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Biomedical subjects

J Simões

Publications and source records attributed to J Simões.

At least 19 recordsLinked to original sources

Assessment of luteal function by ultrasonographic appearance and measurement of corpora lutea in goats.

In order to characterize the evolution pattern of the corpora lutea (CL) and to compare luteal function with their ultrasonographic appearance, 37 estrous cycles of Serrana goats (n=22) were studied during breeding season. A daily transrectal ultrasound scanning was performed through two successive estrous cycles. Both solid and fluid-filled CL were observed and measured in both ovaries of each goat. Additionally, each CL was classified as CL(ICHE) (CL with irregular contours and heterogeneous echotexture) or CL(RCGE) (CL with regular contours and granular echotexture). Ovarian cyclic activity and luteal function were evaluated by biweekly plasma progesterone (P4) determination. The CL (n=60) were first visualized on day 2.9+/-1.0 after the day of ovulation (day 0), showing 7.1+/-1.8mm of diameter and reach their maximum size (12.5+/-1.6mm) on day 10.7+/-3.2 (P<0.001). Two days before the following ovulation (day -2), the CL regressed to 8.4+/-1.3mm (P<0.001). The central cavity was found in 78.3% of CL, and had a persistence of over 50% until the last days of estrous cycle. The ratio CL length/cavity length was low during the first-third and high during the remaining two-thirds of estrous cycle. On day 2, the percentage of CL(ICHE) was 33.3%, and began to decrease to 16.7% on day 6, reaching the minimum of 3.3% on day 10 (P<0.001). This proportion increased on day -3 to 48.3% and reached 90% on day -1 (P<0.001). The correlation between CL size and plasma P4 levels was r=0.63 (n=87; P<0.001). A negative correlation between the daily proportion of CL(ICHE) and plasma P4 levels was found (r=-0.95; n=18; P<0.001). These results suggest that the ultrasonographic appearance of CL is a reliable parameter for the assessment of luteal function in goats. Both the characterization of echotexture and size of central cavity could be valuable tools to differentiate between phases of normal estrous cycles.

Analysis of Variance↗

Follicular dynamics in Serrana goats.

Twenty-two Serrana goats were studied through two successive estrous cycles in order to characterize their follicular dynamics during the breeding season. The ovaries of the goats were scanned daily by real-time ultrasonography and all follicles >or=3mm were measured and classified. The data were classified by the number of follicular waves per goat to test the hypothesis that temporal and morphological differences between the last follicular wave of an ovary, irrespective of ovulation, will affect the selection of the next ovulatory wave. The mean interovulatory interval was 20.7+/-1.0 days (mean+/-S.D.). Three to five waves per estrous cycle were observed and 61.3% (19/31) of cycles had four waves. In estrous cycles with four waves, the day of onset of the first, second, third and fourth wave was 1.4+/-1.0, 6.9+/-1.4, 11.6+/-1.8 and 16.8+/-1.6, respectively. No differences (P>0.05) were found between the day of onset of the first and second waves for estrous cycles with three, four or five waves. However, the day of onset of the third and fourth waves occurred later when the number of waves per estrous cycle increased (P<0.001). The duration of the interwave interval (time between the day of onset of two consecutive waves) was longer when the second wave was ovulatory. The length of the growth phase (2.4+/-0.9 days) and size (5.9+/-0.7 mm) of the dominant follicle in the second wave were lower (P<0.01) than for the first wave (3.3+/-1.2 days and 6.6+/-0.9 mm, respectively) and the fifth wave (4.1+/-1.2 days and 7.5+/-1.0mm, respectively). Within pairs of ovaries, the onset of the last wave occurred later (P<0.05) and was less variable in ovulatory ovaries (day 16.8+/-1.4, n=20) than in anovulatory ovaries (day 15.1+/-3.7, n=20). The length of the growing phase was longer (P<0.001) in the last waves of ovulatory ovaries (3.1+/-0.9 days) than in the last waves of anovulatory ovaries (1.7+/-0.8 days). These results support the hypothesis that the day of onset of the ovulatory wave is related to or, at least, conditioned by the luteolysis and the decrease in plasma progesterone. In summary, the estrous cycle of Serrana goats is characterized by sequential follicular wave growth with a great variability in their onset and duration, with the exception of the ovulatory wave. The temporal and morphological differences observed in the last wave of estrous cycle provide strong evidence for the role of progesterone in their regulation.

Animals↗

Morphometry of ovarian structures by transrectal ultrasonography in Serrana goats.

The accuracy of transrectal real-time ultrasonography (RTU) scanning technique to detect ovarian structures (follicles and corpus luteum) of Serrana goats was compared to the data obtained by observation of ovarian sequential slices. This slicing technique (SLI) was considered as reference method. The laparoscopy and laparotomy techniques were also used for corpora lutea identification. For this purpose the ovaries of 14 females were observed, 7-8 days after ovulation, by transrectal ultrasonography followed by laparoscopic examination. Then ovaries were removed and studied by slicing. In the sliced sections of each ovary (n=28), follicles and corpus luteum (CL) were identified and counted. CL and follicular diameters were measured using a millimetre scale. The total number of follicles, counted by RTU, was significantly lower than that observed by SLI (P <0.01). This difference was mainly due to the under estimation of <2 mm follicles category. The correlation coefficient between category data obtained by RTU and SLI methods for the number of follicles > or =3 mm was high (r2=0.95, P <0.001), which highlights the use of UTR as a potential methodology to study the follicular dynamic of goats. There were no significant differences (P >0.05) between the average number (mean +/- S.D.) of corpus luteum identified per ovary by RTU (0.71 +/- 0.75), laparoscopy (0.58 +/- 0.71), laparotomy (0.67 +/- 0.76) or SLI (0.83 +/- 0.76) methods. The accuracy for the identification of ovulation, validated by CL detection on D7-D8 by SLI (100%), was 91.7%, 87.5% and 83.3% by RTU, laparotomy and laparoscopy, respectively. The negative predictive value of RTU, laparotomy and laparoscopy to verify the absence of a CL in the ovary was 81.8%, 75.0% and 69.2%, respectively. The specificity of all three methods for the CL identification was 100%. No significant differences (P >0.05) were found in the probability to detect the exact number of CL (0, 1 or 2) counted in each ovary between the RTU (87.5%), laparotomy (83.3%) and laparoscopy (75.0%) methods when compared with the reference method. The diameter of spherical CL could be estimated with reliability (r2=0.86; P <0.001). The real-time ultrasonographic scanning proved to be a highly accurate method for detection and measurement of several categories of follicles and CL size in Serrana goats. The results of the present study show that laparoscopy and RTU are similarly reliable techniques for CL detection. However, the RTU represents a non-traumatic technique with advantages to animal welfare both in experimental and reproductive evaluation of the size of ovarian structures.

Animals↗

[Etiologic diagnosis of viral meningitis. Study of 142 cases].

Viral meningitis is a common disease, most often benign and striking predominantly children. In 1997, there was an outbreak of viral meningitis in the North of Portugal and this pathology accounted for 496 admissions to the Infectious Diseases Department of S. João Hospital. The authors' aim was to determine the etiology of the cases of viral meningitis admitted to the S. João Hospital by, in a first phase, searching enterovirus and serology for mumps in a sample of 142 patients with symptoms, signs and cerebrospinal fluid (CSF) cytochemical abnormalities typical of viral meningitis, in the absence of any bacterial or fungal growth (in blood and/or CSF) and with negative soluble bacterial antigens in CSF. The enterovirus was detected by polymerase chain reaction (PCR) and, in a small number of cases, by shell vial culture. The diagnosis of mumps was made by the detection of specific IgM antibodies in serum, using an enzyme-linked immunosorbent assay. The diagnosis was reached in 70 patients (49.3%): 47 (33.1%) had mumps meningitis and 23 (16.2%) enterovirus infection (PCR positive in all; culture positive in only 2 cases). In 72 patients (50.7%), the agent was not identified. Although only two agents were searched for, the diagnosis was made in a high proportion of cases. The culture method used for the isolation of enterovirus was found to have a low sensitivity.

Child↗

Low-dose (5 mg/kg) desferrioxamine treatment in acutely aluminium-intoxicated haemodialysis patients using two drug administration schedules.

BACKGROUND: According to the recommendations proposed at The Consensus Conference on Diagnosis and Treatment of Aluminium Overload in End-Stage Renal Failure Patients, Paris, 1992 low-dose desferrioxamine (DFO) treatment was applied for the first time in 41 acutely aluminium-intoxicated patients. METHODS AND RESULTS: DFO-related neurological/ophthalmological side-effects were observed in nine of 11 patients with a post-DFO serum aluminium level > 300 micrograms/litre and in two patients of 30 below this level after a single administration of a 5-mg/kg dose of the chelator in the conventional way (i.e. the last hour of a dialysis session). They were no longer observed after introducing an alternative DFO administration schedule (i.e. administration of the chelator 5 h prior to the start of a haemodialysis session; group I: n = 14). A significant decrease in the serum aluminium levels as well as in the post-DFO serum aluminium increment (delta s A1) was observed during the first 6 months, course of low-dose DFO treatment in group I as well as group II (which consisted of patients receiving DFO in the conventional way; n = 27). Low-dose DFO treatment was accompanied by a significant increase in the mean +/- SD serum iPTH levels (group I: 174 +/- 245 up to 286 +/- 285 ng/litre; group II: 206 +/- 272 up to 409 +/- 424 ng/litre; P < 0.005) and the mean corpuscular volume (group I: 80 +/- 6.4 up to 85 +/- 3.7 fL, P < 0.005; group II: 76 +/- 5.0 up to 87 +/- 4.3 fL, (P < 0.0001). Serum ferritin levels significantly decreased in both groups. No further side-effects were observed during the DFO course. Patients in which DFO treatment could be stopped (i.e. subjects in which both serum aluminium and delta sA1 were below 50 micrograms/litre at two successive occasions) before the end of the 6 months' treatment course had a significantly greater residual diuresis (700 +/- 682 ml/min vs 84 +/- 109 ml/24 h). Also, residual diuresis was found to protect against aluminium intoxication as reflected by the values noted in group I versus those in group II. CONCLUSION: The 5-mg/kg DFO treatment provides a safe and adequate therapy for aluminium overload. In severely aluminium-intoxicated patients presenting post-DFO serum aluminium levels above 300 micrograms/litre DFO should be given once weekly 5 h prior to high-extraction dialysis ensuring (i) maximal chelation of aluminium (ii) limited exposure to circulating aluminium noxamine levels, and (iii) adequate removal of the latter compound. Finally, the necessity for a better communication between the local water distribution companies and the dialysis centres is a major lesson that can be drawn from this dramatic intoxication.

Adult↗

Salmonella typhi meningitis.

Whereas typhoid fever is still an endemic disease in some parts of the world, meningeal involvement in this disease is a rare occurrence. We report a case of Salmonella typhi meningitis in a 70-year-old woman. The patient was treated with ampicillin and the only sequela was right-sided deafness.

Aged↗

[Hemodialysis with bicarbonate 30 mEq/l versus 34 mEq/l and acetate: better hemodynamic tolerance and electrolyte and acid-base homeostasis].

The use of bicarbonate buffer in dialysis is more physiological than acetate. The aim of this prospective study was to compare the hemodynamic stability, acid-base and electrolyte balance changes in a group of 5 hospital hemodialysis (HD) patients, with 3 different dialysis fluids: one with 30 mEq/l of bicarbonate (B30), another with 34 mEq/l of bicarbonate (B34) and the last with acetate (ACE). All the patients had more than 12 months in HD. Each patient had HD treatment with one of the 3 different dialysis fluids: ACE, B30, B34. Each HD had a duration of 4 hours, with less than 5% dry weight ultrafiltration (UF) and continuous cardiac monitoring. The following clinical and laboratory data were evaluated: arterial blood pressure (BP), cardiac rate (CR), respiratory rate (RR), cardiac arrhythmias, blood urea, creatinine, sodium, potassium, magnesium, total calcium (Ca), ionised calcium (Ca++), pH, bicarbonate (HCO3-) and pCO2. Statistic analysis was performed using Student's paired t test and ANOVA with Bonferroni correction. Clinical evaluation showed a CR increase only in the ACE group (pre X = 78.4 to 4 degrees h X = 102.6 p < 0.001). Analytical results demonstrated, at the 1st h, Ca++ stability in the B30 group; in the first 30' the pH decreased in the ACE group (pre X = 7.35 to 30' X = 7.34); during HD, HCO3- was not corrected in the ACE group (pre X = 19.4 to 4th h X = 20.0); at 4th, pCO2 also decreased in this group (pre X = 34.5 to 4th h X = 28.4 p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Acetates↗

[Cyclosporin A--a therapeutic alternative in giant-cell arteritis?].

Cyclosporine A (CyA) is an immune modulator that may treat immune diseases. The authors present two cases of temporal arteritis treated with CyA; the two patients improved very quickly and after the first six or eight weeks of treatment there were no clinical or laboratory signs of inflammation. As to adverse effects there was a moderate increase in serum creatinine and arterial pressure levels which were controlled when the CyA dosage was reduced. In view of the good results achieved in these two patients, the authors concluded that CyA may be an alternative therapy for giant-cell arteritis and that this hypothesis should be further investigated in a larger group of patients.

Adrenal Cortex Hormones↗

Subcutaneous recombinant human erythropoietin in hemodialysis and continuous ambulatory peritoneal dialysis.

We compared the effect of twice weekly subcutaneous recombinant human erythropoietin (SC rHuEPO) in two groups of patients treated with a starting dose of 80 U/kg body weight/week: group I, 7 hemodialysis (HD) patients; group II, 8 continuous ambulatory peritoneal dialysis (CAPD) patients. In a third group (group III) of 4 patients transferred from HD to CAPD with anemia previously corrected with intravenous (IV) rHuEPO, we studied the changes in the maintenance SC dose to maintain the same hemoglobin. In groups I and II the mean SC doses required to correct anemia and to maintain hemoglobin/hematocrit levels were similar; the mean time for the correction of anemia was significantly longer in HD patients (p = 0.032). In group III the maintenance SC rHuEPO does was reduced to more than 50% at 12 weeks of CAPD. Subcutaneous rHuEPO is effective in reversing anemia in HD and CAPD patients, but it takes longer to correct anemia in HD with the same initial SC rHuEPO low dose. CAPD patients need lower doses of SC rHuEPO than HD patients in IV therapy to maintain the same hemoglobin levels.

Adult↗

[Prevention of thrombogenesis in the extracorporeal circuit of hemodialysis with a low molecular heparin: standardization of the dosage with a better hemorrhagic risk/effectiveness ratio].

PURPOSE: To test the efficacy and safety of a low molecular. Weight heparin (LMWH)--Fraxiparine, for hemodialysis (HD) anticoagulation, compared with conventional heparin (H) or serum lavage without other anticoagulation (L). DESIGN: Prospective controlled study. PATIENTS AND METHODS: Twenty-nine consecutive patients referred for dialysis in a tertiary care hospital were divided in 3 groups A, B and C, each group A and B patient submitted to 2 dialysis, AI and AII, BI and BII. Group A--n = 10, no bleeding risk, single needle technique, blood flow (Qb) less than 200 ml/min. HD-AI used LMWH 10,000 U pre-HD, HD-AII used H for an ACT 1.5 to 2 times baseline; group B--n = 10, high bleeding risk, double needle dialysis, Qb--200 to 300 ml/min. HD-BI used LMWH 5000 U pre-HD, and HD-BII used only L; Group C--n = 9, no bleeding risk, Qb less than 200 ml/min, all received LMWH 5000 U pre-HD. A semiquantitative screening was done in each dialysis for the presence of dialyser or venous chamber clots, APTT and Anti Xa activity were measured every 30 min., as well as pre and post-dialysis Hb, Htc, and platelets. RESULTS: APTT didn't rise significantly during HD with LMWH in contrast with the AII group with H (32.2 +/- 7.1 vs 63 +/- 25.8, p less than 0.05). The APTT levels in all dialysis with LMWH were identical to BII dialysis With L. Anti xa activity had an early peak at 30 to 60 min. With LMWH (0.62 +/- 0.45 em AI) and a late one at 180 min with H (0.39 +/- 0.2). There was no significant differences between pre and post-dialysis corrected platelet counts, but the lavage group showed the greater decrements (-20% +/- 24). In all the 49 dialysis we had 5 cases of complete clotting of the blood circuit, all of them in the lavage group C. No patients with high risk of hemorrhage had any bleeding increment. CONCLUSION: LMWH prevents clotting as effectively as H, in low doses of 5000 anti Xa units it doesn't interfere with PTT and is far more effective than HD with serum lavage in patients with bleeding risk and/or low blood flow in the dialysis circuit.

Adult↗

[Assessment of iron requirements during treatment of anemia with recombinant human erythropoietin in patients with chronic renal insufficiency under hemodialysis].

Iron deficiency occurs often in patients with recombinant human Erythropoietin (rhEPO) therapy in chronic renal failure (CRF) associated anemia. We have studied 10 patients with CRF on regular hemodialysis (HD), female = 8, male = 2, average age = 49 [32 to 72], time on HD 44.2 +/- 25.0 months. Before starting rhEPO, the mean hemoglobin value was 7.36 +/- 1.29 gr/dl, the mean ferritin 695.4 +/- 276.0 ng/ml, the mean serum iron 160.3 +/- 49.5 micrograms/dl and the mean transferrin saturation 55.3 +/- 12.6%. Transfusional requirements in the 12 months Pré-rhEPO were 10.9 +/- 3.2 units. The rhEPO dose level was 80 U/kg body weight (3 times a week, after HD) in the Correction Period (mean time = 46.7 +/- 18.6 days), being reduced afterwards in order to remain target Hb stable between 10 and 11 gr/dl. Iron deficiency was detected (transferrin iron saturation less than 16% or serum ferritin less than 30 ng/ml) in 5 of the 10 patients. Patients have been divided into two Groups (GI--patients which developed iron deficiency; GII--patients which remained iron replete). There were no significant differences between GI and GII in the serum iron, transferrin and transferrin saturation values of the Pré-rhEPO. Serum ferritin in the Pré-rhEPO was lower in GI than GII (GI = 489.2 +/- 23.6 ng/ml; GII = 901.6 +/- 96.4 ng/ml; p less than 0.01). Falls in the transferrin iron saturation during the Correction Period and 3, 6 and 12 months and in the serum ferritin at 3, 6 and 12 months versus Pré-rhEPO have occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Identification of a period of renal ischemic vulnerability studying the changes in the indicators of acute renal insufficiency after heart surgery with extracorporeal circulation].

We studied the pre operative status and the 1st, 4th, 12th and 24th hours of the post operative period after open heart surgery with cardiopulmonary bypass with a crystalloid solution containing 10 gr of mannitol. We considered acute renal failure (ARF) as being any increase in plasma creatinine values of 0.25 mg/dl for the first 24 hours and 0.5 mg/dl for periods longer than 24 hours. Six patients had transitory ARF (28.5%). The maximum value of plasma creatinine was 2.3 mg/dl and no patients required renal function substitution. There were no deaths. We used as ischemia ARF indicators the urinary flow rate, urine/plasma creatinine ratio, urine/plasma osmolality ratio, sodium fractional excretion and free water reabsorption. We also measured the urinary N-A-Glucosaminidase (NAG). We found that creatinine clearance reached its lowest in the first and fourth hours. Beyond the fourth hour we observed, the urinary flow rate reduce significantly, the urine/plasma creatinine and osmolality ratios reach values traditionally associated prerenal ARF, an increase main free water reabsorption and a decrease in sodium fractional excretion with a close relationship between the less than 1 value and the increase in plasma creatinine. There was a significant NAG increase in the 24 th hour. The evidence of a vulnerability period for renal ischemic lesions between the 4 th and 12 th hour suggests a second mannitol administration during the first four hours of the post operative period.

Acute Kidney Injury↗

Serum ferritin and hemochromatosis alleles in chronic hemodialysis patients.

There have been some reports on the risk of developing hemosiderosis in hemodialysis patients when heavily transfused and simultaneously possessing hemochromatosis alleles (HA). We evaluated 99 patients on chronic hemodialysis estimating their serum ferritin (SF) levels, transfusion rate, and prevalence of HLA A3, B7 and B14 alleles, which are considered to be more frequent in idiopathic hemochromatosis. We analyzed the patients as a whole group and also separately as low or high transfusion groups. There was no correlation between the number of HA and the mean SF levels. The presence of HA is not a risk factor for the development of hemosiderosis when excessive transfusions and parenteral iron administration are avoided.

Adult↗

Analytical characterization of urinary proteins by sodium dodecyl sulphate-polyacrylamide gel electrophoresis in renal disease. Clinical and histopathological correlations.

Sodium dodecyl sulphate-polyacrylamide gel electrophoresis is a method allowing the separation of proteins according to their molecular sizes. For this reason this method is rather useful for the classification of proteinurias as tubular, glomerular, or mixed. In the present study a good correlation was observed between the results of urine electrophoresis in sodium dodecyl sulphate-polyacrylamide gel and both clinical and histopathological data from 32 patients with different forms of renal disease.

Acute Kidney Injury↗

[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↗