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Biomedical subjects

José Santos

Publications and source records attributed to José Santos.

7 recordsLinked to original sources
PubMed2004

Transesophageal echocardiography-guided cardioversion of atrial fibrillation. Selection of a low-risk group for immediate cardioversion.

INTRODUCTION: In patients (pts) with atrial fibrillation (AF) of more than 48 hours' duration, electrical cardioversion (ECV) should only be performed after 3 weeks of effective anticoagulation. Transesophageal echocardiography (TEE) allows earlier ECV; however, despite exclusion of thrombi in the atrium and left atrial appendage (LAA), cases of thromboembolism related to ECV have been documented in AF. To define a low-risk group for cardioversion without previous anticoagulation, pts were selected for immediate ECV if no thrombi or dynamic spontaneous echo contrast (auto-contrast) were found after TEE and if LAA velocity was more than 0.25 m/sec. METHODS AND RESULTS: We performed TEE in 31 consecutive pts referred for ECV for AF of more than 48 hours' duration and without previous anticoagulation. After TEE the pts eligible for immediate ECV began anticoagulation with low molecular weight heparin (enoxaparin), subcutaneously in therapeutic doses, together with warfarin immediately before cardioversion. Enoxaparin was continued until an INR of over 2 was reached. Based on the TEE findings, the pts were divided in 2 groups: immediate ECV, group A, 20 pts with a mean age of 62 +/- 13 years, 6 female; and conventional therapy with warfarin before ECV, group B, 11 pts, mean age of 67 +/- 10 years (p < 0.05), 2 female. None of the pts in either group had mitral stenosis or previous episodes of thromboembolism. The mean transverse diameter of the left atrium in the 31 pts was 47 +/- 4.5 mm, without statistically significant differences between the 2 groups. Of the 11 pts in group B, 3 had a thrombus in the LAA, 6 dynamic spontaneous echo contrast and the remainder LAA velocities of less than 0.25 m/sec. ECV was achieved in all the pts, with no complications. Oral anticoagulation was maintained for at least a month. At one month, sinus rhythm was maintained in 75% of group A and 45% of group B (p < 0.01). CONCLUSION: In pts with AF of more than 48 hours' duration and no previous history of thromboembolism, the use of our exclusion criteria during TEE enabled stratification of a low-risk population for immediate ECV, which was accomplished effectively and safely in 2/3 of the pts. This strategy is associated with early symptomatic improvement, and may contribute to maintenance of sinus rhythm after one month, which was significantly better than in the pts who had prolonged therapy with warfarin before ECV, despite the differences found in age and left ventricular function.

Aged↗
PubMed2004

Acute myocardial infarction in patients aged under 45 years.

INTRODUCTION: Coronary artery disease (CAD) becomes an important cause of morbidity and mortality after the age of 45 years. OBJECTIVE: To evaluate the epidemiology and clinical features of all patients under 45 years old admitted with myocardial infarction. METHODS: We studied 595 patients admitted with myocardial infarction between January 2000 and December 2002. We analyzed risk factors for CAD, clinical profile, therapeutics and complications (arrhythmic, mechanical and ischemic). The patients were divided into two groups: A--under 45 years old and B-- aged 45 or over. RESULTS: Group A--56 patients (9.4%); group B--539 patients (90.6 %). There was a higher prevalence of smoking in group A (57% vs. 23.6%; p < 0.01). Hypertension, diabetes and history of CAD were significantly more common in group B. There were no differences in hyperlipidemia (group A: 43% vs. group B: 43.5%). Fibrinolysis was performed in 28 patients (70%) from group A compared to 40 patients (45.9%; p < 0.01) from group B. Use of digitalis and inotropic agents was greater in group B. No differences were found in other pharmacological therapeutics. We found more complications in group B (24% vs. 11%). CONCLUSIONS: There was a higher prevalence of smoking in patients under 45 years old and of hypertension, diabetes and CAD in patients aged over 45. The high rate of hyperlipidemia in both groups highlights the importance of primary prevention. Fibrinolysis was performed more frequently in younger patients. There were more complications in older patients.

Adult↗
PubMed2003

Hyperhomocysteinemia--case report.

The authors present the case of a 25-year-old female patient, white, with mental retardation and proptosis, and a history of repeated cerebrovascular events. During investigation elevated levels of homocysteinemia and homocystinuria were demonstrated. The authors present a review of related literature.

Adult↗
PubMed2001

The role of a basic surgical skills laboratory as viewed by medical students (6th year).

In the last academic year, a training period in a surgical skills laboratory, using plastic models, was included as a part of the 'Cirurgia 3' ('Surgery 3', 6th year) programme of Faculdade Medicina Lisboa. To evaluate the training period, a structured, anonymous questionnaire was administered at the end, seeking students' responses on their satisfaction in attending the course. A global view of the answers points out students' favourable opinion of the laboratory-training period: concerning students' perceived goals for attending the course, a high degree of satisfaction was reported (globally 73% of computed scores were rated as 'good' or 'very good'); the teaching/learning environment and the delivered content got 90% 'very good' and 'good' ratings; teaching staff performance got the highest percentage of rating scores 'very good' and 'good' (95%). These ratings were dependent on variables that are unlikely to be a reflection only of glamour and seduction (clear explanations and clear demonstration of each component of the skill) and were less dependent on other variables such as 'enthusiasm for teaching' and 'relationship with students', which could be expected to be influenced by the charisma of the tutors. Helping students learn and train in surgical skills in a laboratory is challenging and our results affirm that the environment and the content were valuable for the understanding of the subject, while sessions planning and appropriate teaching technique are essential when practical skills are to be taught and learned.

Journal Article↗
PubMedDate not supplied

The lung parenchyma in low frequency noise exposed Wistar rats.

Previous studies of low frequency noise (LFN) ( pound 500 Hz, including infrasound) exposed Wistar rat trachea and lung show that LFN induces irreversible lesions in the rodent respiratory system. Most notable was the behavior of the tracheal brush cell (BC) where fused microvilli were frequently captured in scanning electron microscopy. This study focuses on the alvoelar BC in LFN-exposed and control rat populations. Ten Wistar rats were exposed to 2160 hours of continuous LFN, then kept 1 week in silence before sacrifice. Another 10, age-matched rats were kept in continuous silence. All were fed standard rat food, and had unrestrained access to water (treated in accordance with 86/609/CE). Lung parenchyma fragments were excised and processed for scanning electron microscopy. In the non-exposed, alveolar walls were thin, and wall structure was well defined. In the LFN-exposed, walls were thickened and wall structure was almost effaced. Macrophages were found in the non-exposed specimens, but were not so frequent in the LFN-exposed. Both vein and artery walls were thickened. In the parenchyma of the exposed rats, an increase in type II pneumocytes was observed, and their microvilli were dramatically altered in terms of cell-surface distribution, sprouting direction, and amount. Unidentified black holes eruptin from the cell surface were observed. In the alveoli, 2 different types of BC's were observed: external and interstitial. In the exposed rats, microvilli of both types of BC were fused. These results confirm that LFN exposure can impinge on the entire respiratory system of living organisms.

Animals↗