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Biomedical subjects

D Ferreira

Publications and source records attributed to D Ferreira.

At least 37 records · Page 2Linked to original sources
PubMed1999

[The variability of the heart rate in the first 24 hours after fibrinolytic therapy in acute myocardial infarct].

AIM OF THE STUDY: The role of heart rate variability changes in the appraisal of reperfusion after fibrinolytic therapy in acute myocardial infarction is still controversial. The aim of this study was to analyze the influence of reperfusion and infarct site on heart rate variability within 24 hours after infarction. PATIENTS AND METHODS: We studied 45 patients with a mean age = 56.3 +/- 12.4 years, 25 with anterior infarction and 20 with inferior infarction. The reperfusion was defined by the simultaneous presence of three classic noninvasive criteria (fast relief of pain, fast regression of ST segment elevation and early peak of CK). We studied heart rate variability parameters in time-domain and frequency-domain on a 24-hour Holter ECG started at the same time as fibrinolytic therapy. RESULTS: Thirty-three patients showed reperfusion. We did not find significant differences in the several parameters of heart rate variability between patients with reperfusion and patients without reperfusion, but the patients with anterior wall infarction showed a significant reduction in SDNN in comparison with patients with inferior wall infarction (84 +/- 28 ms vs 102 +/- 30 ms; p = 0.05). pNN50 (5.3 +/- 7.2 ms vs 10.5 +/- 9.8 ms; p = 0.04), LF (618 +/- 591 ms2 vs 1374 +/- 1761 ms2; p = 0.05) and TP (1415 +/- 1199 ms2/Hz vs 3015 +/- 4243 ms2/Hz). CONCLUSION: These data suggest a relationship between infarct severity and sympathetic activation and/or reduction of vagal modulation, but a potential beneficial effect of reperfusion on autonomic nervous system alterations was not evident in the first day of acute myocardial infarction.

Adult↗
PubMed1999

The natural history of closed mitral commissurotomy--a 20 year follow-up.

AIM: To study the natural history of mitral stenosis in a Portuguese population submitted to closed commissurotomy. METHODS-POPULATION: All the patients submitted to closed mitral commissurotomy in Pulido Valente Hospital. The commisurotomies were performed from 1956 to 1978 and included a total of 1,134 patients (220 males). Based on the clinical records, we studied the baseline characteristics of all the patients (n = 1134) at the time of surgery. An average of 20 years after surgery, we sent a questionnaire to all these patients. The patients who filled out the questionnaire (n = 352) represented the total Population in terms of the principal clinical characteristics. Based on these answers, we studied the long-term results of closed commissurotomy. RESULTS: Closed commissurotomy was performed before the age of 20 in about 10% of the patients and after the age of 49 in only 1.6%. The initial symptoms occurred at 22.0 years and commissurotomy was performed at 30.4 years (averages). The procedure was successful: 99% of patients improved significantly after commissurotomy and two thirds had major or total improvement. CONCLUSIONS: In the natural history of these commissurotomized patients the events were early, with symptoms in their twenties and surgery in their thirties. The events occurred earlier in males than in females. Closed commissurotomy presented, in this study and with these patients, very good results with improvement in 99% of the patients. The positive results the commissurotomies were important and long lasting: there was a low rate of re-intervention (16%) and hospitalization (35%) twenty years after surgery and 53% of the patients are still alive. These good results can be, at least in part, explained by the low age of this population at the time of surgery.

Adolescent↗
PubMed1995

[Variability of heart rate].

AIM: The basic principles of the physiological mechanisms of heart rate variability are discussed. The different methods used in its assessment are evaluated. An overview of its clinical utility is presented. STUDY DESIGN: We reviewed the papers on this area until May 1994 we thought relevant. The more or less succinct description of their conclusions is made and commented. RESULTS: Heart rate frequency and its oscillations are regulated by the autonomic nervous system. Heart rate variability analysis is an easy non invasive means of investigating the autonomic control of the heart. There is a wealth of experimental and clinical evidence linking abnormalities of the autonomic nervous system with the development of serious ventricular arrhythmia and sudden death, and it has been clearly shown that decreased heart rate variability is associated with increased mortality in diabetes and after myocardial infarction. Abnormal heart rate variability has been detected in several other disorders such as hypertension, neurologic diseases, heart failure, renal failure, etc., although here its clinical usefulness is yet to be set. Heart rate variability is influenced by various drugs whose potential protective cardiovascular effect is under investigation. CONCLUSIONS: Heart rate variability analysis is a promising method that can be used as an index of cardiac autonomic balance and has been shown to be of significant clinical value. RR interval variation is controlled by the activity of cardiac sympathetic and parasympathetic nervous system, the function of which is influenced by many factors such as age, sex, position, breathing, hour of the day, therapeutics, etc. Different methods and results have been used by various authors. Standard values are not yet available to be used or compared in different settings. From the interest it has raised all over the world it is expected that very soon this method will have a widespread use in clinical practice, providing useful tools both for diagnostic and prognostic purposes and to monitor and guide therapeutic interventions.

Cardiovascular Diseases↗
PubMed1994

Flavan and procyanidin glycosides from the bark of blackjack oak.

The bark of blackjack oak contains (+)-catechin, (-)-epicatechin, (+)-3-O-[beta-D-glucopyranosyl]-catechin, catechin-(4 alpha-->8)-catechin, epicatechin-(4 beta-->8)-catechin as well as the novel 3-O-[beta-D-glucopyranosyl]-catechin-(4 alpha-->8)-catechin and 3-O-[alpha-L-rhamnopyranosyl-(1-->6)-beta-D-glucopyranosyl]-catechin, as major components. The latter rutinoside of catechin is especially interesting because of the exceptionally small J2,3 C-ring coupling. The glucoside of catechin-(4 alpha-->8)-catechin is only the second proanthocyanidin found in nature in which a 3-O-glycoside is present in the upper 'extender unit' of a dimer.

Biflavonoids↗
PubMed1992

[Formation of left ventricular thrombus in acute myocardial infarction: significance of the determination of fibrinogen, of products of fibrinogen degradation, and of plasminogen].

OBJECTIVE: To evaluate the significance of the fibrinogen, the plasminogen and the fibrinogen degradation products levels as marks of left intraventricular thrombosis (LIVT) in acute myocardial infarction (AMI). METHODS: 219 consecutive patients of AMI admitted in a Coronary Care Unit of an University Hospital, were prospectively studied. All protocols included a clinical evaluation, an M-mode and 2D echocardiographic study and blood samples, at day 1, 3, 7 and at hospital discharge. In the intraventricular thrombus evaluation just the 4 Asinger grade was considered. In the laboratory evaluation we used: the Clauss chronometric method for the fibrinogen, the colorimetric method for the plasminogen and the agglutination in plaque for the FDP. The patients with ECO in the 2 or 3 Asinger grades and those in which ECO and laboratory study were not performed in the same day, were excluded. 101 patients remained on the study, and they were divided in two groups: 53 patients with LIVT and 48 patients without it. RESULTS: In both groups the fibrinogen raised along the first six days of the AMI, however in the group with LIVT this level didn't raise as high as in the group without LIVT (p < 0.001). In the FDP evaluation two peaks were found, one at 48 hours and another on the 6 th day, but there were no differences between the two groups. The plasminogen values raised along the first week of AMI, in a similar way in both groups. CONCLUSIONS: a) Fibrinogen levels raises in AMI, but this elevation is significantly smaller in the group with LIVT, which suggests fibrinogen consume in fibrin formation of the thrombus. b) FDP and plasminogen levels raise along the first week of AMI, but in a similar way in the two groups. c) None of these parameters permitted to individualize patients with thrombus formation.

Aged↗
PubMed1992

[A case of incessant junctional tachycardia in a female patient with aneurysm of the interauricular septum].

A permanent supraventricular tachycardia (SVT) was diagnosed in a 54-year-old hypertensive but cardiologically asymptomatic female patient, admitted to a surgery department for biliary lithiasis and hepatic echinococcosis. Heart rate was about 130 bpm and ECGs showed negative P waves in leads I, II, III, aVF, and precordial leads V2 to V6, being the RP' interval longer than P'R interval. Pharmacological intervention during Holter monitoring (20 hours) was instituted: following i.v. propranolol (4 mg), heart rate progressively decreased (to 112 bpm), mainly due to an increase in SVT RP' interval, and brief, spontaneous SVT interruptions occurred, preceded by P'R interval prolongation; SVT stopped after P' recording, and resumed after 2 sinus beats, (showing enlarged P waves and slightly prolonged PR interval), induced by cycle length shortening; later on, under i.v. amiodarone infusion (100 mg/hour) and coincident with the sleeping period, SVT cycle length progressively increased (to 600 msec), due to equivalent increases in P'R and R'P intervals. Two premature ventricular contractions (PVC) occurred during Holter monitoring at a coupling interval of 80-85% of SVT cycle length (480 msec): one PVC apparently originated in left ventricle lateral wall, captured the atria, which were activated 75 msec earlier than expected; the other PVC, apparently originated in left ventricle septoapical region, did not interfere with SVT cycle length. Before these data, a diagnosis of circus movement tachycardia, incorporating a concealed accessory pathway with slow retrograde conduction and ventricular insertion in the postoroseptal or left posterior paraseptal region, and showing minor impairment of antegrade AV nodal conduction, was made. Invasive electrophysiological study was then discarded. With combined oral antiarrhythmic therapy (amiodarone, 600 mg/d), plus propafenone, 450 mg/d), sinus rhythm was permanently restored, with evidence of intraatrial block, slightly prolonged PR interval and no preexcitation. Transesophageal echocardiography revealed a small atrial septal aneurysm associated with a small atrial septal defect; echocardiographic features were consistent with the hypothesis of incomplete regression of the atrial septal aneurysm after partial closure of the atrial septal defect. Abdominal surgery (cholecystectomy plus partial hepatic pericystectomy) was performed without any complications or SVT recurrences. During a 6-month follow-up period, maintaining amiodarone (200 mg/d) and propafenone (450 mg/d), the patient remained SVT-free, and Holter monitoring performed at 3 and 5 months showed permanent sinus rhythm and 1:1 AV conduction with slightly prolonged PR interval (less than 0.29 sec and shortening at faster heart rates). This case documents Holter monitoring capability for the evaluation of tachycardia mechanisms in patients with permanent SVT.

Amiodarone↗
PubMed1990

[The importance of heart disease in the various types of cerebral vascular disease. A prospective study].

UNLABELLED: A prospective study was performed in 106 patients with acute stroke. The main purpose was the cardiac evaluation in the different types of cerebrovascular disease: Intracerebral hemorrhage (H), Cortical ischaemic events (C) and Subcortical ischaemic events (SC) and also to evaluate the interest of echocardiography in detecting occult cardiac sources of emboli. The study population included 54 men and 52 women with a mean age of 66.8 +/- 10.3 years. A thorough neurologic and cardiologic study with a computed tomography of the brain (TAC) and an echocardiogram (ECO) were performed in all patients. It was found 24 (23%) of H, 40 (38%) of C and 32 (30%) of SC. In the past history, heart diseases were more prevalent in C (p less than 0.04); previous stroke and systemic hypertension (HTA) were less prevalent in H (p less than 0.008) and in C (p less than 0.004), respectively. Atrial fibrillation (FA) was more frequent in ischaemic stroke (p less than 0.02) and within these in C (p less than 0.005). No more clinical and functional cardiac features or echocardiographic aspects had any difference in their prevalence in different types of stroke. Without clinical heart disease there were 19 (18%) cases but only in 10 were found in their echocardiograms a potentially embolic heart disease (PEHD) but 8 of them had questionable pathologic significance. IN CONCLUSION: C had more heart disease in their past history; FA is more frequent in C; it is difficult to diagnose a cerebral embolism with only a coexistent C and CPE, but if there is FA or a past history of heart disease in a C, the diagnosis of cerebral embolism is more probable; finally, echocardiography is of limited value to diagnose a PEHD in the elderly, however it makes possible to better evaluate most cardiac situations.

Acute Disease↗
PubMed1986

[Value of velocimetric and echotomographic examination in monitoring central catheterizations].

Thrombosis around a centrally-implanted catheter is a complication of this method of venous approach. Usually asymptomatic, it is normally detected by phlebography, histopathology or computed angiotomography. Thirty-five patients with catheters in internal jugular vein composed of silicone (13 cases) or polyurethane (22 cases) were followed up by velocimetric and echotomographic examinations before introduction and one and three weeks after introduction of a catheter, these exploratory procedures possessing the advantage of being rapid, repetable and non-invasive. Three thrombosis were diagnosed using this method, including two without clinical signs, one on a silicone and two a polyurethane catheter. This represents 8.6% of total population, comparable with results of phlebography and histopathology reported in the litterature. The echotomographic appearance of the fibrinoplatelet sleeve left by the catheter after its removal is also described. Combined velocimetric and echotomographic examination is an investigational method which is non-invasive, reliable, rapid and repeatable for evaluation of appearance, localization, extension and also follow up of thrombosis.

Adolescent↗
PubMedDate not supplied

Social skills training for drug prevention in high-risk female adolescents.

BACKGROUND: The effectiveness of social skills training/social network restructuring in the primary and secondary prevention of drug use was examined in a multiethnic cohort of 296 female adolescents ages 14 to 19 years who were pregnant or parenting and/or at risk for drug use. METHODS: Subjects were randomly assigned to one of two conditions: (a) PALS Skills Training or (b) a control intervention involving no skills training. PALS Skills Training is a combination of cognitive and behavioral techniques to improve social skills and to restructure the teens' social network. All students also participated in a 16-week normative education "Facts of Life" course. RESULTS: The prevalence of alcohol and any drug use increased significantly over the three assessment periods in the PALS Skills group but not in the No Skills group. Teens in the PALS Skills group who reported no drug use at baseline were 2.9 times as likely to be using marijuana than teens in the No Skills group at 3 months postintervention. PALS Skills Training was no more effective in the secondary prevention of drug use than the control intervention. CONCLUSIONS: Social skills training was found to be ineffective as a means of primary prevention among non-drug-using high-risk adolescents and may even be counterproductive as a means of primary prevention of marijuana use in this population. When combined with normative information on drug use prevalence, acceptability, and hazards, social skills training is no more effective as a means of secondary prevention than normative education alone.

Adolescent↗
PubMedDate not supplied

Platelet glutamate receptor supersensitivity in major depressive disorder.

Dysregulation of glutamate has been described in depression, and supersensitivity of platelet glutamate receptors has been found in both psychotic major depression and schizophrenia. The aim of this study was to examine the platelet glutamate receptor sensitivity in patients with nonpsychotic, unipolar major depression to assess whether this is a marker of depression or of psychosis. Glutamate receptor sensitivity was assessed using the platelet intracellular calcium response to glutamate (0-100 micromol) measured by spectrofluorometry. The depression group showed a significantly greater platelet intracellular calcium response to glutamate stimulation than the control group, both in terms of absolute values (p = 0.007) and percentage of response from baseline (p = 0.030). These data suggest that platelet glutamate receptors may be supersensitive in depression and that the platelet may be a possible peripheral marker of glutamate function in depression.

Adolescent↗