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Biomedical subjects

M O Silva

Publications and source records attributed to M O Silva.

9 recordsLinked to original sources
PubMed1993

Fulminant or subfulminant non-A, non-B viral hepatitis: the role of hepatitis C and E viruses.

BACKGROUND: Although non-A, non-B (NANB) viral hepatitis has been implicated as an etiology of fulminant hepatitis, hepatitis C virus (HCV) has not been shown to result in acute hepatic failure and hepatitis E virus (HEV) has predominantly been associated with fulminant hepatitis among pregnant women. METHODS: Using polymerase chain reaction to detect HCV and HEV genomes, four-antigen radioimmunoblot assay (4-RIBA) to measure anti-HCV antibodies, and enzyme-linked immunosorbent assay (ELISA) to detect anti-HEV immunoglobulin M (IgM) antibodies, 17 patients with sporadic fulminant or subfulminant hepatitis of presumed NANB viral etiology were studied. RESULTS: The diagnosis of acute NANB viral hepatitis was made based on clinical information, serological tests, biochemical profiles, and pathological features. All 17 patients were negative for anti-HEV IgM antibodies and HEV RNA in either serum and/or liver. HCV RNAs were detected in 2 patients although anti-HCV antibodies were negative in all of them. CONCLUSIONS: It is shown that HCV is infrequently associated with and HEV is not an identifiable cause of presumed NANB fulminant or subfulminant hepatitis in this patient population. Although further studies will be required for identification of the causative agent, it is possible that another agent is responsible for the occurrence of sporadic NANB fulminant or subfulminant hepatitis.

Acute Disease↗
PubMed1993

Adolescent pregnancy in Portugal: effectiveness of continuity of care by an obstetrician.

OBJECTIVE: To improve health among newborn infants of pregnant adolescents in Portugal, we developed and evaluated a prenatal care intervention. METHODS: The study group consisted of 80 adolescents recruited as they registered for prenatal care at Hospital Santa Maria in Lisbon. The intervention consisted of three components: initiation of prenatal care at registration, continuity of care by the same obstetrician, and emphasis on the specific nutritional and other health needs of pregnant adolescents. Controls were recruited after delivery on the maternity ward of the same hospital and were matched for age at conception, race, socioeconomic status, years of education, planned versus unplanned pregnancy, and previous body mass index. Controls received the routine care provided to pregnant adult women, including initiation of prenatal care at some point after registration and care by different general practitioners at each visit. RESULTS: Twenty mothers in the control group did not receive prenatal care and were excluded from further analysis. Mothers in the intervention group had their first prenatal visit 2 weeks sooner (P = .02) and had on average almost twice the number of prenatal visits (P = .0001) as controls. They gained 2.0 kg more on average compared with controls (P = .05). Infants of the mothers in the intervention group weighed an average of 181 g more than those in the control group. Fewer infants in the intervention group needed care in the high-risk pediatric unit (P = .005). When potentially confounding variables were controlled in a multivariate analysis, infants in the intervention group weighed on average 174 g more than those in the routine-care group (P = .02). CONCLUSION: This intervention, based on traditional tenets of good medical care, is effective in improving the outcomes of infants born to adolescent mothers in Portugal.

Adolescent↗
PubMed1991

Interferon-induced chronic active hepatitis?

A 54-year-old man with chronic B hepatitis was treated with interferon alfa. Despite resolution of the hepatitis B viral infection, he experienced severe jaundice, ascites, and encephalopathy. Further work-up showed hyperglobulinemia, chiefly immunoglobulin G, and positive smooth muscle and anti-nuclear antibodies. Because of these "autoimmune" features, the patient was treated with prednisone. One month later, a significant clinical and biochemical improvement was observed. A possible autoimmune mechanism induced by interferon alfa is proposed as the cause for the perpetuation of the necroinflammatory activity.

Autoimmune Diseases↗
PubMed1991

Hepatic dysfunction accompanying acute cocaine intoxication.

We identified 39 patients with acute cocaine intoxication and rhabdomyolysis over an 8-year period. Twenty-three of the patients (59%) demonstrated biochemical evidence for hepatic dysfunction. Sixteen of these patients had severe liver injury as defined by an alanine aminotransferase (ALT) of greater than 400 U/l (group A). Seven had an ALT between 36-399 U/l (group B) and 16 showed no evidence of liver injury (group C). In contrast to those with normal ALT, the clinical course of the group A patients was more often accompanied by profound hypotension (44 vs. 0%, p less than 0.025), disseminated intravascular coagulation (50 vs. 0%, p less than 0.005), hyperpyrexia (75 vs. 25%, p less than 0.025) and acute renal failure (81 vs. 0%, p less than 0.001). Seven of the group A patients expired (44%). Histologic examination of liver tissue obtained from post-mortem samples demonstrated extensive centrilobular and midzonal necrosis in three cases and panlobular necrosis in two others. A mild lymphocytic infiltrate with bile duct proliferation was present in each specimen. We conclude that cocaine intoxication can be accompanied by liver dysfunction which is most likely multifactorial; the presence of severe dysfunction identifies a patient with potentially significant morbidity and mortality.

Adult↗
PubMed1989

Danazol-induced cholestasis.

A 39-yr-old female on high-dose Danazol presented with jaundice and pruritus. Danazol-induced cholestasis was suspected, and the drug was discontinued. A liver biopsy revealed panlobular cholestasis with portal and periportal inflammation. The cholestasis resolved completely in 8 wk. This is a rare case of Danazol-induced cholestasis and should be considered in the differential diagnosis of drug-induced liver injury.

Adult↗
PubMedDate not supplied

Hepatitis C virus genotypes in hemophiliacs in the state of Minas Gerais, Brazil.

BACKGROUND: Hepatitis C virus (HCV) is a positive-strand RNA virus composed of at least 10 genotypes and dozens of subtypes. Six major genotypes can be distinguished by restriction fragment length polymorphism (RFLP) analysis of the amplified 5' noncoding region (NCR) of the genome. The genotypes are unequally distributed throughout the world. Types 1 and 3 are most common in Europe and the United States. Although fewer studies have been performed in Brazil, the pattern seems to mirror that in the other areas. HCV infection is highly prevalent among hemophiliacs and is a major cause of chronic liver disease. STUDY DESIGN AND METHODS: This study investigated a sample of the hemophiliac population in the state of Minas Gerais, Brazil, by RFLP analysis of the 5' NCR. RESULTS: It was observed that 84.1 percent were of genotype 1 and 13.6 percent of genotype 3. Sequence analysis of nine isolates confirmed the RFLP results and determined that all of the type 1 isolates belonged to subtype 1a. Phylogenetic analysis by parsimony and distance revealed that lineages of genotypes 1, 2, and 3, and 4 could be separated. The isolates of type 3 from this study were distinct from published sequences, which possibly indicated their different geographical origin. CONCLUSION: Although the frequency of genotypes observed (types 1 and 3) among hemophiliacs in the state of Minas Gerais was higher than that in the southern part of the country, these frequencies were not different from those in other groups of patients in Brazil and other countries studied. Further investigation is needed of the evidence that the type 3 isolates observed in these studies are significantly different from other isolates previously characterized by sequence analysis.

Base Sequence↗
PubMedDate not supplied

[Doppler flowmetry of feto-maternal circulation: III --Absent and reverse diastolic flow in the umbilical artery].

Twelve cases of extreme umbilical blood flow impairement (8 cases with loss of end-diastolic blood flow and 4 cases with reversed flow) found among 658 pregnancies studied by continuous Doppler between April 1st 1989 and March 31st 1990, are reported. The findings were associated to intra-uterine growth retardation (92%), maternal hypertensive disease (50%) and perinatal death (33%); fetal Trisomy 21 was the sole problem in one of the cases with absent end-diastolic frequencies. Our results are discussed and compared to similar data reported recently. Clinical management is proposed, according to umbilical blood flow patterns, length of gestation and underlying clinical situations.

Blood Flow Velocity↗