left main with 3 vessel disease. However, only in the Q-Wave infarction group was a statistically significant difference found between the group with ST/T changes compared to the group without these changes, concerning to the existence of more severe coronary disease.

Acute Disease↗