Biomedical subjects
Publications and source records attributed to A Barbosa.
The following is a translation of the proposed diagnostic criteria established by a European group for twelve common psychosomatic syndromes found in general clinical practice. Many of them have the potential to occur during different stages of a large variety of diseases and their detection could lead to better holistic provision of health care.
The aim of this study was to construct a typology integrating sociodemographic, clinical and personality data of alcohol-dependent patients. We studied a consecutive population attending an alcohol-dependent outpatient psychiatric department, assessed by instruments that measured psychiatric, psychopathological, personality and sociodemographic characteristics of alcohol-dependent patients. The factorial analysis allowed us to define three main expressions of alcoholism: physical, psychological and social. In the elicited typology, both physical and social appear mixed in their expression. The psychological expression is divided into two main categories: the alexithymic (with a depressive personal and family history) and the psychopathologic type (with actual depression and anxiety). This typology should allow us to correlate these types with neurophysiological and biochemical patterns and could be particularly useful in building an etiologic model of alcohol dependence which could contribute to a better prediction of prognosis and choice of the best therapeutic intervention.
The development of consultation-liaison psychiatry in Portuguese general hospitals raises the need for specific training to be included in the preparation of psychiatric trainees. In order to contribute to a better quality of liaison psychiatric training we propose guidelines for this training period. We describe the aims of a training period, the core curriculum, the structure of this training and provide a bibliography. We also propose a systematic evaluation profile for psychiatric trainees and supervisor.
We report a case of a 29-year-old man presenting skin ulcerations on both sides of the mandible. The diagnosis of dermatitis artefacta was based on the morphology and evolution of the lesions, on the patient's borderline personality, on the objects found in his possession, and a later admission of having an involvement in the aggravation of the lesions.
BACKGROUND: Although most epidemiological data are gathered by interviews, few studies ascertain their reliability. This study quantified inter-observer reliability of environmental, biological and health characteristics of underprivileged children, in a southern Brazilian state. METHODS: Five health care professionals who had received extensive standardized interview and observation training interviewed mothers and observed the home environments of a random sample of 102 children. A second interview was conducted by a sixth health professional who had received separate but identical training without the initial interviewer knowing a follow-up interview would be conducted. Data from the two independent interviews and observations were compared for agreement using the kappa statistic. RESULTS: There was excellent agreement (kappa > 0.75) for most of the household characteristics, such as type of walls, ceiling, floor and windows in spite of the diversity of buildings. Presence of the parents, number of people in the house-hold, age of the mother and health assistance were reliable as well. However, information about skin colour of the mother and the number of cracks in the house only reached fair agreement. CONCLUSIONS: These results showed that data gathered by observation and interviews generate accurate information about environmental, biological and health care characteristics. Those based on written information, such as birth date, were highly concordant.
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Phosphine is an important fumigant in the grain industry and has been reported to be genotoxic in occupationally exposed fumigators. This study reports on the effects of phosphine inhalation exposure at up to, and exceeding, occupational relevant levels in a subchronic (0.3, 1.0 and 4.5 ppm, 13 weeks) and a short term repeated-dose (5.5 ppm, 2 weeks) study in both sexes of Balb-c mice. The following end-points were examined: micronucleus induction in bone marrow, peripheral blood, spleen lymphocytes and skin keratinocytes, mutations at the hypoxanthine-guanine phosphoribosyl transferase locus in lymphocytes, and weight gain and relative organ weights (kidneys, lungs, liver, heart, brain and spleen). After subchronic exposure, there was a highly significant negative linear correlation between proportional weight gain and exposure in both sexes (multiple linear regression, r = -0.56, P < 0.0001), with female mice showing a greater effect. Females also showed an increase in relative organ weights at the highest test dose, in contrast to males where there was a slight decrease. A statistically significant increase in micronucleus frequency was seen in the bone marrow and spleen lymphocytes of both sexes, but only at the highest concentration. The short term repeated-dose study revealed a slight decrease in weight gain in both sexes, with a greater effect in females. It is concluded that phosphine is weakly genotoxic in both sexes of mice, and has an effect on weight gain. However, the weak genotoxic effect may not be biologically significant as it was seen only in the subchronic study and only at the highest test concentration of 4.5 +/- 0.8 ppm (approaching the LD50). Although such exposure conditions are unlikely to be encountered in an occupational environment, caution should continue to be exercised in the use of phosphine until more data become available.
Phosphine has been claimed to cause chromosomal damage at exposures close to the current time weighted average exposure standard of 0.3 ppm (0.4 mg/m3). The current study involved 31 phosphine fumigators and 21 controls during the high fumigation season. All were volunteers and were evaluated for genotoxicity variables, including micronuclei in peripheral blood lymphocytes and urine mutagenicity. In parallel, all fumigators and 17 controls were evaluated for full haematology, multiple biochemical analysis, whole blood organochlorines, and whole blood and serum cholinesterase activity. The results for micronuclei showed no significant differences between fumigators and controls, but detected a strong association between age and increased frequency of micronuclei. Measurement of urine mutagenicity did not show any significant difference between fumigators and controls, but did show increased excretion of mutagens in smokers. All haematological and biochemical variables were within normal ranges, except for some non-specific changes in biochemistry. At monitored occupational exposures of < 2.4 ppm/h our results show no association between phosphine exposure and genotoxic or toxicological effects in fumigators.
It is known that in general hospitals there is an increasingly high percentage of elderly patients that frequently develop psychiatric morbidity during hospital stay. This has lead the authors to perform a comparative study involving patients referred to Consultation/Liaison Psychiatry, in order to establish guidelines for a future approach. The first 1.000 referrals to the Consultation/Liaison Psychiatry Unit of the Santa Maria Hospital were analysed by comparing patients aged 65 or above to other observed patients. The results indicate a clearly lower percentage of elderly patients referred and a longer average length of stay at the moment of referral. Medical diagnoses show a preponderance of cardiologic, malignant and respiratory diseases, whereas intoxication, the prime diagnosis in the younger group, is much less represented above the age of 65. Identically, referrals due to suicide attempt were significantly less frequent in this group. Psychiatric diagnoses show a greater prevalence of organic mental disorders, followed by mood disorders, while in the younger the latter prevail. The post-discharge plan shows a higher percentage of elderly patients referred to general practitioners and medical specialties and a lower one for psychiatric care, as opposed to the younger group. The conclusions point towards the need for programs directed to early detection and treatment of psychopathological disorders (organic and depressive mental disorders) of elderly people admitted to a general hospital. This will be achieved through a close collaboration between C/L psychiatrists and medical staff, families and community facilities.
This article mentions ther present main lines of psychosomatic research either in what concerns the elimination of the concept of psychosomatic illness, or in what concerns its etiological understanding of the peculiar ways of therapeutic approach. We specify some methodological problems resulting from using several instruments to collect data and measure them. We analyse the theoric relevance of the constructs: depressive equivalents and, specially, the alexithymia one. Starting from the consensual phenomonological description of this construct, we explain its psychodynamic understanding, its neurophysiologic basis and sociocultural determination. We question the relationship between alexithymia and psychosomatic illness. We point out the pertinency of its utilization as a risk or maintainance factor and the possibility of its modelling by ambiance factors. We clarify the main heuristic contributions of this construct to psychosomatic investigation and we analyse, critically and concisely, the validity and fidelity of some instruments of measure built to measure it. It is necessary to pay prior attention to psychosomatic investigation in the health area. We propose lines of investigation to be developed in our country that should have a multidisciplinary perspective.
264 consecutive cases of ECCE are reviewed. In this series 28 cases of Nd YAG laser capsulotomy have been performed. Visual results are excellent: visual acuity is improved in 90% of cases. The rate of complications is low: 1 case of retinal detachment, 2 cases of IOP raise, no clinical CME. Laser therapy is performed when visual acuity decreases, prior to other extra clinical examination.
An attempt was made to assess the course of physiological response to stress - an autonomic regulation process - in 60 newborn infants during the 1st month of life. Data used in this study were based on results of the B.N.B.A.S. (Brazelton Neonatal Behavioral Assessment Scale) applied on the 1st, 3rd and 28th days of life. An improvement of scores was demonstrated in all items throughout the 1st month of life.
An experimental group of 30 newborn infants had contact with their mothers for half an hour in the delivery room, and a control group followed the usual hospital routine, being shown briefly to their mothers before being taken to the nursery. In both groups permanent rooming-in began from the sixth hour of life. The infants' behaviour was assessed one, three and 28 days after birth by means of the Brazelton scale, and the behaviour of the dyad was observed during feeding on the third and 28th day. Infants in the experimental group interacted significantly better on days three and 28, and their mothers had higher scores for affectionate behaviour on the 28th day.
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Forty consecutive patients with Ullrich-Turner syndrome (UTS) were followed-up and investigated for the presence of Y chromosome fragments in their genomes. We used the polymerase chain reaction (PCR) to detect SRY (sex-determining region on the Y chromosome) and the sequence-tagged sites (STS) sY57, sY59, sY85, sY94, sY124 and sY157--which correspond to regions 3C (sY57 and 59), 5C, 5G, 5P, and 6F, respectively, of the Y chromosome--searching for Y fragments that could bear the putative locus (loci) for gonadoblastoma (GBY). It has been shown that the presence of GBY greatly increases the risk of dysgenic gonads to undergo malignant transformation. Among our 40 patients, we found Y-derived sequences--including SRY and the region spanning from sY57 to sY94--in two. These two patients had a marker chromosome detected by conventional cytogenetic analysis (45,X/46,X + mar). Their gonads were excised and found to be streaks. In one of the patients, we found foci of primitive sex cords (amidst the gonadal stroma), oviducts and Wolffian remnants. Fluorescence in situ hybridization (FISH) did not show Y chromosome material in her gonad-derived fibroblasts. The other girl had hyperplastic Leydig cells in the gonadal stroma, oviducts and Wolffian remnants, with signs of epididymal differentiation. PCR assays performed on DNA extracted from paraffin-embedded gonadal tissue were negative for SRY sequences in both patients. These findings show that all UTS patients should be examined for Y chromosome material, and that positive cases should have their dysgenic gonads excised due to the high risk of malignancy.
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