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Biomedical subjects

M E Santos

Publications and source records attributed to M E Santos.

13 recordsLinked to original sources
PubMed2001

Hemorrhagic stroke: experience of an internal medicine department.

Stroke is the third leading cause of death in most industrialised countries, among adults aged 65 years or more. In Portugal, however, it is the leading cause of death. Intracerebral hemorrhages comprise approximately 10 to 15% of all strokes. This particular type of stroke is associated with a worse prognosis. There is little published data concerning stroke in the Portuguese population, especially on the hemorrhagic type of the disease. The aim of the present study was to improve our knowledge on the epidemiology of hemorrhagic strokes in our community. The hospital charts of 60 patients with intracerebral hemorrhage who were admitted to our wards during the years of 1997 and 1998 were retrospectively reviewed. There was a predominance of male patients aged over 65. In most cases (78.3%), no causal factor was identified (spontaneous or "primary" hemorrhagic stroke). Hypertension was present in 80% of cases and was the most common risk factor. The percentage of putaminal and thalamic hemorrhages (48.3%) was similar to the percentage of lobar hemorrhages (46.7%). This differs from other studies. The prognosis of our patients was fairly good, with 38% of all cases being independent at thirty days. The 30-day case fatality rate was 10%. As in other studies, advancing age, a low Glasgow Coma Scale score, a large hemorrhage size and the intraventricular extension of blood were associated with a worse outcome.

Adult↗
PubMed2000

[Psychiatric emergency service in a university general hospital: a prospective study].

OBJECTIVES: The aim was to carry out a prospective study about the characteristics of the public seen at a psychiatric emergency room and of its service. METHODS: The data were acquired though a protocol developed for this study and applied to all the patients seen during two months. RESULTS: 600 protocols were filled out, corresponding to 96.5% (487 patients) of the attendance during the study period. Most of the patients seen were males, single, with a low educational level, professionally inactive and living with their families. The most frequent diagnoses were psychoactive substance use disorders (26.3%), schizophrenia (15.5%), manic episode (11.8%), major depression (10.9%) and non-psychotic disorders (10.9%). There were differences between gender in some diagnostic categories. After initial evaluation, 2/3 were medicated, (1/2) stayed under observation, and (1/4) stayed more than 10 hours in the service unit. About 20% of the attendance resulted in hospitalization and 60% in referrals to outpatient services. Discharges due to evasion represented only 2.0% of the total. Returning service users did not differ from those seen only once to what concern marital status, professional situation and household conditions. However, returning users presented a higher frequency of previous hospitalization and psychotic disorders. CONCLUSIONS: Individuals with severe psychiatric disorders were seen in an actual emergency situation. The psychiatric emergency service has been expanding its actions and has been an effective part of the mental health service network.

Adult↗
PubMed1999

Problems of patients with chronic aphasia: different perspectives of husbands and wives?

During the early phase following stroke, patients with aphasia and their families are totally involved in the rehabilitation programme, but later, in the chronic phase, after discharge, the family generally has no support and many problems may arise or become more acute and provoke disturbances in this system. The patients with aphasia and their spouses may feel the situation differently according to their own characteristics, including gender. The present study includes 55 spouses of patients with chronic aphasia and 37 controls (spouses of subjects without physical or cognitive impairments) who filled out a questionnaire concerning their respective spouses (European Brain Injury Questionnaire--EBIQ) and some aspects about themselves. It was concluded, from the opinions expressed by the spouses of patients with chronic aphasia that they have problems in several domains not only related to communication or physical impairments. The opinions of husbands and wives of patients with aphasia, but not of the controls, were different, with more references to behaviour changes in women with aphasia. Spouses' responses also show important changes in their own lives. These results stress the importance of adequate attention to the long-term psychosocial problems of patients and relatives.

Adaptation, Psychological↗
PubMed1998

Spontaneous complaints of long-term traumatic brain injured subjects and their close relatives.

Long-term consequences of head injury for patients and families are not well known, given the complexity of variables that have to be studied. Subject's self-experience is one of these less studied aspects. The purpose of this study is to examine the spontaneous complaints of long-term brain injured adult subjects to be compared to the impression of their relatives. A total of 48 chronic head trauma subjects were studied more than 6 years after injury together with a relative, usually a mother or wife. At the beginning of the interview the participants were asked to freely refer their present complaints. In general, relatives referred more complaints about the injured subjects than the injured subjects referred about themselves. This occurred in several domains: somatic, physical, cognitive, and behavioural. Memory problems were highly reported by both groups. Somatic complaints were more frequently reported by patients and behavioural problems were more often reported by relatives. Mothers and wives had different profiles or responses. Mothers' opinions were identical to those of their TBI sons in all domains. These different results must be taken into consideration so that the real needs of patients and relatives can be addressed.

Adult↗
PubMed1995

Longitudinal measurement of anticardiolipin antibodies during normal pregnancy: a prospective study.

We have previously shown that elevation of anticardiolipin antibodies (aCL) at the first prenatal visit is associated with increased fetal loss in normal pregnancy. The variation in aCL levels during normal pregnancy has not been established. To examine this question we measured IgG, IgM and IgA aCL levels five times during pregnancy at weeks 5-15, 16-25, 26-35, 36-37 and at delivery. Data were analyzed to determine: (a) the within and between subject variability of aCL during pregnancy; (2) the temporal trend of aCL; and (3) the relation of serial measures of aCL with maternal complications of pregnancy. We divided our cohort of 354 subjects into two groups. Group A included those subjects with consistently normal levels of aCL and group B those subjects with at least one elevated level of aCL. In group A the within subject variability was relatively low (28-34%). In group B we found wide fluctuations in aCL levels and a within subject variability of 88-91%. Subjects in group B had no increase in maternal complications of pregnancy. The present data suggest that aCL may fluctuate significantly during normal pregnancy and there is little clinical value in measuring aCL on a serial basis during pregnancy.

Adolescent↗
PubMed1994

Rates of spontaneous mutation in bacteriophage T4 are independent of host fidelity determinants.

Bacteriophage T4 encodes most of the genes whose products are required for its DNA metabolism, and host (Escherichia coli) genes can only infrequently complement mutationally inactivated T4 genes. We screened the following host mutator mutations for effects on spontaneous mutation rates in T4: mutT (destruction of aberrant dGTPs), polA, polB and polC (DNA polymerases), dnaQ (exonucleolytic proofreading), mutH, mutS, mutL and uvrD (methyl-directed DNA mismatch repair), mutM and mutY (excision repair of oxygen-damaged DNA), mutA (function unknown), and topB and osmZ (affecting DNA topology). None increased T4 spontaneous mutation rates within a resolving power of about twofold (nor did optA, which is not a mutator but overexpresses a host dGTPase). Previous screens in T4 have revealed strong mutator mutations only in the gene encoding the viral DNA polymerase and proofreading 3'-exonuclease, plus weak mutators in several polymerase accessory proteins or determinants of dNTP pool sizes. T4 maintains a spontaneous mutation rate per base pair about 30-fold greater than that of its host. Thus, the joint high fidelity of insertion by T4 DNA polymerase and proofreading by its associated 3'-exonuclease appear to determine the T4 spontaneous mutation rate, whereas the host requires numerous additional systems to achieve high replication fidelity.

Bacteriophage T4↗
PubMed1994

[Early and delayed cardiac mortality after acute myocardial infarction in the pre-thrombolytic era. Prognosis value of an ergometric test and coronary arteriography].

PURPOSE: To determine the relationship among clinical data, attenuated treadmill stress test (ST), cinecoronaryarteriography (CINE), ejection fraction (EF) with early-late mortality in patients after acute myocardial infarction (AMI). METHODS: Prospective study in 96 consecutive patients aged < 70 with AMI that were submitted to ST and CINE. Assessment of cardiac mortality was made 1-3 years post-AMI (period I) and at the end of follow-up (7-10 years-period II). RESULTS: First year and 10th year mortalities were 8% and 36%, respectively. Positive predictive value for cardiac death in period I was 10% for ST, 7% for multivessel coronary artery disease (MVCAD) and 9% for left ventricular ejection fraction (LVEF) < 30, while in period II they were 45%, 42% and 50%, respectively. Actuarial survival analysis (Kaplan-Meyer) disclosed mortality rates of 53% and 20% (p = 0.06) on period II for positive and negative ST, respectively, 45% and 22% (p < 0.03) for MVCAD and single-vessel disease, respectively, and 73% and 35% (p < 0.001) for those with and without left main coronary artery obstruction, respectively. In the multivariate regression analysis (Cox's model), only MVCAD (p < 0.002), LVEF < 30 (p < 0.003), positive ST (p < 0.007) and post-AMI angina (p < 0.01) were independently related to late mortality. CONCLUSION: Both attenuated ST and CINE are poor predictors of post-AMI early and late mortalities. However, multivariate regression analysis disclosed positive ST, MVCAD and LVEF < 30 as independent variables related to late mortality. This data indicate that myocardial ischemia, number of obstructed coronary arteries and poor left ventricular systolic function are the true determinants of post-infarction cardiac mortality.

Actuarial Analysis↗
PubMed1992

Clinical significance of immunoglobulin A versus immunoglobulins G and M anti-cardiolipin antibodies in patients with systemic lupus erythematosus. Correlation with thrombosis, thrombocytopenia, and recurrent abortion.

Serum levels of immunoglobulins (Ig) A, G, and M anti-cardiolipin (aCL) antibodies were determined by enzyme-linked immunosorbent assay in a group of selected systemic lupus erythematosus female patients. Patients were divided into three groups based on their clinical history of thrombosis with or without thrombocytopenia (group I), thrombocytopenia alone (group II), and neither of these (group III). After the aCL antibody levels were determined, the patients' obstetric histories of pregnancies and abortions were reviewed. A high incidence of one or more abortions was seen only in group I patients. A high prevalence of elevated levels of IgA and IgG (but not IgM) aCL antibodies was observed in group I patients. However, among the patients in group II, only the levels of IgA aCL antibodies were increased. In both groups, the addition of the IgA aCL determination--to the classical IgG and IgM aCL assays--increased the prevalence of positive reactors in 31.6%. These results indicate that high levels of IgA aCL antibodies correlated better with thrombocytopenia than either IgG or IgM. Also, the importance of including the determination of IgA aCL antibodies to assess properly the risk of thrombosis, thrombocytopenia, and recurrent abortions in systemic lupus erythematosus patients is demonstrated.

Abortion, Habitual↗
PubMed1991

[Is coronary cineangiography more accurate than early bicycle ergometry test in the identification of high-risk acute myocardial infarction survivors?].

PURPOSE: To determine if attenuated early treadmill stress testing is more or less accurate than cinecoronary arteriography in the identification of high-risk acute myocardial infarction (AMI) survivors. PATIENTS AND METHODS: In a prospective study 96 non-selected and consecutive AMI survivors underwent cinecoronary arteriography in the 4th week of hospitalization and were followed up for a period of 3 to 39 (21.7 +/- 11.0) months. One-half of the patients were randomly submitted to an attenuated heart rate-limited treadmill stress testing in the 3rd week. Seven patients were lost in the follow-up. Of the remaining 89 patients 5 died of cardiac causes. Cardiac events (death, reinfarction, angina and heart failure) occurred in 26 patients. Multivessel coronary artery disease was found in 67 patients (75%) and mean left ventricular ejection fraction was 49.1 +/- 15.6%. Positive treadmill stress testing for myocardial ischemia occurred in 20 of 43 patients (46%). RESULTS: All patients who died of cardiac causes or who had a cardiac event had multivessel coronary artery disease, the mean left ventricular ejection fraction was 38.6 +/- 16.6% and 45.2 +/- 16.4%, respectively, and two-thirds of patients had positive stress testing. For cardiac death, multivessel coronary artery disease had better sensitivity than positive stress testing and left ventricular ejection fraction less than 0.3 (100% vs 67% vs 20%, respectively) while ejection fraction had better specificity than stress testing and multivessel coronary artery disease (87% vs 55% vs 21%, respectively). Stress testing had a better positive predictive value than multivessel coronary artery disease and ejection fraction (53% vs 38% vs 36%, respectively while multivessel coronary artery disease had better negative predictive value than stress testing and ejection fraction (100% vs 77% vs and 70%, respectively). The association of data obtained from cinecoronarography study between themselves and with positive treadmill stress testing did not significantly improve the sensitivities, specificities and predictive values in relation to the results obtained by isolated data. CONCLUSION: In survivors of acute myocardial infarction cinecoronary arteriography is not more accurate than, treadmill stress testing and both have limited value in the identification of patients who are candidates for cardiac death or events in the first few years after AMI. A negative stress testing and coronary arteriography (one-vessel disease) is more informative than a positive one.

Chi-Square Distribution↗
PubMed1984

Associative visual agnosia: a case study.

This report describes a case of associative visual agnosia caused by a left sided, cortico-subcortical, inferior temporo-occipital infarction. Performance on visual perceptual tests was normal, while it was defective on visual classification tasks. Visual agnosia was interpreted as a visuo-verbal disconnection plus a categorization deficit for visual meaningful common stimuli. The left occipito-temporal lesion disrupted the visual classification process and prevented access of visual information to language areas and limbic system. The absence of right hemispheric lesion accounted for the normal recognition of familiar faces and other unique individual stimuli such as familiar places, whose recognition occurs through contextual evocation.

Agnosia↗