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Biomedical subjects

M de Carvalho

Publications and source records attributed to M de Carvalho.

At least 55 records · Page 3Linked to original sources
PubMed1996

Motor neuron disease presenting with respiratory failure.

Respiratory failure accounts for the majority of deaths in amyotrophic lateral sclerosis (ALS) but only rarely is ALS diagnosed on the basis of respiratory insufficiency. We report four ALS patients presenting with acute respiratory failure. In three patients we have performed EMG needle examination of both hemidiaphragms which showed severe denervation. We reviewed 25 patients previously described presenting with respiratory failure. Almost all patients showed upper limbs weakness and diaphragm involvement; few patients had bulbar dysfunction. The prognosis of these patients is not always in permanent ventilator dependence. Rapidly progressive ventilatory failure may be a striking initial sign of ALS; the main reason is a weakened diaphragm. There are possibilities of significant improvement after a period of rest with ventilatory assistance. In the initial phase of the disease, bulbar dysfunction is not the more common reason of acute respiratory failure.

Aged↗
PubMed1995

Somatosensory evoked potentials in the differential diagnosis between spinal cord compression and amyotrophic lateral sclerosis.

Spinal cord compression (SCC) often presents a similar clinical picture to amyotrophic lateral sclerosis (ALS). An early differential diagnosis is important because SCC is a potentially treatable clinical disorder. We carried out a longitudinal study of 43 patients with an initial diagnosis of ALS, in order to ascertain the percentage of patients with SCC, and to evaluate the usefulness of somatosensory evoked potentials (SEPs) in early diagnosis. Thirty-three patients had a final diagnosis of ALS and 8 of SCC. SEPs central conduction was abnormal in 3 ALS and 7 SCC patients, respectively (Fisher exact test, p < 0.05). We concluded that SEPs investigation is useful in the differential diagnosis between ALS and SCC patients with pure motor signs.

Adult↗
PubMed1991

Analysis of the use of multiple technologies in neonatal care.

The use of 53 different technologies was studied in 82 patients in a neonatal intensive care unit. Using a coefficient of similarity based on the utilization pattern of these technologies, it was possible to identify five clusters of patients that can be correlated with the primary diagnostic groups and such other variables as birth weight (BW), gestational age, length of stay (LOS), and weight gain. Four interdependent models were identified by multiple regression analysis. The number of different therapeutic technologies applied to these patients can be explained (r = 0.67) by their Apgar scores, gestational age, and an index of severity of illness based on the diagnostic group. The number of different diagnostic technologies used is directly related to the number of therapies delivered (r = 0.63) and, jointly with BW, determines LOS (r = 0.73). Finally, weight gain is explained by LOS and BW (r = 0.65).

Cluster Analysis↗
PubMed1991

Estimating the effectiveness of perinatal care technologies by expert opinion.

The majority of technologies in use in perinatal care were organized into 45 technological functions. Forty-six experts from 19 different regions of Brazil and other Latin American countries then selected a "basic package" (BP) of 15 technological functions. Considering the 12 main causes of perinatal mortality in Brazil, the experts estimated the number of preventable deaths, assuming universal coverage by the BP and the additional reductions that could be obtained by gradually adding other technological functions to the BP. A simulation was performed for the 26 states of Brazil to identify regional priorities for the diffusion of technological functions. For most regions, the BP appears to be the most effective intervention, with the potential of reducing perinatal mortality by 33%, followed by "coordination of services and referral of pregnant women" (14%), and "treatment of respiratory conditions" (11.8%).

Attitude of Health Personnel↗
PubMed1982

Milk intake and frequency of feeding in breast fed infants.

To provide normative data for healthy full term infants in the United States when the mothers were encouraged to feed as often and as long as the infants wished, 46 mother-infant pairs were studied in the first month after delivery. Mothers recorded the length and time of each breast-feeding for the first 14 days postpartum, and weighed the infant before and after each feeding during a 24-48 h period at 1 month. The mean frequency of feeding during the first 2 weeks of life was 9.8 +/- 2.5 feeds/24 h and the mean duration of feeding was 162 +/- 50 min/24 h. Infants heavier at birth demanded significantly more feedings and nursed longer during the first 14 days of life. At one month the infants were nursing an average of 7.2 +/- 1.3 times/24 h and the mean duration of feeds was 158 +/- 63 min/24 h. Although the frequency of feeding during the first 14 days postpartum was significantly higher than at 1 month, the total duration of feeding in 24 h was similar. Daily milk intakes at 1 month ranged from 395 to 1011 ml (mean 681 +/- 136 ml) and were not significantly correlated with either the frequency or duration of feedings.

Body Weight↗
PubMed1981

Effects of water supplementation on physiological jaundice in breast-fed babies.

The effect of water supplementation in normal, term, breast-fed babies with physiological jaundice was studied. Water supplementation was given to 120 babies and 55 received no extra fluids. There was no significant difference between the two groups when peak serum bilirubin levels and incidence of phototherapy were compared.

Bilirubin↗
PubMedDate not supplied

[Parents' perceptions of their infants' hospitalization in a neonatal intensive care unit].

OBJECTIVE: To analyze the parents' perception of their infants hospitalization in a neonatal intensive care unit (NICU) and suggest a more humane and individualized care in this highly stressful environment. METHODS: We recorded and analyzed the interview of 20 young, low socioeconomic class couples having their first baby admitted to a NICU of a public hospital. RESULTS: Fear, stress and doubts were frequent feelings among parents. Heath professionals were often too busy to explain in detail what was happening. When talking to parents, doctors and nurses usually used medical terminology which was poorly understood by parents. CONCLUSION: The environment of a NICU is perceived by parents as being cold, impersonal and highly stressful. Listening to and understanding parents' needs is mandatory if one wants to provide a more humane and individualized care for high risk newborn infants and their families.

English Abstract↗
PubMedDate not supplied

[Nitric oxide in the treatment of neonatal pulmonary hypertension].

This study describes the effects of nitric oxide in newborns with persistent pulmonary hypertension. We studied 9 infants with severe respiratory failure characterized by hypoxemia and pulmonary hypertension. All infants met ECMO criteria and the oxygenation index (OI) was greater than 25. Mean birth weight was 2698 -/+ 661 g and gestational age was 36.4 -/+ 2.6 weeks. Nitric oxide was administered in a Y circuit in the inspiratory line of the mechanical ventilator. Nitric oxide and NO2 concentrations were monitored with electrochemical analyzers (PACI and PACII-Draeger). Pulmonary hypertension was diagnosed with clinical and echocardiografic criteria, with detection of right to left shunt with color doppler. All patients showed a dramatic improvement in oxigenation after nitric oxide administration. The drug reduced the mean OI, which was 48.5 before its administration, to 17.7 after 30', 14.1 after 6 hours, and 10.5 after 12 hours. We observed in all patients a reduction in pulmonary vascular resistance, reversal of the right to left shunt without any effects on systemic arterial pressure. Metahemoglobin levels did not reach 1.5% in any patient. Only one out of the 9 patients died, after reversal of the pulmonary hypertension, from other complications of perinatal asphyxia. Our data show that nitric oxide is a promising drug in the treatment of neonatal pulmonary hypertension and that it may reduce the need of ECMO in severe respiratory failure.

English Abstract↗
PubMedDate not supplied

[Single x double phototherapy for the treatment of hyperbilirubinemia in high risk newborn infants].

This is a randomized, prospective, controlled study to compare the efficacy of single versus double halogen phototherapy in high risk patients admitted to a newborn intensive care unit. Eighty patients were allocated to receive single (N=43) or double (N=37) phototherapy. The groups were similar in clinical and laboratory characteristics. Total serum bilirubin (SB), hematocrit and total serum protein were assessed by microanalysis prior to the beginning of the study and at 6, 12, 18 and 24 hours of treatment. The percent decline of SB was significantly higher in the double phototherapy group. This difference is first noted at 12h of treatment (10% vs 1.8%, p< 0.01) and is acentuated at the end of the study (19.4% vs 1.6%, p< 0.0001). Weight loss, variations in the hematocrit and total serum protein were similar in both groups. Cutaneous rash and temperature instability were not noted among the patients studied.Our results demonstrate that double phototherapy is more efficient than single phototherapy in treating hyperbilirubinemia in high risk newborn infants.

Clinical Trial↗
PubMedDate not supplied

[Indications of phototherapy for full term newborn infants with non-hemolytic hyperbilirubinemia: a critical analysis].

Phototherapy is a common procedure in the neonatal period. However there is great controversy in the literature about when and at which serum bilirubin levels phototherapy and exchange transfusion should be indicated. The aim of this paper is to review the literature and to suggest guidelines to help pediatricians in deciding when to treat non-hemolytic jaundice in full-term newborn infants.

English Abstract↗