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Safety of CoronaVac and ChAdOx1 vaccines against SARS-CoV-2 in patients with rheumatoid arthritis: data from the Brazilian multicentric study safer ChAdOx SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- arthritis SARS-CoV
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Cruz, Vitor Alves

; Guimarães, Camila Rêgo, Jozelia Machado, Ketty Lysie Libardi Lira Miyamoto, Samira Tatiyama Burian, Ana Paula Neves Dias, Laiza Hombre Pretti, Flavia Zon Batista, Danielle Cristina Filgueira Alves Mill, José Geraldo Oliveira, Yasmin Gurtler Pinheiro de Gadelha, Carolina Strauss Estevez Gouveia, Maria da Penha Gomes Moulin, Anna Carolina Simões Souza, Bárbara Oliveira Aguiar, Laura Gonçalves Rodrigues Vieira, Gabriel Smith Sobral Grillo, Luiza Lorenzoni Lima, Marina Deorce de Pasti, Laís Pizzol Surlo, Heitor Filipe Faé, Filipe Moulaz, Isac Ribeiro Macabú, Mariana de Oliveira Ribeiro, Priscila Dias Cardoso Magalhães, Vanessa de Oliveira Aguiar, Mariana Freitas de Biegelmeyer, Erika Peixoto;, Flávia Maria Matos Melo Campos Kayser, Cristiane Souza, Alexandre Wagner Silva de Castro, Charlles Heldan de Moura Ribeiro, Sandra Lúcia Euzébio Telles, Camila Maria Paiva França Bühring, Juliana Lima, Raquel Lima de Santos, Sérgio Henrique Oliveira Dos Dias, Samuel Elias Basualto Melo, Natália Seixas de Sanches, Rosely Holanda da Silva Boechat, Antonio Luiz Sartori, Natália Sarzi Hax, Vanessa Dória, Lucas Denardi Rezende, Rodrigo Poubel Vieira de Baptista, Katia Lino Fortes, Natália Rodrigues Querido Melo, Ana Karla Guedes de Melo, Tâmara Santos Vieira, Rejane Maria Rodrigues de Abreu Vieira, Adah Sophia Rodrigues Kakehasi, Adriana Maria Tavares, Anna Carolina Faria Moreira Gomes Landa, Aline Teixeira de Costa, Pollyana Vitoria Thomaz da Azevedo, Valderilio Feijó Martins-Filho, Olindo Assis Peruhype-Magalhães, Vanessa Pinheiro, Marcelo de Medeiros Monticielo, Odirlei André Reis-neto, Edgard Torres Dos Ferreira, Gilda Aparecida Souza, Viviane Angelina de Teixeira-Carvalho, Andréa Xavier, Ricardo Machado Sato, Emilia Inoue Valim, Valeria Pileggi, Gecilmara Salviato Silva, Nilzio Antonio da

Advances in Rheumatology

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2024, Volume 64 elocation 58

Resumo: En | Texto: En | PDF: En

Abstract Background Patients with immune-mediated rheumatic diseases (IMRDs) have been prioritized for COVID-19 vaccination to mitigate the infection severity risks. Patients with rheumatoid arthritis (RA) are at a high risk of severe COVID-19 outcomes, especially those under immunosuppression or with associated comorbidities. However, few studies have assessed the safety of the COVID-19 vaccine in patients with RA. Objective To evaluate the safety of vaccines against SARS-CoV-2 in patients with RA. Methods This data are from the study “Safety and Efficacy on COVID-19 Vaccine in Rheumatic Diseases,” a Brazilian multicentric prospective phase IV study to evaluate COVID-19 vaccine in IMRDs in Brazil. Adverse events (AEs) in patients with RA of all centers were assessed after two doses of ChAdOx1 (Oxford/AstraZeneca) or CoronaVac (Sinovac/Butantan). Stratification of postvaccination AEs was performed using a diary, filled out daily and returned at the end of 28 days for each dose. Results A total of 188 patients with RA were include, 90% female. CoronaVac was used in 109 patients and ChAdOx1 in 79. Only mild AEs were observed, mainly after the first dose. The most common AEs after the first dose were pain at the injection (46,7%), headache (39,4%), arthralgia (39,4%), myalgia (30,5%) and fatigue (26,6%), and ChAdOx1 had a higher frequency of pain at the injection (66% vs 32 %, p < 0.001) arthralgia (62% vs 22%, p < 0.001) and myalgia (45% vs 20%, p < 0.001) compared to CoronaVac. The more common AEs after the second dose were pain at the injection (37%), arthralgia (31%), myalgia (23%), headache (21%) and fatigue (18%). Arthralgia (41,4% vs 25%, p = 0.02) and pain at injection (51,4% vs 27%, p = 0.001) were more common with ChAdOx1. No serious AEs were related. With Regard to RA activity level, no significant difference was observed between the three time periods for both COVID-19 vaccines. Conclusion In the comparison between the two immunizers in patients with RA, local reactions and musculoskeletal symptoms were more frequent with ChAdOx1 than with CoronaVac, especially after the first dose. In summary, the AE occurred mainly after the first dose, and were mild, like previous data from others immunizing agents in patients with rheumatoid arthritis. Vaccination did not worsen the degree of disease activity. immunemediated immune mediated (IMRDs COVID19 COVID 19 COVID-1 risks (RA outcomes comorbidities However SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- Safety Diseases, Diseases Brazil (AEs ChAdOx Oxford/AstraZeneca OxfordAstraZeneca Oxford AstraZeneca (Oxford/AstraZeneca Sinovac/Butantan. SinovacButantan Sinovac/Butantan . Sinovac Butantan (Sinovac/Butantan) diary 18 include 90 female 10 79 46,7%, 467 46,7% , 46 7 (46,7%) 39,4%, 394 39,4% 39 4 (39,4%) 30,5% 305 30 5 (30,5% 26,6%, 266 26,6% 26 6 (26,6%) 66% 66 (66 3 % 0.001 0001 0 001 62% 62 (62 22 22% 45% 45 (45 20 20% 37%, 37 37% (37%) 31%, 31 31% (31%) 23%, 23 23% (23%) 21% 21 (21% 18%. 18% (18%) 41,4% 414 41 (41,4 25 25% 0.02 002 02 51,4% 514 51 (51,4 27 27% related level summary COVID1 1 COVID- SARS-CoV (Sinovac/Butantan 9 46,7 (46,7% 39,4 (39,4% 30,5 (30,5 26,6 (26,6% (6 0.00 000 00 (4 (37% (31% (23% (21 (18% 41,4 (41, 0.0 51,4 (51, 46, (46,7 39, (39,4 30, (30, 26, (26,6 ( (37 (31 (23 (2 (18 41, (41 0. 51, (51 (46, (39, (30 (26, (3 (1 (5 (46 (39 (26

https://doi.org/10.1186/s42358-024-00397-5

Expert Recommendations on Monkeypox (MPX) in Pregnancy, Postpartum and Lactating Women MPX (MPX Pregnancy
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Mattar, Rosiane

; Braga Neto, Antonio Rodrigues

; Luz, Adriana Gomes

; Hatanaka, Alan

; Zaconeta, Alberto

; Guazzelli, Cristina Aparecida Falbo

; Traina, Evelyn

; Baptista, Fernanda Spadotto

; Osanan, Gabriel

; Duarte, Geraldo

; Ramos, Jose Geraldo Lopes

; Oppermann, Maria Lucia

; Francisco, Rossana Pulcineli Vieira

; Cardoso, Sigrid Maria Loureiro de Queiroz

; Quintana, Silvana Maria

; Sun, Sue Yazaki

; Borges, Vera Therezinha Medeiros

Revista Brasileira de Ginecologia e Obstetrícia

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Dez 2022, Volume 44 Nº 12 Páginas 1122 - 1125

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1055/s-0042-1759635

Carcass characteristics, meat quality and composition of lambs finished in cultivated pastures
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ARAÚJO, Cynthia Gabriela Fernandes de

; COSTA, Marcone Geraldo DIFANTE, Gelson dos Santos EMERENCIANO NETO, João Virgínio GURGEL, Antonio Leandro Chaves COSTA, Carolina Marques ARAÚJO, Itânia Maria Medeiros de SILVA, Maria Gabriela da Trindade MEDEIROS, Mariana Campelo

Food Science and Technology

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2022, Volume 42 elocation e71420

Resumo: En | Texto: En | PDF: En

Abstract Thirty-two Santa Inês male lambs, not castrated, were distributed in a randomized block design to evaluate the effects of different tropical forage cultivars (two Panicum maximum (Syn. Megathyrsus maximus): Aruana and Massai, and two Brachiaria brizantha (Syn. Urochloa brizantha) Marandu and Piatã) on carcass characteristics, quality, physical composition, and meat chemistry. The data were subjected to an analysis of variance, and the means compared using the Tukey test at 5% significance. There was no effect of cultivars on body weight, slaughter weight, and biometric measurements of the carcass. The Aruana and Piatã cultivars provided higher weights of hot and cold carcasses when compared to the Massai and the Marandu had no significant differences compared to the others. The animals kept in the pasture of the Aruana cultivar showed higher shank yields. However, forage cultivars did not affect the ribeye area or subcutaneous fat thickness. There was also no effect of cultivar on pH, temperature, cooking losses, cooling losses, and meat shear strength. The cultivars did not change the quality and composition of the meat. However, the Aruana, Piatã, and Marandu cultivars were the ones that provided higher carcass weights and ham yields.

https://doi.org/10.1590/fst.71420

Native and introduced forage cacti in Saanen dairy goat diets
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Góes Neto, Pedro Etelvino de

; Silva, José Geraldo Medeiros da Aguiar, Emerson Moreira de Melo, Airon Aparecido Silva de Lima, Guilherme Ferreira da Costa Cardoso, Daniel Barros Silva, Hildelblano Pereira da

Acta Scientiarum. Animal Sciences

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2021, Volume 43 elocation e51029

Resumo: En | Texto: En | PDF: En

ABSTRACT. This study aimed to assess the nutrient intake and milk production of dairy goats fed with total mixed rations with different species of forage cacti. Five pluriparous Saanen goats (50 ± 4 kg) at nine weeks of lactation were allocated in a Latin square (5 x 5) with five diets and five periods. Each period was composed of 10 days for adaptation and seven days for collection. The treatments were composed of 473.0 to 501.0 g kg-1 of forage cacti: xiquexique (Pilosocereus gounellei), mandacaru (Cereus jamacaru), facheiro (Pilosocereus chrysostele), cactus cladodes cv. miúda (Nopalea cochenillifera Salm-Dyck) and cactus cladodes cv. orelha de elefante mexicana (Opuntia stricta); plus sabiá hay (Mimosa caesalpiniifolia) (188.0 to 198.0 g kg-1) and concentrate (311.0 to 329.0 g kg-1). The intake of dry matter, organic matter, ether extract, neutral detergent fiber, total carbohydrates, and water intake through diet components were unaffected by experimental diets. For milk production and feed efficiency, no difference was observed among the diets. All diets containing different species of forage cacti can be used for dairy goats feed.

https://doi.org/10.4025/actascianimsci.v43i1.510 436 downloads

Pasture structure and sheep performance supplemented on different tropical grasses in the dry season
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Fernandes, Leonardo Santana Difante, Gelson dos Santos Costa, Marcone Geraldo Emerenciano Neto, João Virgínio Araújo, Itânia Maria Medeiros de Dantas, Joederson Luiz Santos Gurgel, Antonio Leandro Chaves

Revista mexicana de ciencias pecuarias

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Mar 2020, Volume 11 Nº 1 Páginas 89 - 101

Resumo: Es En | Texto: Es En | PDF: Es | PDF: En

Resumen El objetivo fue evaluar las características productivas y estructurales de los pastos tropicales y el rendimiento de las ovejas suplementadas durante la estación seca. Los tratamientos consistieron en las variedades Marandú, Piatã, Massai y Aruana manejadas bajo una media intermitente con siete días de ocupación y 35 días de descanso, con una carga variable. Las variables evaluadas fueron producción de forraje, los componentes morfológicos, la composición química, de los pastos y la productividad de las ovejas. La producción de forraje fue similar entre las diversas variedades, mientras que la producción y el porcentaje de hojas fueron mayores en el la variedad Massai. Hubo diferencias entre los cultivos para los contenidos de FDN, FDA, LDA y cenizas en los dos ciclos de pastoreo. Las ganancias más bajas por animal y por área se observaron en los pastizales de Aruana, mientras que no hubo diferencias para estas variables entre los otros cultivos. Las variedades Massai, Marandú y Piatã se pueden utilizar como una opción de forraje para la época seca cuando están asociados con la suplementación proteica para ovejas criadas para carne.

Abstract The objective was to evaluate the productive and structural characteristics of tropical grasses and the performance of sheep supplemented during the dry season. The treatments consisted of Marandu, Piatã, Massai and Aruana cultivars managed under intermittent stocking with seven occupation days and 35 d of rest, with a variable stocking rate. The evaluated variables were the forage masses, the morphological components, the chemical composition of the pasture and sheep performance. The forage mass was similar among the cultivars, while the leaf blade mass and percentage were higher in the Massai cultivar. There were differences between the cultivars for the NDF, ADF, ADL and ash contents in the two grazing cycles. The lowest gains per animal and gain per area were observed in the Aruana grass pastures, while there were no differences for these variables among the other cultivars. Massai, Marandu and Piatã cultivars can be used as a forage option for the dry period when associated with protein supplementation for sheep being raised for meat.

https://doi.org/10.22319/rmcp.v11i1.5083

Recommendations of the Brazilian Society of Rheumatology for the diagnosis and treatment of chikungunya fever. Part 2 - Treatment
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Marques, Claudia Diniz Lopes Duarte, Angela Luzia Branco Pinto Ranzolin, Aline Dantas, Andrea Tavares Cavalcanti, Nara Gualberto Gonçalves, Rafaela Silva Guimarães Rocha Junior, Laurindo Ferreira da Valadares, Lilian David de Azevedo Melo, Ana Karla Guedes de Freire, Eutilia Andrade Medeiros Teixeira, Roberto Neto, Francisco Alves Bezerra Medeiros, Marta Maria das Chagas Carvalho, Jozélio Freire de Santos, Mario Sergio F. Océa, Regina Adalva de L. Couto Levy, Roger A. Andrade, Carlos Augusto Ferreira de Pinheiro, Geraldo da Rocha Castelar Abreu, Mirhelen Mendes Verztman, José Fernando Merenlender, Selma Ribeiro, Sandra Lucia Euzebio Costa, Izaias Pereira da Pileggi, Gecilmara Trevisani, Virginia Fernandes Moça Lopes, Max Igor Banks Brito, Carlos Figueiredo, Eduardo Queiroga, Fabio Feitosa, Tiago Tenório, Angélica da Silva Siqueira, Gisela Rocha de Paiva, Renata Vasconcelos, José Tupinambá Sousa Christopoulos, Georges

Revista Brasileira de Reumatologia

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2017, Volume 57 Supl. 2 Páginas s438 - s451

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo A febre chikungunya tem se tornado um importante problema de saúde pública nos países onde ocorrem as epidemias, visto que metade dos casos evolui com artrite crônica, persistente e incapacitante. Os dados na literatura sobre terapêuticas específicas nas diversas fases da artropatia ocasionada pela infecção pelo vírus chikungunya (CHIKV) são limitados, não existem estudos randomizados de qualidade que avaliem a eficácia das diferentes terapias. Há algumas poucas publicações sobre o tratamento das manifestações musculoesqueléticas da febre chikungunya, porém com importantes limitações metodológicas. Os dados atualmente disponíveis não permitem conclusões favoráveis ou contrárias a terapêuticas específicas, bem como uma adequada avaliação quanto à superioridade entre as diferentes medicações empregadas. O objetivo deste trabalho foi elaborar recomendações para o tratamento da febre chikungunya no Brasil. Foi feita uma revisão da literatura com seleção de artigos baseados em evidência, nas bases de dados Medline, SciELO, PubMed e Embase e de resumos de anais de congressos, além da opinião dos especialistas para dar apoio às decisões tomadas para definir as recomendações. Para a definição do grau de concordância foi feita uma metodologia Delphi, em duas reuniões presenciais e várias rodadas de votação on line. Este artigo refere-se à parte 2 das Recomendações da Sociedade Brasileira de Reumatologia para Diagnóstico e Tratamento da Febre Chikungunya, que trata especificamente do tratamento.

Abstract Chikungunya fever has become an important public health problem in countries where epidemics occur because half of the cases progress to chronic, persistent and debilitating arthritis. Literature data on specific therapies at the various phases of arthropathy caused by chikungunya virus (CHIKV) infection are limited, lacking quality randomized trials assessing the efficacies of different therapies. There are a few studies on the treatment of musculoskeletal manifestations of chikungunya fever, but these studies have important methodological limitations. The data currently available preclude conclusions favorable or contrary to specific therapies, or an adequate comparison between the different drugs used. The objective of this study was to develop recommendations for the treatment of chikungunya fever in Brazil. A literature review was performed via evidence-based selection of articles in the databases Medline, SciELO, PubMed and Embase and conference proceedings abstracts, in addition to expert opinions to support decision-making in defining recommendations. The Delphi method was used to define the degrees of agreement in 2 face-to-face meetings and several online voting rounds. This study is part 2 of the Recommendations of the Brazilian Society of Rheumatology (Sociedade Brasileira de Reumatologia - SBR) for the Diagnosis and Treatment of chikungunya fever and specifically addresses treatment.

https://doi.org/10.1016/j.rbre.2017.06.004 38509 downloads

Recommendations of the Brazilian Society of Rheumatology for diagnosis and treatment of Chikungunya fever. Part 1 - Diagnosis and special situations
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Marques, Claudia Diniz Lopes Duarte, Angela Luzia Branco Pinto Ranzolin, Aline Dantas, Andrea Tavares Cavalcanti, Nara Gualberto Gonçalves, Rafaela Silva Guimarães Rocha Junior, Laurindo Ferreira da Valadares, Lilian David de Azevedo Melo, Ana Karla Guedes de Freire, Eutilia Andrade Medeiros Teixeira, Roberto Bezerra Neto, Francisco Alves Medeiros, Marta Maria das Chagas Carvalho, Jozélio Freire de Santos, Mario Sergio F. Océa, Regina Adalva de L. Couto Levy, Roger A. Andrade, Carlos Augusto Ferreira de Pinheiro, Geraldo da Rocha Castelar Abreu, Mirhelen Mendes Verztman, José Fernando Merenlender, Selma Ribeiro, Sandra Lucia Euzebio Costa, Izaias Pereira da Pileggi, Gecilmara Trevisani, Virginia Fernandes Moça Lopes, Max Igor Banks Brito, Carlos Figueiredo, Eduardo Queiroga, Fabio Feitosa, Tiago Tenório, Angélica da Silva Siqueira, Gisela Rocha de Paiva, Renata Vasconcelos, José Tupinambá Sousa Christopoulos, Georges

Revista Brasileira de Reumatologia

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2017, Volume 57 Supl. 2 Páginas s421 - s437

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo A febre chikungunya tem se tornado um importante problema de saúde pública nos países onde ocorrem as epidemias. Até 2013, as Américas haviam registrado apenas casos importados quando, em outubro desse mesmo ano, foram notificados os primeiros casos na Ilha de Saint Martin, no Caribe. No Brasil, os primeiros relatos autóctones foram confirmados em setembro de 2014 e até a semana epidemiológica 37 de 2016 já haviam sido registrados 236.287 casos prováveis de infecção pelo chikungunya vírus (CHIKV), 116.523 confirmados sorologicamente. As mudanças ambientais causadas pelo homem, o crescimento urbano desordenado e o número cada vez maior de viagens internacionais têm sido apontados como os fatores responsáveis pela reemergência de epidemias em grande escala. Caracterizada clinicamente por febre e dor articular na fase aguda, em cerca de metade dos casos existe evolução para a fase crônica (além de três meses), com dor persistente e incapacitante. O objetivo deste trabalho foi elaborar recomendações para diagnóstico e tratamento da febre chikungunya no Brasil. Para isso, foi feita revisão da literatura nas bases de dados Medline, SciELO e PubMed, para dar apoio às decisões tomadas para definir as recomendações. Para a definição do grau de concordância foi feita uma metodologia Delphi, em duas reuniões presenciais e várias rodadas de votação on line. Foram geradas 25 recomendações, divididas em três grupos temáticos: (1) diagnóstico clínico, laboratorial e por imagem; (2) situações especiais e (3) tratamento. Na primeira parte estão os dois primeiros temas e o tratamento na segunda.

Abstract Chikungunya fever has become a relevant public health problem in countries where epidemics occur. Until 2013, only imported cases occurred in the Americas, but in October of that year, the first cases were reported in Saint Marin island in the Caribbean. The first autochthonous cases were confirmed in Brazil in September 2014; until epidemiological week 37 of 2016, 236,287 probable cases of infection with Chikungunya virus had been registered, 116,523 of which had serological confirmation. Environmental changes caused by humans, disorderly urban growth and an ever-increasing number of international travelers were described as the factors responsible for the emergence of large-scale epidemics. Clinically characterized by fever and joint pain in the acute stage, approximately half of patients progress to the chronic stage (beyond 3 months), which is accompanied by persistent and disabling pain. The aim of the present study was to formulate recommendations for the diagnosis and treatment of Chikungunya fever in Brazil. A literature review was performed in the MEDLINE, SciELO and PubMed databases to ground the decisions for recommendations. The degree of concordance among experts was established through the Delphi method, involving 2 in-person meetings and several online voting rounds. In total, 25 recommendations were formulated and divided into 3 thematic groups: (1) clinical, laboratory and imaging diagnosis; (2) special situations; and (3) treatment. The first 2 themes are presented in part 1, and treatment is presented in part 2.

https://doi.org/10.1016/j.rbre.2017.05.006 37996 downloads

FATAL DISSEMINATED CRYPTOCOCCOSIS WITH RENAL INVOLVEMENT IN AN HIV-INFECTED PATIENT
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DAHER, Elizabeth De Francesco NASSERALA, Jarinne Camilo Landim SILVA JUNIOR, Geraldo Bezerra da OLIVEIRA, Adriana Regina Vilarinho de MEDEIROS NETO, José Urbano de SOUSA, Anastácio Queiroz

Revista do Instituto de Medicina Tropical de São Paulo

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Ago 2015, Volume 57 Nº 4 Páginas 365 - 367

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO Introdução: Apresentamos um caso fatal de criptococose disseminada em homem jovem cujo diagnóstico de HIV foi feito no momento da admissão na emergência. Relato de caso: O paciente, de 23 anos, sexo masculino, tinha história de febre diária de um mês de duração, associada à diarreia, perda de peso, cefaleia, vômitos e convulsões generalizadas. Tinha ainda história de diabetes mellitus, alcoolismo e drogadição. Ao exame físico havia palidez, desorientação e períodos de agitação. Os exames laboratoriais mostraram 3.440 leucócitos/mm3 (5% linfócitos), hemoglobina de 10 g/dL, 83,000 plaquetas/mm3, creatinina de 0,7mg/dL, ureia de 19 mg/dL, Na, K e enzimas hepáticas dentro dos limites da normalidade. A lactato desidrogenase era 494 UI/L. Análise do líquor revelou 10 leucócitos/mm3 (58% neutrófilos, 31% linfócitos, 11% monócitos) e 2 hemácias/mm3, glicose de 122 mg/dL e proteína de 36 mg/dL. A análise com tinta da Índia revelou seis blastoconídeos de Cryptococcus/mm³. O VDRL foi negativo e o anti-HIV positivo. Foi iniciado tratamento com hidratação venosa, insulina, fenitoína, fluconazol, pirimetamina, sulfadiazina, ácido folínico e anfotericina B. O paciente não apresentou melhora e evoluiu com obnubilação e hipotensão, sendo intubado e iniciada ventilação mecânica. Foram administradas drogas vasoativas, e o paciente evoluiu a óbito menos de 24h após a admissão. A autópsia revelou criptococose disseminada, com grave envolvimento renal. Conclusão: A criptococose é via-de-regra, doença sistêmica que afeta principalmente indivíduos imunocomprometidos, especialmente com AIDS, e quando diagnosticada tardiamente apresenta alta mortalidade.

SUMMARY Introduction: We present a fatal case of disseminated cryptococcosis in a young man whose diagnosis of HIV infection was made at the time of admission to the emergency room. Case report: The patient was a twenty-three-year-old man, with a history of daily fever during one month associated with diarrhea, weight loss, headache, vomiting and generalized seizures. He also had a history of diabetes mellitus, alcoholism and drug addiction. Upon physical examination the patient was pale, disoriented and had periods of agitation. White blood cells count was 3,440/mm3 (5% lymphocytes), hemoglobin was 10g/dL, platelets were 83,000/ mm3. Creatinine was 0.7 mg/dL; urea 19 mg/dL; Na, K, and liver enzymes were within normal limits. Lactic dehydrogenase was 494 IU/L. Cerebrospinal fluid (CSF) analysis revealed 10 white blood cells/mm3 (58% neutrophils, 31% lymphocytes, 11% monocytes) and 2 red blood cells/mm3. India ink test revealed six Cryptococcus yeasts/mm3. CSF glucose was 122 mg/dL and protein was 36 mg/ dL. VDRL test was negative and anti-HIV test was positive. Intravenous hydration, insulin, phenytoin, fluconazole, pyrimethamine, sulfadiazine, folinic acid, and amphotericin B were started. The patient did not improve and became obtunded and hypotensive. He was intubated and put on mechanical respiration. He received vasoactive drugs and died less than 24 hours after admission. A postmortem examination was performed and revealed disseminated cryptococcosis, with severe involvement of the kidneys. Conclusion: Cryptococcosis, as a rule, is a systemic disease that affects mostly immunocompromised individuals, especially patients with AIDS. When diagnosed late in its course it has a very high mortality.

https://doi.org/10.1590/S0036-46652015000400018 2188 downloads

Automatic segmentation and classification of blood components in microscopic images using a fuzzy approach
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Vale, Alessandra Mendes Pacheco Guerra Guerreiro, Ana Maria Guimarães Dória Neto, Adrião Duarte Cavalvanti Junior, Geraldo Barroso Leitão, Victor Cezar Lucena Tavares de Sá Martins, Allan Medeiros

Revista Brasileira de Engenharia Biomédica

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Dez 2014, Volume 30 Nº 4 Páginas 341 - 354

Resumo: En | Texto: En | PDF: En

INTRODUCTION: Automatic detection of blood components is an important topic in the field of hematology. Segmentation is an important step because it allows components to be grouped into common areas and processed separately. This paper proposes a method for the automatic segmentation and classification of blood components in microscopic images using a general and automatic fuzzy approach. METHODS: During pre-processing, the supports of the fuzzy sets are automatically calculated based on the histogram peaks in the green channel of the RGB image and the Euclidean distance between the leukocyte nuclei centroids and the remaining pixels. During processing, fuzzification associates the degree of pertinence of the gray level of each pixel in the regions defined in the histogram with the proximity of the leukocyte nucleus centroid closest to the pixel. The fuzzy rules are then applied, and the image is defuzzified, resulting in the classification of four regions: leukocyte nuclei, leukocyte cytoplasm, erythrocytes and blood plasma. In post-processing, false positives are reduced and the leukocytes (including the nucleus and cytoplasm), erythrocytes and blood plasma are segmented. RESULTS: A total of 530 microscopic images of blood smears were processed, and the results were compared with the results of manual segmentation by experts and the accuracy rates of other approaches. CONCLUSION: The method demonstrated average accuracy rates of 97.31% for leukocytes, 95.39% for erythrocytes and 95.06% for blood plasma, avoiding the limitations found in the literature and contributing to the practice of the segmentation of blood components.

https://doi.org/10.1590/1517-3151.0626 4655 downloads

10.

Performance and rumen parameters of crossbred dairy cows fed two sugarcane varieties combined or not with soybean hulls
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Lima, Maria Lúcia Pereira Simili, Flávia Fernanda Medeiros, Maria Izabel Merino de Balieiro Neto, Geraldo Ribeiro, Enilson Geraldo Paz, Claudia Cristina Paro de

Revista Brasileira de Zootecnia

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Dez 2014, Volume 43 Nº 12 Páginas 654 - 661

Resumo: En | Texto: En | PDF: En

Two sugarcane varieties (IAC86-2480 and IAC91-2195) combined or not with soybean hulls (SH), partially replacing corn in concentrate, were included in the diet of crossbred dairy cows to evaluate the effects on feed intake, milk production, milk composition and rumen parameters of crossbred cows. The sugarcane varieties (IAC86-2480 and IAC91-2195) and concentrate compositions (with and without SH) were analyzed in a 2 × 2 factorial arrangement. Treatments were assigned to blocks by lactation period to evaluate feed intake, milk production and milk composition. A Latin square design was used to analyze rumen parameters. Feed intake, milk production and composition were similar among treatments. Average daily feed intake was 19.93 kg DM in cows fed IAC86-2480 sugarcane and 17.98 kg DM in those fed IAC91-2195, and their average milk production was 19.27 kg and 18.94 kg, respectively. The treatments with IAC86-2480 and IAC91-2195 had different effects on ruminal pH (6.47 and 6.61, respectively) and ammoniacal nitrogen (12.88 and 16.57 mg/dL, respectively). Sugarcane variety and concentrate composition had an interaction effect on volatile fatty acid levels and acetic acid/propionic acid ratio (93.62 mM and 2.54 for IAC86-2480 with SH; 106.70 mM and 2.41 for IAC86-2480 without SH; 115.70 mM and 3.30 for IAC91-2195 with SH; and 93.21 mM and 1.81 for IAC91-2195 without SH, respectively). Sugarcane variety and soybean hull inclusion in feed concentrate do not affect feed intake, milk production or composition in crossbred cows, although these variables change fatty acid production and ruminal pH.

https://doi.org/10.1590/S1516-35982014001200005 1623 downloads

11.

Laparoendoscopic Single-site Repair of Retrocaval Ureter Without any Special Devices
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Rebouças, Rafael B. Monteiro, Rodrigo C. Medeiros Júnior, Porfírio F. de Madruga Neto, Antônio C. Soares Junior, Marcos M. Guedes, Camila N. Moura, Rícia N. P. Camilo Neto, Geraldo Alencar, Gustavo M. C. de Souza, Giácomo F. Britto, Cesar A.

International braz j urol

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Jan 2013, Volume 39 Nº 1 Páginas 141 - 142

Resumo: En | Texto: En | PDF: En

INTRODUCTIONThe retrocaval ureter is a rare congenital anomaly. The extrinsic compression may be responsible for obstruction and pain symptoms. The laparoscopic approach has been used with good results and less morbidity than the open surgery. Herein we describe a case of retrocaval ureter treated with LESS. To our knowledge, this represents the second such case reported in the literature, and the first without using any special devices, such as, single port or bended instruments.PRESENTATIONFemale, 23 years, complaining of right low back pain for a long time and recurrent urinary tract infection. Renal ultrasound demonstrated right-sided hydronephrosis and intravenous urography suggested the presence of retrocaval ureter. DTPA renal scintigraphy confirms delay in the elimination of contrast through the right kidney. A laparoendoscopic single-site repair was planned.The patient was placed in rightside-up modified flank position. A semicircular intra-umbilical incision was made and the conventional trocars (one 10 mm and two 5 mm) were inserted through the same incision on different points of the aponeurosis. The colon was dissected medially and the proximal ureter lateral to the vena cava was identified and dissected. An extra corporeal repair with Vycril 2-0 was used to facilitate the ureteral dissection and the anastomosis. A segment of ureter was ressected due to the tortuosity. Two 4-0 Vycril sutures were used to perform a running anastomosis. An ureteral stent was placed after the posterior layer on an antegrade fashion. A suction drain was left through the umbilicus.RESULTSThe total operative time was 145 min. The blood loss was minimal. The patient was discharged on the third postoperative day and resumed total activity about 10 days after surgery. The double J was removed within 4 weeks.DISCUSSIONAlbeit technically challenging, LESS repair for retrocaval ureter might represent a feasible new treatment option for this rare anatomic anomaly. Special devices could help on the procedure, however they are not essencials.

https://doi.org/10.1590/S1677-5538.IBJU.2013.01.19 1189 downloads

12.

Monoallelic thyroid peroxidase gene mutation in a patient with congenital hypothyroidism with total iodide organification defect
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Neves, Solange Caires Mezalira, Paola Rossi Dias, Vera M. A. Chagas, Antonio J. Viana, Maria Targovnik, Hector Knobel, Meyer Medeiros-Neto, Geraldo Rubio, Ileana G. S.

Arquivos Brasileiros de Endocrinologia & Metabologia

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Nov 2010, Volume 54 Nº 8 Páginas 732 - 737

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

O objetivo deste estudo foi identificar defeitos genéticos em paciente com hipotireoidismo congênito (HC) por disormonogênese e defeito total de incorporação de iodeto (DIIT). Neonato do sexo masculino com HC diagnosticado pelo rastreamento neonatal. Exames clínicos e radiológicos confirmaram que o paciente apresentava HC severo e permanente com DIIT (teste de perclorato: 99%). A região codificadora dos genes TPO, DUOX2, DUOXA2 e 2957 pares de bases (pb) do promotor de TPO foram sequenciados. No paciente foi identificada a duplicação em heterozigose GGCC no éxon 8 do gene TPO (c.1186_1187insGGCC). Nenhuma outra mutação foi localizada nos genes TPO, incluindo o promotor, DUOX2 ou DUOXA2. Descrevemos paciente com grave defeito de organificação de iodeto, provocando HC severo com bócio, em consequência de uma única mutação monoalélica no gene TPO. A expressão monoalélica no tecido tireoideano explicaria a associação de uma doença autossômica recessiva com uma única mutação monoalélica.

The aim of this study was to identify the genetic defect of a patient with dyshormonogenetic congenital hypothyroidisms (CH) with total iodide organification defect (TIOD). A male child diagnosed with CH during neonatal screening. Laboratory tests confirmed the permanent and severe CH with TIOD (99% perchlorate release). The coding sequence of TPO, DUOX2, and DUOXA2 genes and 2957 base pairs (bp) of the TPO promoter were sequenced. Molecular analysis of patient's DNA identified the heterozygous duplication GGCC (c.1186_1187insGGCC) in exon 8 of the TPO gene. No additional mutation was detected either in the TPO gene, TPO promoter, DUOX2 or DUOXA2 genes. We have described a patient with a clear TIOD causing severe goitrous CH due to a monoallelic TPO mutation. A plausible explanation for the association between an autosomal recessive disorder with a single TPO-mutated allele is the presence of monoallelic TPO expression.

8368 downloads Citado 1 vez em SciELO

13.

Construção e validação de um Sistema Integrado de Dados de Intervenção Coronária Percutânea no Brasil (Registro ICP-BR): perfil clínico dos primeiros 1.249 pacientes incluídos
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Paula, Leonardo J. C. de Lemos, Pedro A. Medeiros, Cesar Rocha Marin-Neto, José A. Figueiredo, Geraldo Luiz Polanczyk, Carisi A. Wainstein, Marco V. Ribeiro, Antônio L. P. Lodi-Junqueira, Lucas Oliveira, Flavio R. A. Sarmento-Leite, Rogério Mattos, Luiz Alberto Cantarelli, Marcelo J. C. Brito Jr., Fábio Sândolide Carvalho, Antonio C. C. Barbosa, Maurício R.

Revista Brasileira de Cardiologia Invasiva

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2010, Volume 18 Nº 3 Páginas 256 - 262

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

INTRODUÇÃO: A intervenção coronária percutânea cresceu de modo expressivo nas últimas décadas. Entretanto, relatos de resultados imediatos e a longo prazo desse procedimento em instituições brasileiras são esporádicos e restritos a alguns centros. A presente proposta objetiva descrever um sistema nacional para a avaliação dos indivíduos tratados por intervenção coronária percutânea no Brasil. MÉTODOS: O Registro ICP-BR foi constituído por meio de rede informatizada para a captação de dados, via web, sobre angioplastias coronárias realizadas no dia a dia da cardiologia intervencionista, sem critérios de exclusão. Em sua fase piloto, 8 centros nacionais foram selecionados para a coleta inicial de dados. Relatamos o perfil clínico e a evolução intra-hospitalar dos primeiros pacientes incluídos. RESULTADOS: De março de 2009 a dezembro de 2009, foram incluídos 1.249 pacientes na base de dados. No total, 60% foram tratados pelo Sistema Único de Saúde, 38% por planos de saúde e 2% eram pagantes. A média de idade era de 63,7 ± 11,3 anos, 36% eram diabéticos, 12% tinham cirurgia prévia e 27% tinham angioplastia prévia. À admissão, 39% eram estáveis e 18% tinham infarto com supradesnivelamento do segmento ST. Ultrassom intracoronário ou reserva fracionada de fluxo foram utilizados em 2,8% dos casos. Stents foram utilizados em 93% dos procedimentos, sendo farmacológicos em 16,2% dos pacientes. A mortalidade foi de 0,2% nos pacientes estáveis, de 2,4% nos casos de coronariopatia aguda sem supradesnivelamento do segmento ST, de 6,1% nos pacientes com infarto com supradesnivelamento do segmento ST e de 3,6% naqueles com "equivalente anginoso". CONCLUSÕES: Descrevemos a construção e a efetiva implementação de sistema informatizado para a coleta detalhada de dados sobre procedimentos de intervenção percutânea coronária no Brasil. Em decorrência do caráter inclusivo sem restrições (all-comers) e do seguimento prospectivamente desenhado dos pacientes, esse sistema de captação e registro poderá contribuir de forma decisiva para que se trace o perfil das intervenções percutâneas coronárias em nosso País.

BACKGROUND: Percutaneous coronary intervention has grown dramatically in recent decades. However, reports of immediate and long-term results of this procedure in Brazilian institutions are sporadic and limited to some centers. This study is aimed at describing a national system to evaluate patients treated by percutaneous coronary intervention in Brazil. METHODS: The ICP-BR Registry was established by a computerized network for data capture on coronary angioplasties performed in day-to-day interventional cardiology, without exclusion criteria. In the pilot phase 8 national centers were selected for the initial data collection. We report the clinical profile and in-hospital evolution of the first patients included. RESULTS: From March 2009 to December 2009, 1,249 patients were included in the database. In total, 60% were treated by the Unified Health System, 38% by health insurance plans and 2% were private patients. Mean age was 63.7 ± 11.3 years, 36% were diabetic, 12% had prior surgery and 27% prior angioplasty. Upon admission, 39% were stable and 18% had ST elevation myocardial infarction. Intracoronary ultrasound or fractional flow reserve was performed in 2.8% cases. Stents were used in 93% of procedures, and drug-eluting stents in 16.2% of the patients. Mortality was 0.2% in stable patients, 2.4% in patients with acute coronary syndromes without ST elevation, 6.1% in patients with ST elevation myocardial infarction and 3.6% in those with anginal equivalent. CONCLUSIONS: We describe the development and implementation of a computerized system to collect detailed data on percutaneous coronary intervention procedures in Brazil. Given the inclusive unrestricted character (all-comers) and prospective follow-up of patients, this data capture and recording system may contribute decisively to profile percutaneous coronary intervention in our country.

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14.

Iodine nutrition in Brazil: where do we stand?
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Medeiros-Neto, Geraldo

Arquivos Brasileiros de Endocrinologia & Metabologia

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Jun 2009, Volume 53 Nº 4 Páginas 470 - 474

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

A legislação para corrigir deficiência crônica de iodo no Brasil iniciou-se em 1955. O sal iodado seria distribuído somente em áreas endêmicas de bócio, com dose fixa de 10 mg Iodo/kg de sal. Na década de 1982 a 1992, o Instituto Nacional de Alimentação e Nutrição assumiu o Programa Nacional para a Deficiência Crônica de Iodo e forneceu o iodato de potássio a todos os produtores de sal. Em 1992, o INAN foi dissolvido. Nova legislação foi promulgada em 1995. A Anvisa ficou encarregada de supervisionar o teor de iodo em amostras de sal. No período de 1998 a 2004, o teor de iodo no sal foi elevado para 40 a 100 mg I/kg de sal. O excesso nutricional de iodo na população possivelmente aumentou a prevalência de tireoidite de Hashimoto e hipertireoidismo. Inquérito epidemiológico nacional (PNAISAL) em escolares, em execução, indicará as futuras determinações para a adição de iodo no sal.

Brazilian legislation, since 1955, failed to achieve its objectives because the issue was not properly addressed: iodized salt was only available in endemic areas, at a low amount of 10 mg Iodine/kg salt. Lack of surveillance and cooperation were common errors. From 1982 to 1992, the INAN distributed potassium iodate to the industry free of charge, but it was abolished in 1991. Only four years later (1995) was a new law enacted effective in determining that all salt for human use should be iodized at levels established by the Health Authorities. During the period comprising 1998 to 2004, excessive iodination of salt (40 to 100 mg/kg) could lead to an increased prevalence of chronic autoimmune thyroiditis and iodine-induced hyperthyroidism. In 2003, the content of iodine/kg of salt was lowered to 20 to 60 mg I/kg salt. A national survey of schoolchildren is currently underway and will indicate the changes required for adequate iodine in salt for human use.

6545 downloads Citado 4 vezes em SciELO

15.

The prevalence of thyroid dysfunction in elderly cardiology patients with mild excessive iodine intake in the urban area of São Paulo
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Duarte, Glaucia C. Tomimori, Eduardo K. Camargo, Rosalinda Y. A. Rubio, Ileana G.S. Wajngarten, Mauricio Rodrigues, Amanda G. Knobel, Meyer Medeiros-Neto, Geraldo

Clinics

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Fev 2009, Volume 64 Nº 2 Páginas 135 - 142

Resumo: En | Texto: En | PDF: En

OBJECTIVES: To evaluate the prevalence of thyroid dysfunction in elderly cardiac patients in an outpatient setting. SUBJECTS AND METHODS: A total of 399 consecutive patients (268 women, age range 60-92 years) who were followed at Heart Institute were evaluated for thyroid dysfunction with serum free T4, TSH, anti-Peroxidase antibodies, urinary iodine excretion measurements and thyroid ultrasound. RESULTS: Hyperthyroidism (overt and subclinical) was present in 29 patients (6.5%), whereas hypothyroidism (overt and subclinical) was found in 32 individuals (8.1%). Cysts were detected in 11 patients (2.8%), single nodules were detected in 102 (25.6%), and multinodular goiters were detected in 34 (8.5%). Hashimoto's thyroiditis was present in 16.8% patients, most of whom were women (83.6%). The serum TSH increased with age and was significantly higher (p= <0.01) in patients, compared to the normal control group. No significant differences in serum TSH and free T4 values were observed when patients with atrial fibrillation (AF) where compared with those without arrhythmia. The median urinary iodine levels were 210 µg/L (40-856 µg/L), and iodine levels were higher in men than in women (p<0.01). Excessive iodine intake (urinary iodine >300 µg/L) was observed in one-third of patients (30.8%). CONCLUSIONS: Elderly patients have a higher prevalence of both hypo- and hyperthyroidism as well as thyroid nodules when compared with the general population. About one-third of the older patients had elevated urinary secretion of iodine and a higher prevalence of chronic Hashimoto's thyroiditis. It is recommended that ultrasonographic studies, tests for thyroid function and autoimmunity should be evaluated in elderly patients.

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