HIV and HTLV prevalences among women seen for sexually transmitted diseases or pregnancy follow-up in Maputo, Mozambique.
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Adult↗
Biomedical subjects
J Melo
Publications and source records attributed to J Melo.
Antibiotics are associated with lower relapse rates in outpatients with acute exacerbations of COPD.
BACKGROUND: COPD is a complex disease with exacerbations characterized by worsening of symptoms resulting in deteriorating lung function. STUDY OBJECTIVE: To assess predictive factors of relapse for patients with acute exacerbations of COPD (AECB). DESIGN: Retrospective cohort analysis of visits for AECB. SETTING: Veterans Affairs Medical Center. PATIENTS: Three hundred sixty-two visits (173 patients) with documented COPD treated as outpatients for AECB. MEASUREMENTS: Severity of underlying COPD, severity of AECB, comorbid conditions, therapy, and relapse rates (return visit within 14 days with persistent or worsening symptoms). RESULTS: Each visit was analyzed individually (referred to as a patient-visit). One group received antibiotics (270 patient-visits), and the second group (92 patient-visits) did not. Both groups had similar demographics and severity of underlying COPD. The overall relapse rate was 22%. The majority of patient-visits (95%) with severe symptoms at presentation were prescribed antibiotics vs only 40% of those with mild symptoms. Twenty-nine of 92 patient-visits (32%) were followed by relapse in the group that was not given antibiotics, whereas only 50 of 270 (19%) treated with antibiotics relapsed (p < 0.001). Those treated with amoxicillin had an even higher relapse rate (20 of 37 patient-visits, or 54%) than those who did not receive antibiotics (p = 0.006). CONCLUSIONS: Relapse from AECB was not related to the severity of underlying disease or to the severity of the acute exacerbation. Patients treated with antibiotics had significantly lower relapse rates than those who did not receive antibiotics. However, the specific choice of antibiotic is important because those treated with amoxicillin had the highest relapse rates of all groups.
Acute Disease↗
Pulmonary evaluation and prevalence of non-invasive ventilation in patients with amyotrophic lateral sclerosis: a multicenter survey and proposal of a pulmonary protocol.
In order to evaluate the current standard of care for the management of respiratory failure in patients with amyotrophic lateral sclerosis (ALS), a questionaire was mailed to the Medical Directors of 48 multidisciplinary ALS centers in the United States. Twenty centers reported information on 2357 patients, mean of 124 patients per center. Pulmonary function tests were performed at each visit in 17/20 institutions. Arterial blood gases, maximal expiratory pressures and maximal inspiratory pressures were followed in three centers and serum chloride was monitored in only four centers. The use of non-invasive ventilation (NIV) was extremely variable (range 0-50%) and included 360 patients (15%). The majority of centers used symptoms/signs of hypoventilation and worsening forced vital capacity (FVC) to initiate NIV with no established protocol. A FVC between 20 and 40% was used by most centers to initiate NIV. Due to great variability in the approach to monitoring pulmonary function among ALS centers and the modest effects of current medications to slow disease progression, we propose the use of a structured protocol which can prospectively study the role of NIV in prolonging survival and improving quality of life.
Amyotrophic Lateral Sclerosis↗
Modelling a parasystolic rhythm in a heart-transplant patient.
A parasystole from a heart-transplant patient is analysed using a beat-to-beat RR interval time series obtained from an electrocardiogram (ECG). The dysrhythmia, resulting from the co-existence of two pacemakers, the sinus node and an ectopic focus, presents distinctive regular patterns, with transitions from one pattern to another occurring abruptly. It is shown that the parasystolic rhythm can be simulated by a model involving two oscillators firing at fixed rates, under the restriction that neither is allowed to fire during the other's refractory period. It is found that the structure of the generated RR time series is essentially determined by the ratio of the periods of the two oscillators. In the case of a heart-transplant patient with a small heart-rate variability as a result of heart denervation, the model predicts the RR intervals with an error of less than 6% for an 80-beat sequence. From a physiological point of view, the results imply that the interaction between the two pacemakers in the heart is fairly weak, and hence the parasystole observed in the heart-transplant patient can be modelled as pure parasystole.
Adult↗
Surgery for atrial fibrillation using radiofrequency catheter ablation: assessment of results at one year.
OBJECTIVE: The results obtained in 43 patients using direct intraoperative radiofrequency catheter ablation, as an alternative to surgical incisions, to perform atrial fibrillation surgery, are presented. METHODS: Forty-three patients with ages ranging from 43 to 74 years (x = 59), with chronic atrial fibrillation with an average duration 6+/-5 years were operated. Eleven patients suffered from clinically relevant tachyarrythmia and eight had previous thromboembolic events. All but one patient had concomitant mitral valve surgery. Direct intraoperative radiofrequency catheter ablation was used to perform endocardial bilateral isolation of the pulmonary veins from the left atrium. RESULTS: There were no local or general complications, namely bleeding or thromboembolic events. Of the 33 patients with more than 3 months of follow-up, 36% remained in atrial fibrillation (Santa Cruz score 0); 30% had Score 4; 18% had Score 3; 6% had Score 2; 9% had Score 1. CONCLUSIONS: We conclude that the use of intraoperative radiofrequency catheter ablation is fast and safe. Presently, this is our method of choice for surgical treatment of atrial fibrillation in mitral patients.
Adult↗
Electrosurgical treatment of atrial fibrillation with a new intraoperative radiofrequency ablation catheter.
BACKGROUND: To assess the efficacy of a new catheter for intraoperative radiofrequency ablation. METHODS: We operated 35 mitral patients with atrial fibrillation of which 27 had chronic atrial fibrillation with a mean duration of 8 +/- 6 years. Most patients were in functional class III or IV. All patients were operated under cardiopulmonary bypass using sternotomy in 29 patients, right thoracotomy in 5 and left thoracotomy in 1. RESULTS: Bilateral pulmonary vein isolation with radiofrequency catheter ablation was achieved in 7 +/- 4 minutes. There was no mortality or morbidity. Out of the 27 patients with one to three months follow-up 60% were out of atrial fibrillation and 48% had both atria contracting (scores 3 and 4). A longer time is required to assess the end result of these techniques, because the complete healing of the ablation lesions takes 3 to 6 months. CONCLUSIONS: We conclude that with appropriate tools and settings the use of intraoperative radiofrequency catheter ablation is fast, safe and effective. Its indications can be extended to other types of atrial fibrillation patients.
Aged↗
No evidence of chaos in the heart rate variability of normal and cardiac transplant human subjects.
INTRODUCTION: The variability observed in the heart rate may reflect fundamental aspects of cardiac activity. It has been under discussion whether heart rate variability (HRV) is due to noise or chaos, which is irregular behavior occurring in deterministic nonlinear systems. METHODS AND RESULTS: Using chaos analysis techniques, we analyzed HRV of five normal and five human cardiac transplant subjects at rest. HRV is studied using the beat-to-beat RR interval time series extracted from the ECG. The cardiac transplant subjects exhibited a much smaller HRV than the normal subjects because of heart denervation. We present the map and correlation dimension estimation for the RR time series. To test for nonlinear correlations in the dynamics, we built surrogate time series that have the same power spectra as the experimental time series, but also have randomized phases. The experimental and the surrogate data were compared using the correlation integral. No correlation dimension was found for the RR time series of either the normal or the cardiac transplant subjects. Nevertheless, nonlinear correlations were detected in the HRV of the normal subjects but not in HRV of the cardiac transplant subjects. For the latter, no significant changes were observed in the correlation integral as a function of time after transplantation. CONCLUSION: We found no evidence of low-dimensional chaos in the HRV of normal and cardiac transplant subjects. However, some nonlinear correlations were detected in the HRV of the normal subjects, which may be associated with autonomic nervous system influence.
Electrophysiology↗
[Prevalence of dyslipidemias in adult ambulatory laboratory tests from different health care providers].
OBJECTIVE: To detect differences in the prevalence of dyslipidemia in adult ambulatory laboratory tests from three different health care providers, in Salvador-Brazil, 1995. METHODS: The study was carried out using a probabilistic sample of 24 out of 104 laboratories (approximately equal to 25%) which performed the same enzymatic method for lipid tests with the same quality control. Laboratory tests results were separated into three groups, according to health care provider: Sistema Unico de Saúde (SUS, governamental), Health Maintenance Organizations (HMO), and Private or Patients Health Insurance (PHI). Criteria for dyslipidemias in mg/dl were: total cholesterol > or = 240; LDL-c > or = 160; HDL-c < 35 and triglycerides > or = 200. Prevalence rates, 95% confidence intervals (CI) and chi (2) test were used in the analysis. RESULTS: From the 5464 adult subjects, 14.8% were from SUS, 31.6%. from HMO and 53.6% PHI. The highest prevalence for hypercholesterolemia--28.0% (CI 24.0; 32.0) and for LDL-c > or = 160mg/dL--30.4% (CI 27.6; 33.2), were found in the HMO group. PHI had the highest prevalence for HDL-c < 35mg/dL--12.3% (CI 10.0; 13.8), and for hypertrygliceridemia--17.8% (CI 16.3; 19.3). Most of the differences among health providers were statistically significant. CONCLUSION: The best lypid profile observed in subjects from SUS suggests social differences in the prevalence of dyslipidemias. As compared to other dyslipidemias, HDL-c < 35mg/dL prevalence was lower than expected in all three groups. The data may provide insights to medical doctors and other health care professionals regarding the questions of dyslipidemias. It can also provide objective information to the patients and encourage them to change their life styles.
Adult↗
Acute respiratory distress syndrome. Liquid ventilation.
In summary, the use of partial liquid ventilation with perfluorocarbon seems to be safe in neonates, children, and adults with ALI or ARDS. Partial liquid ventilation can be used for the following goals: recruitment of lung volume; enhancement or uniformity of lung inflation; improved oxygenation; improved lung compliance; and prevention or minimization of lung damage induced by mechanical ventilation. Partial liquid ventilation improved gas exchange and lung mechanics in test subjects. Cardiopulmonary interaction and long-term safety require further study. Extrapolations from animal data, however, suggest that there are no long-term undesired effects. The current clinical data strongly suggest that close monitoring and adjustment of ventilator parameters during drug instillation are necessary to reduce hypoxia, bradycardia, and pneumothorax. Further studies are required to explore the efficacy of partial liquid ventilation with perfluorocarbon in ALI or ARDS subjects, in particular, to evaluate the safety and efficacy of smaller doses; mechanical ventilation strategies; and outcomes. Additional research including large randomized studies is clearly required to answer these and other questions.
Animals↗
L-2-Hydroxyglutaric aciduria: clinical, biochemical and magnetic resonance imaging in six Portuguese pediatric patients.
We present clinical, biochemical and cranial magnetic resonance imaging data of six pediatric patients with L-2-hydroxyglutaric aciduria. All the children have the same ethic origin and lived in the northern area of Portugal. Our findings reinforce the described phenotype of this rare metabolic disease with mental deficiency, severe cerebellar dysfunction, mild extrapyramidal and pyramidal symptoms, progressive macrocephaly and seizures. Magnetic resonance imaging revealed subcortical leukoencephalopathy, cerebellar atrophy and signal changes in the putamina and dentate nuclei. These were similar to those of the previous reports in all patients. The urinary excretion of L-2-hydroxyglutaric acid was variably increased in all patients. The other persistent biochemical abnormality was hyperlysinemia. We have found a strong correlation between the severity of the clinical manifestations and the extension of the lesions in the neuroimaging studies. There was no correlation between the clinical findings and the amount of urinary excretion of L-2-hydroxyglutaric acid. We report the second case in the literature of a cerebral thalamic tumor in L-2-hydroxyglutaric aciduria; neuropathological examination of the surgical biopsy demonstrated a diffuse fibrillary astrocytoma.
Adolescent↗
Pontocerebellar hypoplasia with microcephaly and dyskinesia: report of two cases.
We present two clinically diagnosed cases of pontocerebellar hypoplasia with microcephaly and dyskinesia (pontocerebellar hypoplasia type 2) from two different Portuguese families. Both children presented neurological involvement from birth, progressive microcephaly, exuberant chorea and dystonia, myoclonic jerks, pontocerebellar hypoplasia, and progressive cerebral cortical atrophy. One child had consanguineous parents.
Atrophy↗
[Prevalence of dyslipidemias in adults in laboratory tests from Salvador, Brazil].
PURPOSE: To determine the prevalence of dyslipidemia in non-hospital laboratory tests of adults from Salvador, Brazil. METHODS: The study was carried out in subjects from a probabilistic sample of 25% of a total of 104 local laboratories that used the same enzymatic method for lipid analysis with the quality control as recommended by the Brazilian Society of Clinical Analyses. These represented 93% of all non-hospital laboratories of Salvador in 1995. The odd months of 1995 were selected for sampling in the present study. Criteria for dyslipidemias were: total cholesterol > or = 240; LDL > or = 160; HDL < 35 and triglycerides > or = 200 mg/dl. Prevalence rates and their 95% confidence intervals (CI) and chi 2 test were used in the analyses. RESULTS: Tests from two of the 26 laboratories were not used in the analyses due to file problems or refusal. 7,392 adults were screened, 65% female. We observed prevalence (95% CI) of hypercholesterolemia in 30.0 (27.8; 32.2)%, high LDL in 30.1 (30.8; 35.4)% and hypertriglyceridemia in 30.4 (29.0; 31.4)% of the females. As to the male subjects, prevalences were; 24.0 (20.5; 27.5)% for hypercholesterolemia, 26.1 (22.4; 29.3)% for high LDL, 27.6 (25.7; 29.5)% for hypertriglyceridemia. All gender differences were significant. Low HDL occurred in 15.9 (14.2; 17.8)% of males and in 8.0 (7.1; 8.9)% of females. CONCLUSION: Dyslipidemia is an important risk factor observed in non-hospital laboratory tests of men and women in Salvador. Our data may provide physicians and other health care professionals with objective information to encourage life-style changes.
Adult↗
Longstanding traumatic tricuspid regurgitation with severe right ventricular failure.
A very unusual case of traumatic tricuspid regurgitation is reported, with severe symptoms of right ventricular failure, extreme dilatation of the right heart, echocardiographic and angiographic criteria of major tricuspid regurgitation, and severe right ventricular systolic dysfunction. The patient was referred for heart transplantation, on the assumption that conventional surgery was not possible. After careful evaluation, as the patient had normal pulmonary artery pressure and resistance, a tricuspid valve was replaced with good surgical outcome.
Accidents, Traffic↗
Lack of reciprocal translocation in BCR-ABL positive Ph-negative chronic myeloid leukaemia.
We used fluorescence in situ hybridization (FISH) to metaphase chromosomes with BCR and ABL cosmid probes in conjunction with the polymerase chain reaction (PCR) to study the mechanism by which the ABL proto-oncogene is inserted into a morphologically normal chromosome 22 in patients with Ph-negative chronic myeloid leukaemia characterized by the BCR-ABL chimeric gene. In control patients with Ph-positive CML the ABL probe localized to 22q- and the 3' BCR probe localized to 9q+. In nine Ph-negative CML patients the ABL probe localized to one normal chromosome 9 and to one 'normal' chromosome 22. Both 5' and 3' BCR probes localized exclusively to the chromosomes 22. By PCR all had evidence of BCR-ABL transcripts, but none had evidence of the reciprocal ABL-BCR gene product that is seen in 70% of the Ph-positive CML patients. These data confirm the view that Ph-negative CML results from insertion of ABL-containing DNA sequences into a normal-appearing chromosome 22 without reciprocal translocation of sequences from chromosome 22 to chromosome 9.
Adult↗
Hereditary anaemias in Portugal: epidemiology, public health significance, and control.
A countrywide prospective study aimed at establishing the prevalence of the haemoglobinopathy genes in the Portuguese population was carried out by screening 15,208 randomly selected blood samples from young males. This male based survey provided the opportunity of assessing simultaneously the prevalence of the red cell enzyme glucose-6-phosphate dehydrogenase (G6PD) deficiency, thus giving a picture of these important hereditary anaemias in Portugal. The results showed a low average frequency of beta thalassaemia (0.45%) and haemoglobin S (0.32%) carriers as well as G6PD deficiency (0.51%). However, these disorders are unevenly distributed throughout the country with a higher prevalence in some areas, mainly in the south. The relationship of this pattern of haemoglobinopathies to the known haplotypes linked to beta thalassaemia and sickle cell disease, relevant historical events, and local selective pressure was investigated. Hb D and Hb J are the commonest other structural variants. The implemented programme for control of these hereditary anaemias is described.
Erythrocyte Indices↗
Chronic inflammatory polyradiculoneuropathy complicated by factor VIII antibody.
A 66-year-old man with a 45-month course of chronic inflammatory polyradiculoneuropathy developed a coagulopathy due to an antibody to factor VIII. Despite clinical improvement in the neurologic disease at the onset of the coagulation disorder, antibody to peripheral nerve myelin was demonstrated in high titer. Antibodies to factor VIII and peripheral nerve myelin were both of the IgG class, but were immunologically distinct. This previously unreported association lends further credence to a disturbance in immunoregulation in chronic inflammatory polyradiculoneuropathy.
Aged↗