PubMed Health⌕ Search

Biomedical subjects

E Rodrigues

Publications and source records attributed to E Rodrigues.

At least 19 recordsLinked to original sources
PubMed2006

Long term clinical outcome and bleeding complications among hospital survivors with acute coronary syndromes.

OBJECTIVE: To examine the 21 month clinical outcome and bleeding complications in hospital survivors with non-ST segment elevation acute coronary syndromes (NSTEACS) who were discharged with combined clopidogrel and aspirin anti-thrombotic therapy, and compare with those having ST segment elevation myocardial infarction (STEMI) who were discharged with aspirin alone. DESIGN: Observational study. SETTING: A large university hospital. PATIENTS: 224 patients were admitted to hospital with either NSTEACS or STEMI, and survived to discharge between 1 October 2001 and 31 December 2002. MAIN OUTCOME MEASURES: Cardiovascular death, total death, new myocardial infarction, unstable angina requiring hospitalisation, stroke or transient ischaemic attack, coronary revascularisation; and fatal, life threatening, major and minor bleeding over 21 months after discharge. RESULTS: Despite having no or small infarct (median maximum creatine kinase 155 v 1295 u/l; p<0.001) and taking more antianginal drugs, patients with NSTEACS had similar rates of cardiovascular death (9.5% v 8.3%; p = NS), new myocardial infarction (9.5% v 6.5%; p = NS) or unstable angina requiring hospitalisation (15.5% v 10.2%; p = NS) when compared with STEMI. Fatal, life threatening or major bleeding were <1% in both groups (p = NS); and minor bleeding occurred in 4.3% NSTEACS and 2.8% STEMI patients respectively (p = NS). CONCLUSIONS: Patients with NSTEACS had a similar and unfavourable long term outcome when compared with STEMI. There was no difference in serious bleeding complications between both groups.

Acute Disease↗
PubMed2005

Under-use of beta-blockers in patients with ischaemic heart disease and concomitant chronic obstructive pulmonary disease.

BACKGROUND: Beta-blockers (BB) improve morbidity and mortality in ischaemic heart disease. There is a general reluctance to use BB, especially in patients with chronic obstructive pulmonary disease (COPD), which is perceived as an absolute contraindication. As large numbers of patients are labelled with COPD without objective evidence, they may miss out on the benefit from these drugs. AIM: To assess the use of BB in patients with COPD admitted with acute coronary syndrome (ACS), and to assess the supporting evidence for the diagnosis of COPD in these patients. METHOD: Case-note review and retrospective analysis of 457 consecutive patients admitted with troponin-positive ACS between October 2002 and October 2003. RESULTS: Of 457 ACS patients studied, 246 (54%) were discharged on a BB. Cardiologists prescribed BB in ACS patients more frequently than did general physicians, (70% vs. 30%, respectively). The reasons for withholding BB were: not documented 27%, COPD 33%, heart failure 24%, others 16%. Ninety-four patients (21%) had a diagnosis of COPD; only 58 (62%) of these had been reviewed by a chest physician or had previous pulmonary function tests. Of the 94 patients with COPD, only 15 (16%) were prescribed BB during the admission: 9 by cardiologists and 6 by non-cardiologists. BB were discontinued in two patients due to an increase in dyspnoea. CONCLUSION: Many patients with a diagnosis of COPD have no objective evidence to support the diagnosis and are denied the prognostic benefits of BB when presenting with ACS. Before withholding beta-blockers, COPD and reversibility should be ascertained by pulmonary function testing. The overall use of beta-blockers remains sub-optimal and could be improved in this setting.

Adrenergic beta-Antagonists↗
PubMed2005

Purple digit syndrome and warfarin-induced skin necrosis.

Warfarin is used extensively in clinical practice for numerous indications. It is generally safe. Bleeding is the major risk of warfarin; several uncommon adverse skin manifestations may also be associated with its use. These range from ecchymoses and purpura, haemorrhagic necrosis and maculopapular vesicular urticarial eruptions to cutaneous necrosis, purple digit syndrome and warfarin-induced skin necrosis. Early recognition and diagnosis of these adverse reactions are important to avoid morbidity and possible mortality. All health professionals should be aware of these complications.

Journal Article↗
PubMed2005

Imposex and surface sediment speciation: a combined approach to evaluate organotin contamination in Guanabara Bay, Rio de Janeiro, Brazil.

An integrated biological-chemical survey of organotin compounds was carried out in Guanabara Bay, the second most important Brazilian harbor complex. The biological survey revealed high levels of imposex in Stramonita haemastoma populations. Inside the bay values of relative penis length index from 42.7 to 107.6 and vas deferens sequence index from III to VI were found, while organisms collected outside the bay had values ranging from <0.1 to 35.2 and from 0 to II. None of the females sampled inside the bay were normal and imposex was found in all stations. Surface sediments in the bay are contaminated by tributyltin (10-522 ng/g d.w.) and triphenyltin (<3.9-39.4 ng/g d.w.) with greater concentrations close to shipyards and marinas. The observed predominance of parent compounds (TBT and TPT) is commonly found when recent inputs occur, but may also indicate slow degradation processes in the anoxic conditions of these sediments. To our knowledge, this is the first report of a combined imposex-sediment approach to evaluate organotin contamination in marine environments of South America, and also the first report of TPT detection in environmental matrices in this region.

Animals↗
PubMed2004

The E37X is a common HMGCL mutation in Portuguese patients with 3-hydroxy-3-methylglutaric CoA lyase deficiency.

3-Hydroxy-3-methylglutaric aciduria (OMIM 246450) is an autosomal recessive inborn error of the final step of leucine catabolic and ketogenic pathways, caused by deficiency of the enzyme 3-hydroxy-3-methylglutaryl CoA lyase (HL, HMGCL, EC 4.1.3.4). Clinically, deficiency of the enzyme results in metabolic acidosis, hyperammonemia, and infantile hypoketotic hypoglycaemia usually presenting during the first year of life with vomiting, lethargy, hypotonia, and sometimes with respiratory distress and coma. HL deficiency is relatively common in Arabic populations but seems to be rare in Europe. Our recent experience suggests that HL deficiency is the most frequent organic aciduria in the Portuguese population. We herein report on the molecular study of the HMGCL gene in 11 cases originated from the Northern area of Portugal. We detected the E37X (c.109G > T) mutation, in 84.1% of the alleles, one allele carried the V168fs(-2) (504_505delCT) and other allele the novel D204N (c.610G > A) mutation. The mutation of the last allele remained unidentified. The relatively high frequency of the "common" HMGCL Portuguese mutation makes useful the development of a rapid and specific molecular confirmation of new cases with HL deficiency in our country.

Acidosis↗
PubMed2004

Cardioprotective action of fentanyl in a model of central sympathetic overactivity in rabbits: antiarrhythmic and anti-ischemic effects.

BACKGROUND: Sympathetic overactivity resulting from perioperative noxious stimuli elicits hyperdynamic cardiovascular responses that may lead to myocardial ischemia and/or ventricular arrhythmia, especially in patients presenting with coronary artery disease. In the present study we investigated the cardioprotective effects of clinically relevant doses of fentanyl in an experimental model of sympathetic overactivity associated with myocardial ischemia in anesthetized rabbits. METHODS: Central sympathetic stimulation was achieved through intracerebroventricular (i.c.v.) injection of L-glutamate (10 micro mol), with simultaneous inhibition of nitric oxide (NO) synthesis through i.v. administration of N(omega)-nitro-l-arginine methyl ester (L-NAME; 40 mg kg(-1)). RESULTS: L-glutamate triggered ventricular arrhythmia and electrocardiographic alterations indicative of myocardial ischemia. The intravenous administration of fentanyl (5, 10 or 50 micro g kg(-1)) reduced the incidence of ST-segment shift (70, 20 and 10%, respectively, vs. 66.7% in controls) as well as of T-wave inversion from 58.3% to 30, 20 and 10%, respectively. The total number of ventricular premature complexes per minute fell from 65.2 +/- 16 in the control group to 6.8 +/- 3, 3.5 +/- 2 and 2.6 +/- 1.5, respectively. The occurrence of ventricular tachycardia and bigeminy was completely abolished by fentanyl. Finally, the i.v. administration of fentanyl did not induce significant hemodynamic effects (except for dP/dt(max) in the 50 micro g kg(-1)-dose). CONCLUSION: Fentanyl elicits significant cardioprotective effects in a model of arrhythmia resulting from the association of central sympathetic overactivity with myocardial ischemia in rabbits, independently from its systemic hemodynamic actions.

Anesthesia↗
PubMed2002

Cardiac denervation in mice infected with Trypanosoma cruzi.

The neuronal features of the hearts of mice that were acutely or chronically infected with the Y strain of Trypanosoma cruzi were compared with those of control hearts from uninfected mice. Whole-mount preparations of the murine atria, isolated by microdissection, were stained to reveal neurons with NADH-diaphorase activity. Counts, by a microscopist who was blind to the infection status of the donor mouse, revealed that there were significantly (38%) fewer such neurons in the atria from the acutely infected mice than in the atria from the control hearts. The ganglia of the infected mice were also irregularly distributed, severely damaged ganglia being found beside slightly degenerated or morphologically normal ones. Although the ganglia contained small, medium and large neurons, the apparent destruction caused by T. cruzi was confined to the large ones. As neuron counts in preparations of hearts from mice with chronic infections were 32% lower than those in the control hearts, there appears to be no additional loss of cardiac neurons as the acute infection in mice progresses to the chronic phase.

Acute Disease↗
PubMed2001

Expression and DNA-binding activity of C/EBPalpha and C/EBPbeta in human liver and differentiated primary hepatocytes.

BACKGROUND/AIMS: Limited information is available on the expression and role of C/EBP factors in human liver and hepatocytes. We investigated the expression and DNA-binding activity of C/EBPalpha and C/EBPbeta in human liver needle biopsies, surgical lobectomies and differentiated cultured hepatocytes derived from lobectomies. METHODS: RNA and protein extracts were analyzed by RNAse protection, immunoblot and gel shift assays. RESULTS: C/EBP mRNAs, isoforms and DNA-binding activities were low/undetectable in lobectomies. In contrast, several C/EBPalpha (47, 45, 35 and 33 kDa) and C/EBPbeta isoforms (47, 43, 40, 35 and 21 kDa) were observed in needle biopsies. In cultured hepatocytes, the C/EBP expression pattern dramatically changed with time. C/EBPalpha mRNA and the 45 kDa isoform increased in parallel, reaching a maximum after 3-4 weeks coincident with weak DNA-binding activity. C/EBPbeta mRNA and isoform expression increased rapidly reaching a plateau within 1-2 weeks; all C/EBPbeta isoforms were phosphorylated. C/EBPbeta exhibited greater DNA-binding activity than C/EBPalpha, and this activity paralleled C/EBPbeta isoform expression. CONCLUSIONS: C/EBP isoforms exhibit markedly different expression patterns in lobectomies, needle biopsies and cultured hepatocytes. Stress stimuli during and/or after surgery for lobectomy resections may account for this difference. The pattern of C/EBP isoform expression in long-term highly differentiated cultured hepatocytes is close to that observed in needle biopsies.

Adult↗
PubMed2001

Preliminary observation of 99mTc-thymine imaging in breast neoplasms.

New biological knowledge and new diagnostic tools for breast cancer diagnosis may have an important impact on the strategies followed by oncologists in breast cancer management. So far, it has not been possible to label a nucleotide or its precursor with technetium-99m (99mTc) for use in in vivo studies. In this paper, we report the labelling of a precursor, the nitrogenate base thymine, with 99mTc. It has been used to evaluate breast lesions. After animal studies and with the consent of patients, it was employed for evaluation in humans. Thirty-nine women were studied: 32 patients and seven healthy volunteers. Twenty-three malignant lesions showed uptake of labelled thymine. Of the 12 benign cases, there was one false-positive uptake. Labelled thymine was also taken up by one case of malignant microcalcifications. Labelled thymine can be used as a diagnostic method in the identification of malignant anatomo-radiologic palpable lesions of the breast, observed by mammography, possibly avoiding unnecessary biopsies.

Adult↗
PubMed2000

Clinical outcomes, risk stratification and practice patterns of unstable angina and myocardial infarction without ST elevation: Prospective Registry of Acute Ischaemic Syndromes in the UK (PRAIS-UK)

AIMS: To determine characteristics, outcomes, prognostic indicators and management of patients with acute coronary syndromes without ST elevation. METHODS AND RESULTS: A prospective registry was carried out with follow-up for 6 months after index hospital admission. A history of acute cardiac chest pain was required plus ECG changes consistent with myocardial ischaemia and/or prior evidence of coronary heart disease. Patients with ST elevation or those receiving thrombolytic therapy were excluded. A total of 1046 patients were enrolled from 56 U.K. hospitals. The mean age was 66+/-12 years and 39% were female. The rate of death or non-fatal myocardial infarction at 6 months was 12.2% and of death, new myocardial infarction, refractory angina or re-admission for unstable angina at 6 months was 30%. In a multivariate analysis, patients >70 years had a threefold risk of death or new myocardial infarction compared with those <60 years (P<0.01) and those with ST depression or bundle branch block on the ECG had a five-fold greater risk than those with normal ECG (P<0.001). Aspirin was given to 87% and heparin to 72% of patients in hospital. At 6 months 56% received no lipid-lowering therapy at all. The 6-month rate of coronary angiography was 27% and any revascularization 15%. CONCLUSIONS: In this cohort there was a one in eight chance of death or myocardial infarction, and a one in three chance of death, new myocardial infarction, refractory angina or re-admission for unstable angina, over 6 months. Age and baseline ECG were useful markers of risk. Aspirin, heparin and statins were not given to about one-sixth, one-third and one-half respectively. Rates of angiography and revascularization appear low. A review of treatment strategies of unstable angina and myocardial infarction without ST elevation is warranted in the U.K. to ensure that patients are receiving optimum treatments to reduce mortality and morbidity.

Acute Disease↗
PubMed1997

Antibody response to topical streptokinase.

The aim of this study was to assess anti-streptokinase antibody levels in patients treated with intravenous streptokinase for acute myocardial infarction and in patients treated with topical streptokinase for cutaneous wounds. Sixty-two consecutive patients with acute myocardial infarction (age 65 +/- 12 years), 42 consecutive patients with streptokinase/streptodornase-treated wounds (age 74 +/- 14 years) and a control group of 40 patients with non-streptokinase-treated wounds (age 59 +/- 14 years) were studied over a period of 12 months. Blood was taken prior to commencement of treatment and subsequently at intervals of seven days, one month and six months. Serum was analysed for the presence of anti-streptokinase antibodies, using an ELISA technique. Baseline anti-streptokinase levels were similar in all three groups. Over the subsequent six months, the group treated with intravenous streptokinase developed a significant elevation of antibody levels, whereas antibody levels did not rise significantly in the control group. The group treated with topical streptokinase also developed a significant elevation of antibody levels at one month, but the mean level was significantly lower than that in the intravenous group. By six months, anti-streptokinase levels in the topical group had returned toward baseline values. Topical application of streptokinase causes a significant humoral response by one month, which then declines. The response is significantly lower than that caused by intravenous streptokinase. To ensure clinical thrombolytic efficacy, therefore, it may be preferable to avoid intravenous streptokinase in patients who have been treated with topical streptokinase in the preceding six months.

Administration, Topical↗
PubMed1997

Central Venous Catheter-Related Infections in Intensive Care Units.

Objective: To determine the rates of colonization and infection related to central venous catheter (CVC), the causative microorganisms, and the influence of various factors. Methods: From June to August 1993, all CVC in 4 Intensive Care Units were evaluated from their insertion to removaL Data were collected by 3 nurses. Blood and catheter tips were cultured. Results: Of 84 catheters, 29.8% were colonized, 9.5% of patients showed evidence of local infection, and 4.8% had primary bloodstream infections. The internal jugular vein was the most common site for catheter insertion (81%). Causes of removal were: end of need (48.3%), suspected infection (23.3%), malfunction (20%), routine change (8.3%). Among removals because of suspected infection, 50% presented evidence of local infection, 43% were colonized(>15cfu), but there were no bloodstream infections. The average time of catheter use for those which became colonized was longer than for catheters that did not become colonized (p=0.008). The average time of catheter use associated with removal for infection (local and bloodstream) was longer than for removal for other reasons (p=0.042). Among colonized catheters, 16% developed bloodstream infection and 20% local infection. Immunosupressive drugs, cancer, diabetes mellitus, HIV-infection, and neutropenia were not associated with infection or colonization. The most common microorganisms were gram-negative rods and S.aureus. Conclusions: The duration of venous catheter use increased the risk of colonization and infection. This observation suggests that physicians must strive for the shortest time of use of venous catheters, but it does not indicate a need for routine central venous catheter removal.

Journal Article↗
PubMed1997

Immunohistochemical detection of Dirofilaria immitis using a rabbit polyclonal anti-serum against adult somatic antigens and excretory-secretory products.

An immunohistochemical study on tissue sections of kidney, lung, liver and spleen from six dogs naturally infected by Dirofilaria immitis was carried out, using a rabbit polyclonal anti-serum against somatic antigen (SA) of adult worms, excretory-secretory products (ES) of adult worms and fraction C3 of complement (Dog C3). Positive immunoreactions were observed on circulating microfilariae when anti-SA and anti-ES were used, but no differences were noted between the two anti-sera. No antigen deposits were observed when the three anti-sera (anti-SA, anti-ES or anti-C3) were employed as primary antibody. In two cases of human filariosis (by Loa loa and Mansonella streptocerca) no positive immunoreactions were observed.

Animals↗
PubMed1996

[ORL involvement and Noonan syndrome].

The authors reports on the case of a young, 17-year-old girl, suffering from Noonan's syndrome, with a bilateral conductive hypoacusia. Surgical exploration of the tympanic cavity revealed on one side an attical fixing of the ossicular chain and on the other side a hyperlaxity of the incudostapedial joint. On the basis of this observation, they stress the neglect of a study of the hearing of such patients, whose verbal expression and intellectual level are also impaired. Finally, they study the type of deafness involved and its etiopathology, suggesting the hypothesis of an anomaly in the development of the first branchial arch.

Adolescent↗
PubMed1995

Electric showers as a control measure for Legionella spp. in a renal transplant unit in São Paulo, Brazil. Legionellosis Study Team.

After an outbreak of legionnaires' disease Legionella pneumophila serogroup 1 in a renal transplant unit in São Paulo, Brazil, periodic hyperchlorination and flushing of pipes were instituted as control measures. These were only partially effective as every two to five months water cultures turned positive or new cases of the disease occurred. In November 1993 the hot water was disconnected from the unit and small, plastic electric showers were installed in each bathroom. Over a period of 12 months water from showers and taps was cultured for Legionella spp. every two weeks. On only one occasion was a water culture positive for L. pneumophila from a sink tap. No water sample obtained from showers was positive during the study period. No cases of legionnaires' disease occurred. We considered the use of electric showers an inexpensive and effective method of controlling the problem of Legionella spp. in the water system of our renal transplant unit.

Baths↗
PubMed1994

State-of-the-art myocardial perfusion imaging.

Technetium-99m sestamibi is a new agent that offers several theoretical advantages over Tl-201 for myocardial perfusion imaging. The results of current clinical trials utilizing acquisition and processing parameters similar to those of Tl-201 and a separate 2-day injection protocol suggest that Tc-99m sestamibi and T1-201 SPECT provide similar information with respect to the detection of myocardial perfusion defects, the assessment of the pattern of defect reversibility, the overall detection of CAD, and the detection of disease in individual coronary arteries. Tc-99m sestamibi SPECT appears to be superior to Tc-99m planar imaging because it provides a higher defect contrast and is more accurate for the detection of disease in individual coronary arteries. Significant research is underway to address optimization of acquisition and processing of Tc-99m sestamibi studies and the development of quantitative algorithms for detection and localization of CAD and sizing of transmural and nontransmural myocardial perfusion defects. It is expected that with the implementation of the final results of these new developments, further significant improvement in image quality will be attained, which, in turn, will increase the confidence of image interpretation. The development of algorithms for analysis of diastolic myocardial images may allow better evaluation of small and nontransmural myocardial defects. Furthermore, gated studies may provide valuable information with respect to regional myocardial wall motion, wall thickening, and artifact identification. Simultaneous assessment of ventricular function by performing first-pass studies may provide important information additional to that obtained from analysis of myocardial perfusion, especially in relation to the prognostic significance of different myocardial perfusion patterns. With the implementation of algorithms for attenuation and scatter correction, the overall specificity of Tc-99m sestamibi SPECT should improve significantly because of a substantial decrease in the instances of attenuation-related image artifacts.

Coronary Disease↗