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Biomedical subjects

A Langer

Publications and source records attributed to A Langer.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

Prognostic value of dipyridamole SPECT imaging in low-risk patients after myocardial infarction.

BACKGROUND: The prognostic value of perfusion imaging was assessed in low-risk patients after myocardial infarction (MI) and compared with clinical and angiographic variables. METHODS AND RESULTS: Rest thallium and dipyridamole technetium 99m sestamibi single photon emission computed tomography imaging was performed in 203 (91%) low-risk patients 3 to 21 days after MI who were enrolled in a trial of low-dose warfarin sodium and aspirin. Patients were considered low risk with planned nonintervention, on the basis of an uncomplicated course after MI, negative submaximal stress electrocardiography, and the absence of significant angiographic disease requiring revascularization. During a minimum follow-up of 12 months, 69 patients (34%) had clinical events: 1 cardiac death, 7 MIs, 26 admissions for unstable angina, 18 coronary bypass grafting, and 17 angioplasty. Univariate analysis identified the extent of significant angiographic stenoses (> or =70%) and the extent of scintigraphic defect as predictive of future events. On multivariate analysis, the presence of any scintigraphic reversibility had the strongest correlation with clinical events, with better predictive value than angiographic multivessel stenoses (P =.0006 vs P =.003). CONCLUSIONS: In the low-risk population after MI, scintigraphic reversibility remains a strong predictor of cardiac events, with greater prognostic value than angiographic data. The extent of scintigraphic reversibility was directly correlated with clinical events. Therefore scintigraphic imaging remains clinically relevant for risk stratification in the current low-risk population after MI.

Adult↗
PubMedDate not supplied

A study on maternal mortality in Mexico through a qualitative approach.

This report presents the main qualitative results of a verbal autopsy study carried out in three states of Mexico, which aimed at identifying the factors associated with maternal mortality that could be subject to modifications through concrete interventions. By reviewing death certificates issued in 1995, it was possible to identify 164 households where a maternal death had occurred. One hundred forty-five of these households were visited, and a precoded questionnaire was completed to explore socioeconomic and living conditions, as well as causes of death. An open-ended question to prompt the relatives to narrate all the facts that led to the maternal deaths was included in the questionnaire. This study presents an analysis of that question, focusing on the delays in the care-seeking process and organized according to the model of the three delays: in deciding to seek care, in reaching a care facility, and in actually receiving care after arrival. Additionally, problems related to quality of care are examined. For analysis of the accounts, structural, interactional/community, and subjective variables were identified that allowed refining of our understanding of the problem of maternal deaths. Finally, based on the findings of the study, this article presents a series of recommendations, highlighting that interventions should address the early stages of a complication and focus on decreasing the various forms of inequality (gender and socioeconomic) associated with the occurrence of maternal deaths.

Adolescent↗
PubMedDate not supplied

Pulmonary hemorrhage complicating a typical hemolytic-uremic syndrome.

We describe a case of pulmonary bleeding and subsequent acute respiratory distress syndrome (ARDS) in a 20-month-old female suffering from a typical postdiarrheal hemolytic-uremic syndrome (HUS). Acute renal failure was treated early by peritoneal dialysis. It is of interest to underline that thrombocytopenia or any coagulative impairment was absent when this complication occurred, and spontaneous diuresis recovery was ongoing. All examinations failed to identify a unique site of bleeding in the main stem bronchi or trachea. Complete renal and clinical recovery was obtained in spite of this very uncommon complication. Intensivists should be aware of this rare and potentially fatal complication of typical (D+)HUS.

Acute Kidney Injury↗
PubMedDate not supplied

[Diffuse axonal lesions in childhood].

OBJECTIVE: About 48% of all primary traumatic intracranial lesions are represented by so-called Diffuse Axonal Injury (DAI): a pathologic condition characterized by multiple microscopic lesions and hemorrhage at the level of midline cerebral structures, in the subcortical grey matter, and/or within the brainstem. The natural history of DAI is depressing: 100% of the patients deteriorate rapidly to coma and approximately 50% die, while 50% remain in a vegetative state or with severe neurological deficits. In the present report, we describe the results of a study aimed to evaluating the cerebral hemodynamics and the neuroradiological findings observed in four children (6, 8, 10 and 12 years old) affected by DAI. METHODS: All the patients had been admitted to the Pediatric Intensive Care Unit with Glasgow Coma Score (GCS) of 5. On admission, all patients underwent mechanical ventilation, antiedemigen and barbiturates therapy. Serial CT scan and Transcranial Doppler Sonography (TCD) examinations were carried out in all children. TCD of the middle cerebral arteries was performed through the temporal window. The children underwent insertion of a ventricular catheter for intracranial pressure monitoring. Follow-up time has been, respectively, 4 years, 3 years, 7 and 1 months. RESULTS: The Glasgow Outcome Score (GOS) of three children is 2 (persistent vegetative state), while the GOS of the one child is 3 (severe neurological deficits). CONCLUSION: DAI results in unfortunate prognosis and large health care costs. The proper medical management of this condition should be based on TCD and SjO2 and CEO2 evaluations, in order to monitor efficaciously the cerebral blood flow.

Adolescent↗
PubMedDate not supplied

[Emergency contraception: a simple, safe, effective and economical method for preventing undesired pregnancy].

In the following article, the most recent knowledge on emergency contraception (EC) is reviewed. EC is defined as those contraceptive methods that may be used to prevent an unwanted pregnancy up to 3 days after unprotected intercourse, contraceptive failure or rape. In case of non-hormonal methods (IUD), the time window for pregnancy prevention goes up to 5 days after intercourse. The different regimens now available, hormonal and non-hormonal methods, indications, contraceptive effectiveness, side effects and safety profile, possible mechanisms of action and counseling strategies will be reviewed. The potential benefits on reproductive health of wide-spread knowledge and easy, non-restrictive access to this methodology are emphasized. An extensive list of recent references is enclosed.

Adolescent↗
PubMedDate not supplied

Considerations in the development of the automatic implantable defibrillator.

A highly reliable ventricular fibrillation detector and a satisfactory electrode system for delivering defibrillating pulses to the heart play a central role in the development of an automatic implantable defibrillator suitable for clinical use. Among the four implanted electrode designs tested, the combination of an electrode placed in the superior vena cava with a conformal electrode on the apex of the heart provided satisfactory defibrillation thresholds with ease of implantation. A new sensing method is also described for which an electrogram derived from the defibrillating electrodes is used as input. A form of a density function is developed for a filtered version of the input, ventricular fibrillation being characterized by a density curve lacking a large peak occurring at a level corresponding to the baseline of the filtered signal. These ideas are being incorporated into the design of a prototype implantable defibrillator delivering pulses of 24 joules.

Animals↗
PubMedDate not supplied

Are mummy characteristics reliable indicators of diapause and cold tolerance in the parasitoid wasp Aphidius rhopalosiphi (Braconidae, aphidiinae) ?

Many insect species have evolved different overwintering survival strategies such as cold tolerance or diapause. This study investigated the relationship between Aphidius rhopalosiphi mummy colour and cold tolerance and diapause. Mummy colour was insufficient to discriminate diapausing from non-diapausing individuals. This phenotypic character seems to reflect environmental conditions rather than direct developmental time and cocoon thickness (identification criteria of diapause). There is, however, a relationship between cold tolerance and mummy colour. Dark mummies exhibited significantly higher water content, survival at low temperature and lower supercooling point values than pale mummies. Mummy colour in Aphidius rhopalosiphi seems to be a phenotypic indicator of the cold tolerance.

Adaptation, Physiological↗
PubMedDate not supplied

[The management of the child with head injury: initial assessment].

In western countries, head injury is very important in public health; infact it is the main cause of mortality after infancy and a significant cause of long term disability. The patients with severe head injury needs an intensive care unit management, but the initial approach is a critical phase, too. In fact, it is demonstrated that trauma mortality and morbility are significantly reduced by a quick and well conducted approach. This article focuses the initial management of the injured child.

Cardiopulmonary Resuscitation↗
PubMedDate not supplied

[International cooperation for research in public health: the case of the Latin American Network of Perinatal Investigation].

Health research in Latin America faces serious shortcomings, especially considering the region's dire needs. Multicenter collaboration can be a valuable tool to promote scientific development. In 1985, investigators of four Latin American epidemiologic research centers created the Latin American Network for Perinatal Research. The analysis of the difficulties we had to face in order to implement the first joint study illustrates the obstacles people involved in multicenter projects have to overcome. The conclusion is that in spite of the difficulties, multicenter work is feasible and to be recommended. Results of this kind of studies reach a great external validity and are applicable to broad population sectors.

Argentina↗
PubMedDate not supplied

[Limitations of infant mortality as a health indicator].

Infant mortality is usually accepted as a sensitive indicator of living conditions, and of the coverage and quality of health care in a specific country. However, the validity of this indicator in middle-income countries presents some important limitations. First, underegistration of infant deaths is a common feature. In second place, the national figures hide the great inequalities that may exist among different social sectors and regions. In this paper, the limitations of Mexico's infant mortality rate are analyzed. Underegistration is demonstrated by comparing infant mortality rates obtained from vital statistics data and national health surveys. Differences among social sectors are evident when specific infant mortality rates are compared. Inequalities have been increasing in the last years.

Health Status Indicators↗
PubMedDate not supplied

[Advances in public health investigation. 5 years' work of the Center for Research in Public Health, 1984-1989].

Five years after the creation of the Center for Public Health Research (SPHR), this essay reviews its origins and evolution and points to the challenges it will face in the future. The seven basic organizational principles underlying the academic development of the Center are described. In the quantitative aspect, the institution's growth is reflected in the rapidly increasing trend in the number of researchers, projects and scientific publications, as well as in the volume of the external financial resources received. In the qualitative aspect, the article highlights the ever growing number of themes approached by the seven lines of research, the elaboration of conceptual models, the creation of data bases and the methodological development. Among the most important challenges of the CPHR in the future are: (1) solving existing organizational problems; (2) building links with the decision makers and (3) establishing an equilibrium between relevance and excellence in public health research.

Female↗