Biomedical subjects
Publications and source records attributed to J Sequeira.
Aerococcus urinae is rarely reported as a human pathogen. The pathogenesis of this gram-positive coccus is not fully understood. It has been identified as a cause of urinary tract infections but may be associated with severe infections such as endocarditis and septicaemia. This paper presents a case of lymphadenitis caused by A. urinae.
Many aqueous suspension corticosteroid nasal sprays become less viscous when shaken and sprayed, then return to a more viscous state after application. This time-dependent, reversible loss of viscosity under shear (e.g., shaking or spraying) can be quantified in the rheological property of thixotropy. The flow properties of 5 corticosteroid nasal sprays were measured over a range of shear rates. The formulations tested included Nasonex, Vancenase AQ, Nasacort AQ, Rhinocort Aqua, and Flonase. The yield stress values, as well as an estimate of thixotropy, were compared by using three different sampling techniques, including one that simulated patient use (shaking for 30 sec, spraying, and immediately transferring the sample to the rheometer). The rheological properties of all products indicated that when initially shaken and dispensed, they flowed more freely, followed by recovery of viscosity that would likely inhibit the suspensions from flowing out of the nasal cavity. Under all three tested conditions, Nasonex exhibited the highest yield stress, the largest apparent initial and final viscosities, and the highest apparent thixotropy. The study protocol that simulated patient-use conditions produced the following rank order of measured thixotropy: Nasonex > Flonase > Vancenase AQ > Rhinocort Aqua > Nasacort AQ. The thixotropy of Nasonex was 3.4 to 21.4 times greater and the final viscosity was 3.2 to 17.4 times greater than the values of the other tested products.
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A 71-year-old male who had previously suffered from chronic alcoholism was admitted to the Internal Medicine Service of Coimbra Hospital Center in January 1996 due to asthenia, loss of weight, icterus and abdominal pain, clinical features that had begun six months before admittance to hospital. A physical examination revealed that, in addition to icterus, the patient presented multiple hemangiomas of 1 to 5 cm in diameter, located in the oral cavity, neck, breast and left axilla. These lesions were bluish, elevated and with a rubber-nipple consistency, and had been developing for about 15 years. Subsequent examination revealed normocytic normochromic anemia, cholestatic icterus and the existence of a gastrointestinal hemangioma located in the esophagus. Excisional biopsy of an element proved that it was cavernous hemangioma. A subsequent angio-scintigraphy indicated other aspects suggestive of deep hemangiomas located in the legs, face and cervical region. The authors had the opportunity of examining other members of the patient's family, who apparently did not exhibit similar lesions. They concluded that it was a case of blue rubber bleb nevus syndrome (BRBNS), probably in its sporadic form. Treatment was essentially conservative and the patient is well.
The authors describe two cases of infants admitted to our Unit with respiratory failure caused by a Pneumocystis Carinii pneumonia (PCP). Because their mothers were HIV negative in the first three months of pregnancy. HIV infection was not suspected and the diagnosis was only made after the PCP. Based on these examples we discuss the importance of detecting HIV infection during pregnancy.
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Leukocytoclastic vasculitis (L.V.) is a polymorphous inflammatory dermatosis, characterized clinically by palpable purpura of the lower legs and, histologically by fibrinoid change in the small dermal vessels as well a polymorphonuclear infiltrate and nuclear dust. Fifty one cases (33 females and 18 males) of histologically confirmed L.V., seen at the Dermatologic Clinic, University Hospital of Coimbra, are reviewed. The most common type of skin lesions found were palpable purpura (80%), erythematous papules, vesicles and bullae (45%). Systemic manifestations occurred in 32 patients (63%), predominantly fever (33%), arthralgias (27%), malaise (18%) and gastro-intestinal pain (10%). The most frequent laboratory abnormality was a high E.S.R. found in 80% of the patients tested. Possible causative agents could be identified in 37 patients (73%) and included drugs in 12 patients (24%), drugs and infections in 16 (31%) and infection in 3 (6%). Three patients had malignancies and 2 had rheumatoid arthritis. The course of the disorder was acute in 25 cases (49%), recurrent in 14 (27%) and chronic in 10 (20%). The majority of patients (61%) were treated with systemic corticosteroids.
A three and a half-year-old boy developed stridor after insertion of grommets for bilateral secretory otitis media. Despite treatment with steroids systemically and locally, antibiotics and an antihistamine, the stridor worsened. Microlaryngotracheobronchoscopy (MLB) demonstrated laryngeal granulations, in which, by auramine and Ziehl-Neelsen staining, acid-fast bacilli were seen, and from which subsequently Mycobacterium tuberculosis grew in culture. Following the MLB the child became comatosed and a clinical diagnosis of tuberculosis involving the central nervous system was made. Despite quadruple antituberculous chemotherapy he died 8 days later. A Mantoux test was negative and a chest radiograph was normal. Acid-fast bacilli were not demonstrated on repeated examinations of cerebrospinal fluid, nor were they grown ante mortem or post mortem from samples of cerebrospinal fluid.
1. Changes in basal metabolic rates (BMR), following alterations in the preceding day's dietary protein (8.6, 11.5 and 14.0% of energy) were studied in eight, young, healthy adults over 4 d. 2. Results showed a significant training effect, with BMR values 4.8% lower on day 4 of the study period. Analysis of the results by ANOVA revealed a significant interaction between subjects and diets (P less than 0.005), a significant difference between subjects but no differences in BMR due to the protein content of the diets. 3. Mean coefficient of variation (CV) for intra- and inter-individual differences in BMR from day-to-day was of the order of 4 and 9% respectively. 4. Changes in protein content of the preceding day's diet do not influence variations in BMR which appear to be random in nature with a true CV of 3.8%.
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The Kimray-Greenfield inferior vena cava filter, which is used to prevent pulmonary embolization from the pelvis and lower extremities, has a high patency rate and a low complication rate. In one patient, however, thrombus formation at the apex of the filter during introduction resulted in the filter's failure to open completely so that the entire width of the cava in the transverse diameter was not occluded. This potential complication may be avoided by keeping the introduction time to a minimum and by constantly infusing a heparin solution through the side port of the insertion device while it is in the vena cava.
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In this paper a method for creating geometrical models of tree-like anatomical structures is described. This method is basically interactive and thus it takes advantage of the user's expertise to define highly-structured models even when using nonhomogeneous data sets. First, tubular cavities are reconstructed sequentially; then, junctions between these cavities are provided in such a way that resulting models are continuously shaped (we characterize this property by the G1-continuity (i.e., a tangent plane can be defined at any point on the surface).
Leprosy represented, until a few decades ago, an important public health problem in mainland Portugal. According to the data of the General Directorate of Primary Health Care, the incidence and prevalence rates of the disease have been decreasing progressively and in a significant way during the last years. In view of the fact that it is an endemic disease in regression, we decided to estimate if there were significative changes in the clinical manifestations of the new cases. Therefore, we carried out a comparative study based on the clinical data of 18 patients (13 males and 5 females) with Leprosy who were being followed up in the Dermatology Clinics of Coimbra University Hospital. We differentiated two groups: patients with the diagnosis of the disease before 1990 (old patients), and those diagnosed after 1990 (new patients). The first group had only 8 subjects while the second group had the other 10. We recorded the patients' age, sex, nationality and residence, age at the onset of the disease, number of cases that began before the age of 20, clinical manifestations (according to Ridley and Jopling's classification), and the presence of incapacity determined by the consequences of the disease. We carried out the Student's-t test to appreciate some of the study parameters. We verified that the old patients were on average 11 years younger than the new patients. Leprosy in new patients occurred 11 years later than in the old patients and this difference was statistically significant after the Student's-t test (p < 0.05). Almost one half of the new cases (4 patients in 10) were possible cases of leprosy brought from Brazil, while all the old individuals had an autochthonous origin. The multibacillary forms were predominant in both groups, representing 89% of all patients. The frequency of handicaps was similar in both groups. Although it is based on a small number of patients, our study suggests that the clinical and epidemiological manifestations of leprosy have been changing significantly in the last years and that the changes observed in the form of presentation of the new cases are consistent with the present epidemiological situation. Our study also seems to suggest an increase in the importance of leprosy imported by immigrants from leprosy endemic countries. We point out that this phenomenon, as in the case of AIDS, can theoretically create the conditions for a recrudescence of leprosy, as currently observed with tuberculosis.
The results of a questionnaire sent by the College of Pediatrics of the Portuguese Doctors Association (Ordem dos Médicos) to the pediatric departments all over the country are presented. From the answers of fifty-one services, physical conditions, equipment, human resources, assistancial and scientific activities developed are characterized.