Biomedical subjects

I Almeida

Publications and source records attributed to I Almeida.

9 recordsLinked to original sources

PubMed2002

Lupus nephritis: a retrospective review of 78 cases from a single center.

UNLABELLED: Lupus nephritis (LN) is a frequent and serious manifestation of systemic lupus erythematosus. However, the outcome has progressively improved in the last 3 decades and this was due to more efficient and early treatment of LN and comorbid situations. The aim of our study was to analyze our experience and outcome in LN, to evaluate clinicopathologic and clinicolaboratory correlations and to search for risk factors for renal and patient survival. PATIENTS AND METHODS: We conducted a retrospective study of 78 patients with biopsy-proven LN. RESULTS: Acute renal failure and subnephrotic proteinuria with microhematuria occurred each one in 39.7% of the patients, nephrotic syndrome in 16.7% and nephritic syndrome in 3.8%. The mean serum creatinine at presentation was 1.45 +/- 1.03 mg/dl and the creatinine clearance was 68.2 +/- 40.3 ml/min. Class IV LN existed in 71.8%, Class III in 20.5%, Class V in 6.4% and Class VI in 1.3%. The treatment included steroids and cytotoxic agents in 87.5% of the patients with proliferative LN. Hypertension, serum creatinine and acute renal failure at presentation, as well as significant chronicity on renal biopsy, were significantly correlated with the progression to chronic renal failure in our population. Males were more prone to develop renal flares. 3.8% of the patients died, 9% lost their renal function, 26.9% are in remission, 33.3% still have subnephrotic proteinuria and microhematuria, 7.7% have nephrotic syndrome and 19.2% have chronic renal failure. The mean global follow-up was 102 +/- 74 months and 96.2% of the patients survived. The actuarial renal survival was 96.1% in the first year; 89.9% at 5 years; and 83.7% at 10 and 20 years. CONCLUSION: We can say that hypertension, serum creatinine and acute renal failure at the onset and significant chronicity on renal biopsy, proved to be risk factors for chronic renal failure in our study population. Male gender was a risk factor for renal flares. The achieved global outcome can be considered a good result.

Acute Kidney Injury↗

PubMed2000

Primary fourth ventricular hemorrhage.

A case of primary fourth ventricular hemorrhage with spontaneous recovery is reported. To the best of our knowledge, there is no previous report of this rare clinical entity.

Adolescent↗

PubMed1994

A unified approach to the design of clinical reporting systems.

Computer-based Clinical Reporting Systems (CRS) for diagnostic departments that use structured data entry have a number of functional and structural affinities suggesting that a common software architecture for CRS may be defined. Such an architecture should allow easy expandability and reusability of a CRS. We report the development methodology and the architecture of SISCOPE, a CRS originally designed for gastrointestinal endoscopy that is expandable and reusable. Its main components are a patient database, a knowledge base, a reports base, and screen and reporting engines. The knowledge base contains the description of the controlled vocabulary and all the information necessary to control the menu system, and is easily accessed and modified with a conventional text editor. The structure of the controlled vocabulary is formally presented as an entity-relationship diagram. The screen engine drives a dynamic user interface and the reporting engine automatically creates a medical report; both engines operate by following a set of rules and the information contained in the knowledge base. Clinical experience has shown this architecture to be highly flexible and to allow frequent modifications of both the vocabulary and the menu system. This structure provided increased collaboration among development teams, insulating the domain expert from the details of the database, and enabling him to modify the system as necessary and to test the changes immediately. The system has also been reused in several different domains.

Artificial Intelligence↗

PubMed1992

Modification of the OMED nomenclature: a system approach based on the SISCOPE data model.

The OMED nomenclature represented a turning point in endoscopic computer systems by supplying software developers with an internationally recognized scientific document on which prototypes could be based. The main pitfalls of the OMED system are related to its hierarchical structure, probably not the most effective design to represent endoscopic findings. Based on our experience during the development of SISCOPE, an integrated data management system for endoscopy, an alternative scheme is proposed: Endoscopic descriptions are modeled as a set of objects represented by a data structure whose elements are location, morphology, associated lesions and hemorrhage. 72 objects appear to be sufficient for an accurate representation of all endoscopic scenes and a consistent data model could be created with this approach. Efforts should be made to decrease redundancy in the OMED nomenclature, but extension to other endoscopic data types, such as clinical and pathological diagnosis, is more urgently required. Furthermore, if data exchange between systems is desired, the definition of an Endoscopy Metafile is an absolute requirement.

Database Management Systems↗

PubMed1991

SISCOPE: a multiuser information system for gastrointestinal endoscopy.

SISCOPE is an integrated data management system for use in gastrointestinal endoscopy units which operates in the multiuser mode on UNIX minicomputers or MS-DOS personal computers and can be used for patient bookings, endoscopic data entry and retrieval, and automatic report generation in upper gastrointestinal endoscopy, proctologic examinations, colonoscopy and peritoneoscopy. The description of endoscopic findings is remarkably detailed and data entry very rapid due to an advanced design of input screens that incorporates several recent concepts, including windows, menu bars and pull-down menus; typing is eliminated as data is entered with a mouse by pointing at options within menus. Endoscopic findings can be described under eight headings: morphology, topography, qualifiers, modifiers, signs of bleeding, endoscopic diagnosis, pathological diagnosis and etiology. Terminology is based strictly 3on the OMED system. SISCOPE also allows recording of details on endoscopic procedures, indications for the examination, preparation, premedication, complications and late entry of pathology reports. After entering all data, a report in natural language is produced automatically, the entire process taking one minute on average. Data retrieval programs give on-line access to previous examinations of a given patient and automatically generate activity reports. A formal language allows direct queries to the database and transfer of data for statistical analysis or other data processing. The system is simple to learn and use because operation is intuitive and all endoscopic techniques share the same basic menu structure and screen design.

Computer Systems↗

PubMed1991

Longitudinal comparative study on the influence of computers on reporting of clinical data.

The impact of the clinical database system SISCOPE on medical services was evaluated and objective data compiled on the quality of information recording and reporting using a fully structured data entry system compared to traditional free text reporting. 1565 upper endoscopy reports produced with SISCOPE over a period of 12 months were assessed for completeness and compared to 152 and 208 free text reports done 4 months before and 1 month after the study period, respectively. Data on four common gastrointestinal findings (esophageal varices, ulcers, polyps and tumors) were evaluated. Physicians' compliance with the new system was good, as reflected by a constant level of quality of reporting over time, although a very slight decline in the ratio of computer generated reports to the total number of examinations was noted. Structured reports had an 18% missing data rate and contained 60% more relevant information than free text reports, which had a 48% missing data rate. No educational effect of the system was seen as missing data rates returned to pre-computerization levels just one month after the end of the study. It is concluded that menu-driven structured data entry systems result in production of far superior reports as compared to free text systems, probably due to their reminder effect.

Endoscopy, Digestive System↗

PubMedDate not supplied

Assessment of the immunological surveillance value of humoral and lymphocyte assays in severe human cystic echinococcosis.

Thirty cystic echinococcosis (CE) patients in Uruguay with severe bone or secondary disseminated echinococcosis were immunologically assessed using cellular (lymphocyte transformation assay, LTA) and humoral (specific antibody and subclass responses, circulating antigen and circulating immune-complexes) immunological assays during the course of chemotherapy (albendazole and/or praziquantel). CE patients were divided into 4 groups, according to clinical treatment and outcome: (I) surgery and chemotherapy, (II) chemotherapy with outcome unchanged, (III) chemotherapy with outcome improved, and (IV) chemotherapy considered cured. Increased circulating antigen was of prognostic value in some severe CE cases where levels remained high and/or increased. The lymphoproliferative response in vitro to Echinococcus granulosus antigen was statistically greater in all patient groups compared to normal individuals but at lower levels in improved or cured CE patients. Levels of non-specific LTA response were significantly lower than controls for all groups during albendazole treatment (P < 0.001) but returned to normal levels in cured patients, a result consistent with parasite-induced suppression of cellular responses. This study suggests that, at least in severe osseous and secondary CE, immunosurveillance by specific antibodies, especially total specific immunoglobulin, was overall of more practical use than antigen-specific in-vitro lymphocyte transformation assays.

Adult↗

PubMedDate not supplied

[The family physician and the human immunodeficiency virus seropositive patient].

OBJECTIVES: To characterize a subject who is HIV positive and closely observed in the consultation of clinical immunology (Santo António General Hospital), from a demographic and socio-economic point of view; to determine the percentage of these subjects who have a family doctor; how often they go to a family doctor; the reasons for a more frequent visit to the doctor; if there has been any alteration in the reasons for consulting the family doctor after establishing the diagnosis of HIV infection; who made the diagnosis of HIV infection; to evaluate, from these patient's point of view, if there has been any alteration in the family doctor's attitude or vice versa after the diagnosis. CHARACTERISATION OF THE STUDY: A descriptive, transversal study was carried out from 30/01/97 to 13/03/1997. METHOD: A questionnaire with twenty-two questions was used in a personal interview of a random sample of 100 patients observed in the Consultation of Clinical Immunology at Santo António General Hospital and represented 40% of the population studied. RESULTS: One hundred patients answered the questionnaire, 73 were male and 27 female, with an mean age of 34.73 years. The majority were single, representing 44% of the random sample, 33% had completed primary education (or equivalent), and 28% had attended secondary school (complete or incomplete), 35% of the subjects were employed and 34% unemployed. In what concerns area of residence, the majority live in the metropolitan area of Oporto. The majority of the patients (85%) had a family doctor. Nevertheless, 1/3 had never paid a visit to their doctor and, as for the others, the majority rarely did. After the diagnosis of HIV infection, the reasons that led patients to see their doctors were merely administrative (prescriptions--24.56%, sick leave--21.05%). On the other hand, before the diagnosis, health problems were their major concern and priority (27.54%). The diagnosis was made in equal proportion (28%) by the hospital services and by institutions providing health care for drug addicts. In most cases, from the patient's point of view, there had not been any change in the family doctor's attitude after the diagnosis of HIV infection and vice versa. COMMENTS: Although the majority of the subjects have a family doctor, their demand is very low, therefore, there is a waste of opportunities in terms of primary, secondary and tertiary medical care.

Adult↗

PubMedDate not supplied

[Structuring a clinical information system for hospital services: BASELINE].

Clinical database systems have been in use since 1972, but they still fail to meet most of the requirements they were aimed at. This includes not only the management of administrative tasks, but particularly the support of medical activities. Our study presents an experimental model of a clinical database system for general hospitals, mainly dedicated to the support of some basic, fundamental clinical activities, namely the management of baseline patient data. This model is based on a modular concept, and its core is represented by a Minimal Data Base Set designed to meet the specific requirements of each Department and of each distinct area within a Department. The system does not interfere with routine clinical work and tries to offer a high level of services to users. A number of utilitary programs simplify user interaction with the system, such as a menu-driven data-entry program, a semi-automatic codification program that follows the OMS/ICD-9-CM coding system, and a menu-driven program for data retrieval. Basically, this system can be helpful for the automatic edition of clinical reports and the retrieval of patient records meeting conditions specified by the clinician.

Hospital Information Systems↗