Biomedical subjects
L Moura
Publications and source records attributed to L Moura.
The software challenge for the next decade: the global objects scenario.
This paper discusses the advantages of developing software as pattern-based components. The design and implementation of a pattern-based suite of software components specially constructed for the electronic patient record is presented. The methodology and the lessons learned in the development of these components are discussed. Finally, some comments about the globalization and the need for more integration among component developers in a worldwide basis is discussed.
Renewing information infrastructure at Hospital das Clínicas.
In this paper we describe the process of renewing the Informatics infrastructure of Sao Paulo University Medical School Hospital, a very complex environment. Our proposal consists of a change in the paradigm of Informatics and the use of Information Technology in the hospital. That change aims at making information available to the hospital, its managers, health care workers and patients. The paradigm change is reflected in every aspect of the new infrastructure: human resources, methods, and organizational structure, as we intend to demonstrate in this paper. This process is expected to be concluded by the end of this year, yielding benefits regarding costs, efficiency, and better patient care.
[An increase in renal dopamine production after the administration of radiographic contrast agents].
Renal vasoconstriction and anti-natriuresis conditioned by radiographic contrast agents (CA) may be antagonised by the administration of exogenous dopamine. However, the influence of CA on the activity of renal synthesis of dopamine has not been studied. This study assessed the daily urinary excretion of dopamine, its precursor. L-3, 4-dihydroxyphenylaline (L-DOPA), and its metabolites (acid 3, 4-dihydroxyphenylacetic, DOPAC; homovanillic acid, HVA) 24 hours before and 48 hours following administration of a non ionic and hyposmolar (lopromide) CA in patients (n = 10; average age 61.3 +/- 4.3 years) submitted to coronary angiography. Urinary excretion of noradrenalin, a marker of sympathetic activity, was also assessed during the same period. The deputation of creatinine (Ccr) and the urinary excretion of sodium (UNa+) lowered after the administration of the CA (Ccr, 79.2 +/- 10.2 vs 72.2 +/- 9.6 ml/min/1.73 m2, p < 0.05; UNa+, 112.8 +/- 9.6 vs 61.7 +/- 25.1 mmol/24 h, p < 0.05). On the contrary, the urinary excretion of potassium increased in the period of 24 h following the administration of the AC (31.7 +/- 5.2 vs 103.8 +/- 10.8 mmol/24 h, p < 0.05). There was an increase in the urinary excretion of dopamine as well as noradrelalin during the 24 hour period following the administration of the CA (dopamine, 1260.2 +/- 196.8 vs 1571.5 +/- 170.2 mmol/24 h p < 0.5; noradrenalin, 186 +/- 36.6 mmol/24 h, p < 0.05). On the contrary, the urinary excretion of L-DOPA lowered after the administration of the CA (115.4 +/- 25.5 vs 80.5 +/- 13.2 mmol/24 h, p < 0.05). These results conditioned an increase in the dopamine/L-DOPA ratio in the urine, after the administration of the CA (12.2 +/- 1.5 vs 22.2 +/- 4.5 mmol/24 h, p < 0.05). In conclusion, the administration of CA is accompanied by an increase in the renal production of dopamine which, in these conditions, may act as a compensatory natriuretic hormone.
Use of Standard Therapy for Tuberculosis is Associated with Increased Adverse Reactions in Patients with HIV.
Hepatitis due to anti-tuberculosis therapy is an infrequent, but potentially devastating event. In HIV positive patients with tuberculosis (TB), the consequences are likely to be even greater, as they frequently require other hepatotoxic medications. The object of our study was to determine the frequency of toxic hepatitis during therapy for TB. Included were 198 patients with a presumed or confirmed diagnosis of tuberculosis; of whom, 69 were HIV positive (35%), 75 were negative (38%) and 54 had unknown HIV status (27%). Toxic hepatitis occurred in 15/198 (8%) patients. The incidence of hepatitis in HIV patients was much greater than in HIV negative/unknown [RR=7.5 (2.2-25.6); p=0.0001] and the onset of hepatitis was short (median 7 days in HIV patients). During TB therapy, 1 in S (12.5%) patients taking ketoconazole developed hepatitis; 9/53 (17%) taking sulfamethoxazole-trimethoprim [RR=3.4 (1.1-9.3); p=0.03]. Among the 15 patients who developed hepatitis 11 required hospitalization (mean 19 days), 5 died (33.3%), 2/15 (13%) due to hepatitis. HIV positive patients had a significantly higher rate of toxic hepatitis during anti-tuberculosis therapy than those without HIV infection. Hepatitis occurred just after initiation of TB treatment. Clinical findings were non-specific and hepatic enzyme elevations were moderate, yet hospitalization and mortality rates were high. This suggests that in settings where careful monitoring of patients early in their course of TB treatment is routine, morbidity and mortality may be low, but poor monitoring would have potentially serious consequences. There is a need for new drug treatments (schedules or regimens) for TB in an effort to reduce these adverse events.
[Cerebrospinal fluid in 50 AIDS patients].
Fifty AIDS patients were studied. All patients had anti-HIV antibodies (ELISA) present and met OPAS/Caracas punctuation criteria for AIDS cases in adults. Cerebrospinal fluid (CSF) analysis included pressure, cytology (number of cytomorphological aspects), total protein and electrophoresis, glucose and chloride concentration. Bacteriological and mycological investigations were performed as well as agglutination tests for Cryptococcus. Complement fixation, indirect immunoflorescence, passive hemagglutination and/or ELISA tests were performed for syphilis, toxoplasmosis, viral and fungal infections. All CSF analysis were made in the same laboratory following the same methodology. CSF was altered in 45 cases (90.0%) of the 50 patients studied. The most important alterations observed were: gammaglobulin (55.5%) and total protein (51.1%) increase, hypercytosis (48.9%) and decrease of chloride concentration (40.0%). HIV antibodies were detected in 42 patients (93.3%). Toxomoplamosis, isolated or associated to other agents, was the most frequent opportunistic infection (57.7%). Cerebrospinal fluid should always be examined in AIDS patients with or without neurological symptoms.
[Pharmacologic treatment of acute myocardial infarction: 2 large clinical trials at a central hospital].
OBJECTIVES: To analyse the clinical practice concerning the pharmacological therapy of acute myocardial infarction (AMI), comparing it with the guidelines for the management of AMI and exploring the reasons for its under use or over use. METHODS: Retrospective analysis of clinical records of patients with the discharge diagnosis of AMI. LOCATION: A central hospital in the North of Portugal. SUBJECTS: One hundred and ninety-one patients admitted to the Internal Medicine Department of a central hospital in the North of Portugal between January 1, 1993, and December 31, 1994. RESULTS: Thrombolytic therapy was performed in 24.1% of the patients. At discharge 32.6% of the patients were on therapy with beta blockers, 68% with angiotensin converting enzyme inhibitors (ACEI) and 88.4% with aspirin. Stepwise logistic regression produced the following odds ratios for the variables significantly associated with: a) thrombolytic therapy: hypertension - 0.38; non-Q wave infarction - 0.17; time between onset of symptoms and hospital admission greater than 6 hours - 0.18; admission to coronary unit - 14.72; b) beta blocker therapy: age > 60 years - 0.23; serum LDH > 1000 U/L - 0.41; diastolic blood pressure > 85 mmHg - 3.73; Killip > 1 - 0.08; concomitant therapy with calcium antagonist - 0.33; previous therapy with beta blocker - 14.87; hospital stay greater than 10 days - 2.67; c) ACEI therapy: anterior wall infarction - 3.07; non Q wave infarction - 0.13; congestive heart failure - 9.36; serum creatinine > or = 15 mg/dl - 0.03. CONCLUSIONS: Beta blockers and thrombolytic are under used and ACEI overused. The delay in hospital admission is the most important factor opposing the use of thrombolytic therapy, imposing the need for measures that ean reduce this delay. Therapy with beta blockers (highly cost-effective) can be increased by educational intervention among the physicians. The overuse of ACEI can be ascribed to the good results of randomised trials.
Automatic assessment of scintmammographic images using a novelty filter.
99mTc-sestamibi scintmammograms provide a powerful non-invasive means for detecting breast cancer at early stages. This paper describes an automatic method for detecting breast tumors in such mammograms. The proposed method not only detects tumors but also classifies non-tumor images as "normal" or "diffuse increased uptake" mammograms. The detection method makes use of Kohonen's "novelty filter". In this technique an orthogonal vector basis is created from a normal set of images. Test images presented to the detection method are described as a linear combination of the images in the vector basis. Assuming that the image basis is representative of normal patterns, then it can be expected that there should be no major differences between a normal test image and its corresponding linear combination image. However, if the test image presents an abnormal pattern, then it is expected that the "abnormalities" will show as the difference between the original test image and the image built from the vector basis. In other words, the existing abnormality cannot be explained by the set of normal images and comes up as a "novelty." An important part of the proposed method are the steps taken for standardizing images before they can be used as part of the vector basis. Standardization is the keystone to the success of the proposed method, as the novelty filter is very sensitive to changes in shape and alignment.
Hypermedia patient data retrieval and presentation through WWW.
WWW can be a helpful tool for PACS and HIS data retrieval and presentation. The use of gateways to access both text and hypermedia databases (images and video) enables fetched data to be presented in virtually any computer system. WWW browsers provide a very friendly interface and require little training to operate. This paper presents a prototype that uses a SQL gateway for accessing relational patient databases. The dataset used here include text data from reports of diagnostic procedures as well as pointers to the corresponding images. Images can be displayed by the browsers' viewers.
Magnetic resonance imaging in HTLV-I associated myelopathy.
Magnetic resonance imaging of the brain and spinal cord were carried out for seventeen consecutive patients with HTLV-1 associated myelopathy (HAM). Eight patients had brain abnormalities and four had decreased thoracic spinal cord diameter. Brain lesions were mostly located in subcortical and periventricular areas. Our data suggest that diffuse central nervous system lesions are present in patients with HAM.
HTLV-1 and myelopathy in Salvador (northeastern Brazil): a case control study.
The principal aim of the study was to determine the degree of association between cerebrospinal fluid (CSF) that is positive for HTLV-1 and myelopathy in Salvador, Brazil. From the same hospital, twenty-eight cases of myelopathy and twenty-eight cases showing no neurological disorder were studied using blind selection matched 1:1 by age and sex. The twenty-eight pairs underwent HTLV-1 serology tests. In those with a positive result, anti-HTLV-1 antibodies were investigated in the CSF. The ELISA method was used, complemented by the Western-blot test. Myelopathy was considered associated with HTLV-1 only when the CSF was positive indicating neurotropism of the virus. The mean age of the cases was 44.6 +/- 15.6 years and the control group was 43.5 +/- 16.0 (p > 0.05). An OR of 9.0 was detected with a reliability interval (95%) of 1.652-48.866 and chi-square significant at the 0.02 level. Despite a strong degree of association and considering the low level of precision, there is a need for analytical studies with larger samples which besides improving the precision will allow for greater control of the confounding variables.
[Hemodynamic study with Swan-Ganz catheterization, concomitant to endomyocardial biopsy in heart transplantation patients. Importance in the early diagnosis of rejection].
PURPOSE: To evaluate the role of hemodynamic parameters in the diagnosis of acute rejection who underwent orthotopic cardiac transplantation. METHODS: A protocol was carried out in 19 patients who underwent heart transplantation and in whom Swan-Ganz hemodynamics was performed immediately prior to routine endomyocardial biopsy in the first few months postoperatively. The results of 28 biopsies were divided in group I--severe rejection who needed pulse-therapy (n = 10) and group II--No or mild/moderate rejection who did not need any pulse (n = 18). Hemodynamic parameters were compared between both groups. RESULTS: There were significant differences among hemodynamic parameters in groups I and II. Group I had higher mean right atrial pressures (13.0 x 7.3 mmHg), mean pulmonary pressure (26.3 x 20.4 mmHg), mean wedge pressure (14.4 x 10.9 mmHg) and lower cardiac index (2.57 x 3.10 l/min/m2). CONCLUSION: In a routine situation, hemodynamic measurements, as obtained with Swan-Ganz catheter, simultaneously with endomyocardial biopsies, show significant alterations in transplanted patients who develop acute rejection. This information, obtained earlier than the biopsy results, could shorten the time to initiate pulse-therapy in patients with severe rejection.
Lossy compression in nuclear medicine images.
The goal of image compression is to reduce the amount of data needed to represent images. In medical applications, it is not desirable to lose any information and thus lossless compression methods are often used. However, medical imaging systems have intrinsic noise associated to it. The application of a lossy technique, which acts as a low pass filter, reduces the amount of data at a higher rate without any noticeable loss in the information contained in the images. We have compressed images of nuclear medicine using the discrete cosine transform algorithm. The decompressed images were considered reliable for visual inspection. Furthermore, a parameter was computed from these images and no discernible change was found from the results obtained using the original uncompressed images.
Integrating Hospital Information Systems. The challenges and advantages of (re-)starting now.
With the new technologies available today, more complex and useful Hospital Information Systems (HIS) can be designed and implemented. These new technologies have allowed that information from different sources and nature such as documents, images and signals be integrated within a single environment. Open standards, reliable networks, powerful hardware and software and lower prices are among the issues that make all this possible. One of the main issues is what to do with old systems that do not adhere to this new HIS concept. At the Heart Institute (InCor), a decision was made towards starting developing a new system called I3S. This paper gives a brief description of that system.
Successful pregnancy, delivery and puerperium in a heart transplant patient with previous peripartum cardiomyopathy.
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Danazol. A new perspective in the treatment of HTLV-1 associated myelopathy (preliminary report).
We investigated the efficacy of danazol treatment in eight patients with HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP). Treatment with danazol yielded clinical improvement of urinary control and gait disturbances in 7 out of the 8 patients. The improvement was noted within 15 days of danazol administration. Analysis of factors of relevance to the clinical improvement with danazol showed that the beneficial response was preferentially found in females.
3-D visualization of arterial structures using ultrasound and Voxel modelling.
In this paper, a new type of vascular imaging system is presented which is designed for use in conjunction with percutaneous transluminal treatment techniques (balloon and laser angioplasty, atherectomy etc). Three dimensional computer models of arterial sections are reconstructed in full voxel space from data acquired using a purpose-built, catheter-mounted ultrasound probe. The system is standalone, using commercially available computer hardware and specially written software. The software is equally compatible with source data from other modalities (e.g. CT and MR), and the system can therefore be incorporated into a PACS environment.
[Riboflavin (its action in the field of allergy)].
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