A challenge to nursing education: meeting the health care needs of the Hispanic community.
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Curriculum↗
Biomedical subjects
S Torres
Publications and source records attributed to S Torres.
Violence and abuse of women: a perinatal health care issue.
This article discusses the perinatal health issue of abuse directed at pregnant women by their intimate partners. The incidence, prevalence, and severity of intimate violence during pregnancy are presented, as is a discussion of the possible health disruptions that can occur as a result of violence and abuse. Nursing interventions for abused pregnant women are presented within a framework of advocacy and empowerment. Strategies for primary prevention are outlined, and methods of secondary and tertiary intervention are discussed. The article concludes with a discussion of culturally relevant practice for abused women.
Cultural Characteristics↗
Nursing care of low-income battered Hispanic pregnant women.
Nurses working with pregnant Hispanic women can create barriers in the health care system by not understanding or accepting the variety of ways in which the Hispanic culture perceives and treats pregnancy. This article describes nursing care of low-income, battered Hispanic pregnant women within the context of the Hispanic culture and discusses clinical and nursing implications for interventions. To deliver effective culturally competent care to battered Hispanic pregnant women, nurses need to have a thorough understanding of the variables that influence the health care of Hispanics in the United States, such as the scope of wife abuse in the Hispanic population, sociodemographic characteristics of the Hispanic population in the United States, Hispanic women's access to health care, pregnancy in the Hispanic population, and health care practices of Hispanics in the United States. This will facilitate screening, education, and guidance without upsetting the often precarious security of this period.
Adolescent↗
[Transthoracic and transesophageal comparative echocardiography in mitral valve prolapse].
OBJECTIVE: Transthoracic and transesophageal comparative analysis of functional and morphological abnormalities associated to idiopathic mitral valve prolapse (MVP). DESIGN: Prospective study. SETTING: Outpatients with MVP diagnosis referred to echocardiographic laboratory of Cardiology Institute in Madrid, Spain. MATERIAL AND METHODS: In each case we analyzed by TTE and TEE, anterior, posterior and double localization of MVP, number of prolapsed mitral leaflets/patient, total area of MVP to mitral valve plane, mitral annulus diameter, total area and spatial distribution of mitral regurgitation. RESULTS: TEE diagnosed a greater number of prolapsed mitral leaflets and a greater percentage of double (80%) MVP. MPV area by TEE (50 +/- 31 mm2) was considerably larger (96 +/- 30 mm2) than TTE MVP area (50 +/- 31 mm3. Associated mitral valve regurgitation area calculated through TEE was larger (558 +/- 502 mm2) than the same parameter evaluated by TTE (450 +/- 515 mm2). CONCLUSIONS: TEE is an efficient technique in MVP non invasive diagnosis and particularly sensitive to posterior MVP. Our data could be helpful in MVP cases scheduled for mitral valve repairment.
Adolescent↗
Intramuscular capillary abnormalities in a case of myotonic dystrophy (Steinert's disease).
The structural study of a muscle biopsy from a case of myotonic dystrophy showed endothelial cell and pericyte alterations, and infiltration of lymphocytes, macrophages and mast cells. The histopathological picture was similar to that observed in the muscular compromise of some autoimmune diseases. These findings are interesting because although the aetiology of myotonic dystrophy is still obscure, it has been suggested that in the origin of this disease could be involved either primary muscle fibre damage or that myotonic dystrophy is neurogenic, propositions apparently not directly connected with a relation cause-effect to intramuscular capillary abnormalities.
Atrophy↗
[Value of transesophageal echocardiography in the diagnosis of acute aortic dissection].
We describe our experience of six patients with clinical suspicion of acute aortic dissection (AAD) who were studied consecutively by transesophageal echocardiography (TEE) from April to July of 1991. All of them were previously submitted to transthoracic echocardiogram. The diagnosis was correctly established by TEE in five cases, confirmed by aortography and/or surgery (four cases), or by autopsy (one case). In one patient the diagnosis of AAD was excluded by TEE, and posteriorly by nuclear magnetic resonance. Four patients had a Stanford type A, and one patient a type B dissection. The site of entry was identified in three cases; the intimal entry tear of the type B dissection, not observed by TEE, was localized in the aortic arch by aortography. In three of the four type A dissection cases, a thrombus in the false lumen and an aortic regurgitation were found. No other noninvasive methods were used after the diagnosis of AAD by TEE. The surgical repair was successful in three cases, one of which, without previous necessity of aortography. In our experience, TEE increased extraordinarily the diagnosis efficacy of AAD, making possible an earlier therapeutic approach, and probably contributing to the improvement of the prognosis of this pathology.
Acute Disease↗
[Echocardiographic assessment of interventricular septal defect corrected during the first year of life].
OBJECTIVE: To evaluate the medium term results of surgical closure of ventricular septal defect (VSD) performed during the first year of life, using echocardiography (echo). MATERIAL AND METHODS: We studied prospectively 29 patients aged from 17 to 68 months (mean = 37) who underwent surgical closure of perimembranous VSD during the first year of life. The postoperative follow-up time ranged from 6 to 60 months (mean = 26). Fifteen age-matched normal children were used as a control group in evaluating the left ventricular (LV) systolic function. The echo study included: 1) the assessment of LV systolic function using the shortening fraction, ejection fraction, pre-ejection to ejection time ratio (PET/ET), aortic flow acceleration time, acceleration to ejection time ratio, mean aortic flow acceleration; 2) detection and quantification of residual VSD as well as tricuspid and or aortic regurgitation; 3) determination of right ventricular systolic pressure (RVSP). The RVSP was evaluated from the maximum flow velocity from a residual VSD or tricuspid regurgitation, using the simplified Bernoulli equation. RESULTS: The LV systolic function parameters from patients versus (vs) normals showed a significantly different shortening fraction (34 +/- 5 vs 39 +/- 4; p = 0.005) and PET/ET ratio (0.34 +/- 0.04 vs 0.31 +/- 0.03; p = 0.02). None of the other studied parameters was significantly different from normal. Five (17%) patients had a small residual VSD. Two (7%) patients had mild aortic regurgitation. Tricuspid regurgitation was detected in 23 (79%) patients being trivial in 20 and mild to moderate in 3. The RVSP was quantified in 22 (76%) patients, ranging from 30 to 45 mmHg (mean +/- SD = 36 +/- 4). None of the remaining 7 patients showed changes in the end-systolic interventricular septal configuration. CONCLUSIONS: Our study shows that surgical closure of perimembranous VSD performed during the first year of life was possible without significant mobility. Furthermore, the echo allowed a complete and noninvasive cardiac evaluation of the anatomic, functional and hemodynamic status of this group of patients, thus limiting the need for postoperative control cardiac catheterization.
Echocardiography↗
[Transcutaneous pacemaker in cardiovascular emergencies].
UNLABELLED: OBJECTIVES AND DESIGN OF THE STUDY: Retrospective study to evaluate the efficacy and tolerance of the transcutaneous cardiac pacemaker in the urgent treatment of asystole or severe bradycardia. SETTING: Coronary Care Unit (CCU) and emergency area of the central reference Hospital. PATIENTS: 24 patients, 20 males and four females, aged between 57 and 84 years (mean 70.4 +/- 7.9). Five pts were in asystole and 19 in severe bradycardia. INTERVENTIONS: The transcutaneous pacemaker used, was the "Cardio Aid Zoll NTP" model. The intensity of the electrical stimulation was increased progressively, until electrical capture or intolerable discomfort by the patients was achieved. We defined by electric efficacy, the visualization of pacing spike followed by a deflection due to ventricular depolarization; and by hemodynamic efficacy, the evidence of myocardial contraction, defined as a palpable pulse, synchronous with the pacing artefact. MAIN RESULTS: Stimulation threshold ranged from 30 to 140 mA (mean 67.7 +/- 23.4). The duration of pacing was from 15 minutes to 13 hours, being more than one hour in only four situations. From the 20 conscious patients, or the ones who got conscious, 15 (75%) tolerated well the stimulation. It was intolerable in five pts (25%). No significative side effects due to the use of transcutaneous pacemaker were observed. CONCLUSIONS: The transcutaneous pacemaker was efficient in the electric and hemodynamic stabilization in the majority of patients. It was generally well tolerated and without important side effects. We think that it may be a valid alternative to transvenous pacing technics in the treatment of asystole and severe bradycardia situations.
Aged↗
[Indirect criteria of coronary reperfusion and permeability in patients with acute myocardial infarction who have received thrombolytic therapy].
OBJECTIVE: To evaluate the value of some indirect reperfusion signs (IRS) as markers of coronary artery patency in patients (PTS) with acute myocardial infarction (AMI) submitted to intravenous (IV) thrombolytic therapy (TT). DESIGN: Retrospective study, with analysis of the sensibility (S), specificity (SP) and predictive value (PV) of three IRS: 1. Pain and ST resolution in the first three hours; 2. Peak CK in the first 13 hours; 3. accelerated idioventricular rhythm (AIVR) in the first three hours. SETTING: Coronary Care Unit (CCU) of the Santo António Hospital and Hemodynamic Laboratory of the S. João Hospital, Oporto. PATIENTS: Sixty seven PTS (mean age 53.4 +/- 10.6 years) with confirmed AMI, 62 male and five female, 34 with anterior and 33 with inferior infarction, TT started in the first three hours of the beginning of symptoms in 34 PTS and from three to six hours in 33 PTS, all submitted to coronary angiography in the hospital setting (7.6 +/- 5.9 days after AMI). INTERVENTIONS: IV administration of 1,500,000 U of streptokinase (SK) in 47 PTS and 30 U of APSAC in 20 PTS, preceded by 200 mg IV prednisolone and oral 100 mg acetilsalicylic acid, and followed by IV heparin therapy. Continuous electrocardiographic monitoring, and serial 12 leads ECG and enzymatic assays (at start and 1, 3, 7, 13 and 25 hours of TT). Analysis of the correlation of the three IRS (isolated and in association) with coronary artery patency (TIMI 2 or 3). MEASUREMENTS AND RESULTS: The total patency rate was 79.1%; there was no statistically significant difference with regard to AMI location, time of symptoms onset (0-3 vs 3-6 hours) or thrombolytic agent (SK vs APSAC). The first and second IRS had a high S and a low SP; together S = 79.2%, SP = 64.3% and PV = 89.4%. The third IRS with the first and/or the second one had a low S (about 25%) but SP and PV of 100%. The coronary patency rate of PTS without IRS was always greater than 50%. CONCLUSIONS: The analysed IRS although not very reliable are useful when considered in association. It is possible to assess PTA with high probability of reperfusion if AIVR is present. The absence of IRS does not exclude coronary artery patency. There is still missing more reliable no-invasive reperfusion markers.
Adult↗
[Morphologic course of the left ventricle after renal transplantation. Echocardiographic study].
OBJECTIVE: To characterize and to quantitate the morphologic changes in left ventricle, in renal transplant patients (Pts) treated with cyclosporine, through sequential echocardiographic examinations. DESIGN: A prospective study of renal transplant patients, between October/88 and May/89, who maintained good function of the renal graft during the follow-up. SETTING: Cardiology and Nephrology departments of Santo António Hospital. MATERIAL AND METHODS: 20 patients, 13 men and 7 women, mean age of 33 +/- 10, ranging from 20 to 56, constitute the final group of the study. These patients have been receiving dialysis during 3.8 +/- 2.3 years (0.4-8). Seven patients were excluded, five by echocardiographic criteria and another two because of chronic renal graft disfunction (creatinine greater than 2.0 mg%). The echocardiographic examinations were performed during the first week, and 1, 2, 3, 6 and 12 months after renal transplantation. The following measurements were performed: left ventricular end-diastole diameter (LVED), interventricular septal thickness (IVST), posterior wall thickness (PWT) and left ventricular mass index (LVMI). The measurements were obtained in M-mode following the conventional recommendations. Average values of at least 3 cardiac cycles were used. Heart rate, blood pressure, creatinine, hematocrit, body surface area and fistula patency, were determined at the time of each echocardiogram. MAIN RESULTS: The LVED decreased progressively until the third month, from 51.9 +/- 7 mm to 47.8 +/- 6 mm (p less than 0.001), remaining stable thereafter. The baseline value of IVST, 13.6 +/- 5 mm, was similar at the twelfth month, 13.8 +/- 2 mm (ns). The baseline value of PWT, 13.7 +/- 4 mm, decreased gradually since the second month, having reached 12.7 +/- 2 mm at the twelfth month (ns). The LVMI (g/m2) reduced progressively, from 243 +/- 82 to 190 +/- 38 at the end of the study (p less than 0.05. A high incidence of arterial hypertension was detected during the follow-up period; at the twelfth month, 18 patients (90%) were on antihypertensive drug therapy, 11 of which had blood pressure greater than or equal to 160/95 mmHg. CONCLUSIONS: We verified, one year after the renal transplantation, a significant decrease of LVMI, that was mainly determined by the LVED reduction. Left ventricular walls thickness had no significant variation; we think that the high incidence of hypertension during the follow-up period, in part due to the pressure effect of cyclosporine, may have been responsible for this fact.
Adult↗
[Fistula of the right coronary artery near the right ventricle. An echocardiographic study].
A case of a 42-year-old woman with a right coronary artery fistula into the right ventricle is reported; she was asymptomatic and a continuous precordial murmur was found on physical examination. We discuss the usefulness and limitation of the Echo 2-D/Doppler findings, concerning this diagnosis, which was only definitively established by angiocardiography.
Adult↗
[Ruptured aneurysm of the sinus of Valsalva into the right ventricle--apropos of a case].
A 37 year old man was referred to our institution because of a cardiac murmur, exertional dyspnea and fatigue, symptoms that began since 18 years of age. He reported a cardiac murmur since childhood, with no past history of rheumatic fever or infectious endocarditis. On clinic examination there was a systolic-diastolic murmur louder in the third and fourth left intercostal space, just at the sternal left border. The 2 D-echo revealed a small disruption in the aorto-septal continuity. Right heart catheterisation was performed, showing an increased pressure in the pulmonary artery and right ventricle; an increase in the oxygen saturation on the right heart chambers, suggested the presence of a left-to-right shunt, nevertheless the exact location of the defect was not possible to recognise. The study was complemented with Doppler color flow imaging that revealed a turbulent flow through the defect, with blood flowing from the aortic root into the right ventricular outflow tract. The diagnosis of ruptured aneurysm of sinus of Valsalva was made, being confirmed later by aortic angiography. A rare case is reported in which an aneurysm of the right coronary sinus ruptured into the right ventricle; we emphasize the important contribution of the Doppler color flow imaging to the correct diagnosis, technique rarely described in this type of complication.
Adult↗
[Presence of a non-HLA antigen in B-lymphocytes from patients with rheumatic fever and their relatives defined using monoclonal antibodies].
Numerous investigators have suspected that there is a genetic predisposition to rheumatic fever (RF). In this context a group of investigators at Rockefeller University have produced a monoclonal antibody that identifies an antigen present in 100% of all RF studied at that center. Using this antibody, labeled D8/17, we studied 47 patients with acute rheumatic fever and rheumatic heart disease. Of these, 39 were not receiving steroids at the of the test and 35 were positive for the marker (89.7%). The highest percentage of positive cells was seen in the probands with 34.6 +/- 13.16%, while unaffected mothers, fathers and siblings gave 24.9, 5.2 and 7.3% respectively. The control group had an average of 7.5% of positive cells. This study and previous ones, performed by the Rockefeller University group in which HLA typing was included, suggest an autosomal recessive mode of inheritance, not associated with the MHC system, for the D8/17 antigen. Rheumatic fever; non-HLA antigen in; genetic predisposition in.
Adolescent↗
[Pericarditis caused by cholesterol. Apropos of a clinical case].
A case of a 76 year-old woman with a large pericardial effusion is described. The microscopic examination of the scintillating, yellow-greenish fluid obtained by the first pericardiocentesis, showed numerous crystals of cholesterol. In search of the underlying diseases there were found values of T3, T4 and TSH diagnostic of hypothyroidism. Considering the rapid relapse of the effusion and after a second pericardiocentesis, it was decided to open a pleuro-pericardial window. The biopsy of the pericardium showed deposits of cholesterol on electronics microscopy. She was discharged from hospital two weeks after surgery, showing an evident clinical improvement. Six months later she was feeling well, keeping a normal activity for her age. The values of T3, T4 and TSH were normal, and there were no echocardiographic signs of pericardial effusion. It is presented a rare case of cholesterol pericarditis associated to sub-clinical hypothyroidism, showing the presence of cholesterol, as crystals in the pericardial effusion and, we think for the first time in this pathology, in vesicles of pinocytosis, in the pericardial biopsy. The six months period of follow-up showed a good clinical improvement with the selected therapeutic attitude.
Aged↗
[Behavior of arterial pressure during administration of intravenous streptokinase, in patients with acute myocardial infarct].
OBJECTIVE: To evaluate the effect on blood pressure (BP) of intravenous (IV) streptokinase (SK) in patients (PTS) with acute myocardial infarction (AMI). DESIGN: Retrospective study with analysis of BP registers ten minutes before and during SK infusion. SETTING: PTS admitted to the Coronary Care Unit (CCU) of Santo António Hospital, Oporto. PATIENTS: Thirty-eight male PTS, average ages of 54, ranging from 38 to 67, AMI confirmed, and criteria to thrombolytic therapy. One patient was excluded on account of persistent hypotension since admission. MATERIAL AND METHODS: IV infusion of 1,500,000 U of SK over 60 minutes, preceded by 200 mg IV of prednisolone. BP and heart rate (HR) were evaluated with a Datascope Accutorr 1A set. The lowest value of the systolic BP (SBP) recorded ten minutes before SK infusion was considered the baseline value. We valued the reduction of SBP above 15%, defining its fall as the difference between the baseline value and the minimum value of SBP recorded during the infusion. Hypotension was defined to SBP values below 90 mmHg. MAIN RESULTS: The SBP fall was 40.4 +/- 22.1 mmHg (range 9 to 102), having been recorded the minimum value at 22.9 +/- 10.9 minutes. It was accompanied by diastolic BP (DBP) fall of 30.6 +/- 18.9 mmHg (range -2 to 76) and by a HR increasing from 76.2 +/- 13.7 beats/min. to 80.8 +/- 14.1 beats/min. (p less than 0.01). In 86% of the PTS this fall was transient, lasting 8.9 +/- 6.3 minutes, and was corrected by slowing or stopping the infusion for a few minutes and placing the patient in Trendelenburg position. Two PTS needed sympaticomimetic amines because of persistent BP reduction despite the previous measures. 92% of the PTS had a SBP fall higher than 15% in relation to the baseline value. The SBP was kept over 90 mmHg in 20 PTS (54%); hypotension was recorded in the remaining 14 PTS (38%), and in 10 (27%) of these the SBP fell below 80 mmHg. We couldn't prove that the infarction location and the extension of the ischemic lesion had influenced this BP fall. CONCLUSION: The BP reduction during treatment with high doses of SK deserves some attention because, although transient and easily reversible, it is frequent and sometimes significative. It demands then careful monitoring in order to avoid the hypoperfusion to the ischemic myocardium, that could jeopardize the potential benefits of reperfusion in the reduction of infarction area, the main objective of the thrombolytic treatment.
Adult↗
Schistosoma mansoni shares a protective carbohydrate epitope with keyhole limpet hemocyanin.
The glycanic epitope of the 38,000 Mr Schistosoma mansoni schistosomula major immunogen defined by the IPLSm1 protective mAb was identified in the hemocyanin of the marine mollusc Megathura crenulata, better known as KLH. This antigenic community was exploited to investigate further the biological properties of this epitope. KLH was shown to strongly inhibit the binding of IPLSm1 mAb to its 38,000 Mr target antigen. Immunization of naive LOU rats with KLH elicited the production of anti-S. mansoni antibodies capable of immunoprecipitating the 38,000 Mr schistosomulum antigen. Antibodies to KLH mediated a marked eosinophil-dependent cytotoxicity and passively transferred immunity towards S. mansoni infection. Finally, rats immunized with KLH were significantly protected against a challenge with S. mansoni cercariae. The deglycosylation of KLH completely abolishes its immunological and functional KLH properties, indicating the participation of an oligosaccharidic epitope of the native KLH that is also recognized by the sera of S. mansoni-infected patients. These observations provide new opportunities of access to the well-defined structure of a glycanic epitope potentially available for the immunoprophylaxis and seroepidemiology of schistosomiasis, and a new approach to the isotypic response towards a well-chemically defined epitope.
Animals↗
Observation of phiK pi decay of the K
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Journal Article↗
Inclusive strange-particle production in single-vee events in 200-GeV/c pi -N interactions.
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Journal Article↗