Pesquisa | SciELO

Abstract Objective COVID-19 is associated with an elevated risk of thromboembolism and excess mortality. Difficulties with best anticoagulation practices and their implementation motivated the current analysis of COVID-19 patients who developed Venous Thromboembolism (VTE). Method This is a post-hoc analysis of a COVID-19 cohort, described in an economic study already published. The authors analyzed a subset of patients with confirmed VTE. We described the characteristics of the cohort, such as demographics, clinical status, and laboratory results. We tested differences amid two subgroups of patients, those with VTE or not, with the competitive risk Fine and Gray model. Results Out of 3186 adult patients with COVID-19, 245 (7.7%) were diagnosed with VTE, 174 (5.4%) of them during admission to the hospital. Four (2.3% of these 174) did not receive prophylactic anticoagulation and 19 (11%) discontinued anticoagulation for at least 3 days, resulting in 170 analyzed. During the first week of hospitalization, the laboratory most altered results were C-reactive protein and D-dimer. Patients with VTE were more critical, had a higher mortality rate, worse SOFA score, and, on average, 50% longer hospital stay. Conclusion Proven VTE incidence in this severe COVID-19 cohort was 7.7%, despite 87% of them complying completely with VTE prophylaxis. The clinician must be aware of the diagnosis of VTE in COVID-19, even in patients receiving proper prophylaxis.

https://doi.org/10.1016/j.clinsp.2023.100178

Safety and immunogenicity of influenza A(H3N2) component vaccine in juvenile systemic lupus erythematosus
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Aikawa, Nadia Emi

; Borba, Eduardo Ferreira

; Balbi, Verena Andrade

; Sallum, Adriana Maluf Elias

; Buscatti, Izabel Mantovani

; Campos, Lucia Maria Arruda

; Kozu, Kátia Tomie

; Garcia, Cristiana Couto

; Capão, Artur Silva Vidal

; Proença, Adriana Coracini Tonacio de

; Leon, Elaine Pires

; Duarte, Alberto José da Silva

; Lopes, Marta Heloisa

; Silva, Clovis Artur

; Bonfá, Eloisa

Advances in Rheumatology

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2023, Volume 63 elocation 55

Resumo: En | Texto: En | PDF: En

Abstract Introduction Seasonal influenza A (H3N2) virus is an important cause of morbidity and mortality in the last 50 years in population that is greater than the impact of H1N1. Data assessing immunogenicity and safety of this virus component in juvenile systemic lupus erythematosus (JSLE) is lacking in the literature. Objective To evaluate short-term immunogenicity and safety of influenza A/Singapore (H3N2) vaccine in JSLE. Methods 24 consecutive JSLE patients and 29 healthy controls (HC) were vaccinated with influenza A/Singapore/ INFIMH-16-0019/2016(H3N2)-like virus. Influenza A (H3N2) seroprotection (SP), seroconversion (SC), geometric mean titers (GMT), factor increase in GMT (FI-GMT) titers were assessed before and 4 weeks post-vaccination. Disease activity, therapies and adverse events (AE) were also evaluated. Results JSLE patients and controls were comparable in current age [14.5 (10.1–18.3) vs. 14 (9–18.4) years, p = 0.448] and female sex [21 (87.5%) vs. 19 (65.5%), p = 0.108]. Before vaccination, JSLE and HC had comparable SP rates [22 (91.7%) vs. 25 (86.2%), p = 0.678] and GMT titers [102.3 (95% CI 75.0–139.4) vs. 109.6 (95% CI 68.2–176.2), p = 0.231]. At D30, JSLE and HC had similar immune response, since no differences were observed in SP [24 (100%) vs. 28 (96.6%), p = 1.000)], SC [4 (16.7%) vs. 9 (31.0%), p = 0.338), GMT [162.3 (132.9–198.3) vs. 208.1 (150.5–287.8), p = 0.143] and factor increase in GMT [1.6 (1.2–2.1) vs. 1.9 (1.4–2.5), p = 0.574]. SLEDAI-2K scores [2 (0–17) vs. 2 (0–17), p = 0.765] and therapies remained stable throughout the study. Further analysis of possible factors influencing vaccine immune response among JSLE patients demonstrated similar GMT between patients with SLEDAI < 4 compared to SLEDAI ≥ 4 ( p = 0.713), as well as between patients with and without current use of prednisone ( p = 0.420), azathioprine ( p = 1.0), mycophenolate mofetil ( p = 0.185), and methotrexate ( p = 0.095). No serious AE were reported in both groups and most of them were asymptomatic (58.3% vs. 44.8%, p = 0.958). Local and systemic AE were alike in both groups ( p > 0.05). Conclusion This is the first study that identified adequate immune protection against H3N2-influenza strain with additional vaccine-induced increment of immune response and an adequate safety profile in JSLE. ( www.clinicaltrials.gov , NCT03540823).

https://doi.org/10.1186/s42358-023-00339-7

Cost-Effective Trap qPCR Approach to Evaluate Telomerase Activity: an Important Tool for Aging, Cancer, and Chronic Disease Research
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Pinto, Thalyta Nery Carvalho

; Fernandes, Juliana Ruiz

; Arruda, Liã Barbara

; Duarte, Alberto José da Silva

; Benard, Gil

Clinics

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2021, Volume 76 elocation e2432

Resumo: En | Texto: En | PDF: En

OBJECTIVES: Telomeres are a terminal “DNA cap” that prevent chromosomal fusion and degradation. However, aging is inherent to life, and so is the loss of terminal sequences. Telomerase is a specialized reverse transcriptase encoded by self-splicing introns that counteract chromosome erosion. Telomerase activity is observed during early embryonic development, but after the blastocyst stage, the expression of telomerase reduces. The consequences of either insufficient or unrestrained telomerase activity underscore the importance of ongoing studies aimed at elucidating the regulation of telomerase activity in humans. In the present study, we aimed to standardize a simplified telomerase repeat-amplification protocol (TRAP) assay to detect telomerase activity in unstimulated and PHA-stimulated mononuclear cells. METHODS and RESULTS: Our optimized qPCR-based can efficiently evaluate telomerase activity. Quantification of protein and DNA between unstimulated and PHA-stimulated peripheral blood mononuclear cells revealed cellular activation and cell-cycle entry. The assay also showed that relative telomerase activity is significantly different between these two conditions, supporting the applicability of the assay. Furthermore, our findings corroborated that telomerase activity decreases with age. CONCLUSIONS: Telomeres and telomerase are implicated in aging and development of chronic diseases and cancer; however, difficulty in accessing commercial kits to investigate these aspects is a critical constraint in health surveillance studies. Our optimized assay was successfully used to differentiate telomerase activity between unstimulated and stimulated cells, clearly showing the reactivation of telomerase upon cell activation. This assay is affordable, reproducible, and can be executed in resource-limited settings.

https://doi.org/10.6061/clinics/2021/e2432 639 downloads

Use and misuse of biomarkers and the role of D-dimer and C-reactive protein in the management of COVID-19: A post-hoc analysis of a prospective cohort study
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Gonçalves, Fabio Augusto Rodrigues

; Besen, Bruno Adler Maccagnan Pinheiro

; Lima, Clarice Antunes de

; Corá, Aline Pivetta

; Pereira, Antônio José Rodrigues

; Perazzio, Sandro Félix

; Gouvea, Christiane Pereira

; Fonseca, Luiz Augusto Marcondes

; Trindade, Evelinda Marramon

; Sumita, Nairo Massakazu

; Duarte, Alberto José da Silva

; Lichtenstein, Arnaldo

; Bonfa, Eloisa

; Utiyama, Edivaldo M.

; Segurado, Aluisio C.

; Perondi, Beatriz

; Miethke-Morais, Anna

; Montal, Amanda C.

; Harima, Leila

; Fusco, Solange R. G.

; Silva, Marjorie F.

; Rocha, Marcelo C.

; Marcilio, Izabel

; Rios, Izabel Cristina

; Kawano, Fabiane Yumi Ogihara

; Jesus, Maria Amélia de

; Kallas, Ésper George

; Carmo, Carolina

; Tanaka, Clarice

; Souza, Heraldo Possolo de

; Marchini, Julio F. M.

; Carvalho, Carlos

; Ferreira, Juliana C.

; Levin, Anna Sara Shafferman

; Oliveira, Maura Salaroli

; Guimarães, Thaís

; Lázari, Carolina dos Santos

; Sabino, Ester

; Magri, Marcello M. C.

; Barros-Filho, Tarcisio E. P.

; Francisco, Maria Cristina Peres Braido

; Costa, Silvia F.

Clinics

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2021, Volume 76 elocation e3547

Resumo: En | Texto: En | PDF: En

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is associated with high mortality among hospitalized patients and incurs high costs. Severe acute respiratory syndrome coronavirus 2 infection can trigger both inflammatory and thrombotic processes, and these complications can lead to a poorer prognosis. This study aimed to evaluate the association and temporal trends of D-dimer and C-reactive protein (CRP) levels with the incidence of venous thromboembolism (VTE), hospital mortality, and costs among inpatients with COVID-19. METHODS: Data were extracted from electronic patient records and laboratory databases. Crude and adjusted associations for age, sex, number of comorbidities, Sequential Organ Failure Assessment score at admission, and D-dimer or CRP logistic regression models were used to evaluate associations. RESULTS: Between March and June 2020, COVID-19 was documented in 3,254 inpatients. The D-dimer level ≥4,000 ng/mL fibrinogen equivalent unit (FEU) mortality odds ratio (OR) was 4.48 (adjusted OR: 1.97). The CRP level ≥220 mg/dL OR for death was 7.73 (adjusted OR: 3.93). The D-dimer level ≥4,000 ng/mL FEU VTE OR was 3.96 (adjusted OR: 3.26). The CRP level ≥220 mg/dL OR for VTE was 2.71 (adjusted OR: 1.92). All these analyses were statistically significant (p<0.001). Stratified hospital costs demonstrated a dose-response pattern. Adjusted D-dimer and CRP levels were associated with higher mortality and doubled hospital costs. In the first week, elevated D-dimer levels predicted VTE occurrence and systemic inflammatory harm, while CRP was a hospital mortality predictor. CONCLUSION: D-dimer and CRP levels were associated with higher hospital mortality and a higher incidence of VTE. D-dimer was more strongly associated with VTE, although its discriminative ability was poor, while CRP was a stronger predictor of hospital mortality. Their use outside the usual indications should not be modified and should be discouraged.

https://doi.org/10.6061/clinics/2021/e3547

Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital
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Marques, Heloisa Helena de Sousa

; Pereira, Maria Fernanda Badue

; Santos, Angélica Carreira dos

; Fink, Thais Toledo

; Paula, Camila Sanson Yoshino de

; Litvinov, Nadia

; Schvartsman, Claudio

; Delgado, Artur Figueiredo

; Gibelli, Maria Augusta Bento Cicaroni

; Carvalho, Werther Brunow de

; Odone Filho, Vicente

; Tannuri, Uenis

; Carneiro-Sampaio, Magda

; Grisi, Sandra

; Duarte, Alberto José da Silva

; Antonangelo, Leila

; Francisco, Rossana Pucineli Vieira

; Okay, Thelma Suely

; Batisttella, Linamara Rizzo

; Carvalho, Carlos Roberto Ribeiro de

; Brentani, Alexandra Valéria Maria

; Silva, Clovis Artur

; Eisencraft, Adriana Pasmanik

; Rossi Junior, Alfio

; Fante, Alice Lima

; Cora, Aline Pivetta

; Reis, Amelia Gorete A. de Costa

; Ferrer, Ana Paula Scoleze

; Andrade, Anarella Penha Meirelles de

; Watanabe, Andreia

; Gonçalves, Angelina Maria Freire

; Waetge, Aurora Rosaria Pagliara

; Silva, Camila Altenfelder

; Ceneviva, Carina

; Lazari, Carolina dos Santos

; Abellan, Deipara Monteiro

; Santos, Emilly Henrique dos

; Sabino, Ester Cerdeira

; Bianchini, Fabíola Roberta Marim

; Alcantara, Flávio Ferraz de Paes

; Ramos, Gabriel Frizzo

; Leal, Gabriela Nunes

; Rodriguez, Isadora Souza

; Pinho, João Renato Rebello

; Carneiro, Jorge David Avaizoglou

; Paz, Jose Albino

; Ferreira, Juliana Carvalho

; Ferranti, Juliana Ferreira

; Ferreira, Juliana de Oliveira Achili

; Framil, Juliana Valéria de Souza

; Silva, Katia Regina da

; Kanunfre, Kelly Aparecida

; Bastos, Karina Lucio de Medeiros

; Galleti, Karine Vusberg

; Cristofani, Lilian Maria

; Suzuki, Lisa

; Campos, Lucia Maria Arruda

; Perondi, Maria Beatriz de Moliterno

; Diniz, Maria de Fatima Rodrigues

; Fonseca, Maria Fernanda Mota

; Cordon, Mariana Nutti de Almeida

; Pissolato, Mariana

; Peres, Marina Silva

; Garanito, Marlene Pereira

; Imamura, Marta

; Dorna, Mayra de Barros

; Luglio, Michele

; Rocha, Mussya Cisotto

; Aikawa, Nadia Emi

; Degaspare, Natalia Viu

; Sakita, Neusa Keico

; Udsen, Nicole Lee

; Scudeller, Paula Gobi

; Gaiolla, Paula Vieira de Vincenzi

; Severini, Rafael da Silva Giannasi

; Rodrigues, Regina Maria

; Toma, Ricardo Katsuya

; Paula, Ricardo Iunis Citrangulo de

; Palmeira, Patricia

; Forsait, Silvana

; Farhat, Sylvia Costa Lima

; Sakano, Tânia Miyuki Shimoda

; Koch, Vera Hermina Kalika

; Cobello Junior, Vilson

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2021, Volume 76 elocation e3488

Resumo: En | Texto: En | PDF: En

OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.

https://doi.org/10.6061/clinics/2021/e3488

Prevalence of anti-SARS-CoV-2 antibodies in outpatients of a large public university hospital in Sao Paulo, Brazil
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Oliveira, Luanda Mara da Silva

; Tiyo, Bruna Tiaki

; Silva, Lais Teodoro da

; Fonseca, Luiz Augusto Marcondes

; Rocha, Rosana Coura

; Santos, Vera Aparecida dos

; Ceneviva, Carina

; Bedin, Anderson Aparecido

; Almeida, Alexandre de

; Duarte, Alberto José da Silva

; Oshiro, Telma Miyuki

Revista do Instituto de Medicina Tropical de São Paulo

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2020, Volume 62 elocation e91

Resumo: En | Texto: En | PDF: En

ABSTRACT Coronavirus disease 19 (COVID-19) is caused by SARS-Cov-2 and the manifestations of this infection range from an absence of symptoms all the way up to severe disease leading to death. To estimate the prevalence of past infection in a population, the most readily available method is the detection of antibodies against the virus. This study has investigated the prevalence of anti-SARS-CoV-2 antibodies in outpatients of the Hospital das Clinicas, in Sao Paulo city (Brazil), which is a large university hospital belonging to the public health system that cares for patients with complex diseases who need tertiary or quaternary medical care. Our serological inquiry was carried out for 6 weeks, with once-a-week blood sampling and included 439 patients from several outpatient services. Overall, 61 patients tested positive for anti-SARS-CoV-2 IgG (13.9%); 56.1 % of the patients live in Sao Paulo city, with the remaining living in other towns of the metropolitan area; 32.8% of the patients testing positive for IgG antibodies to SARS-CoV-2 were asymptomatic, 55.7% developed mild or moderate disease and 11.5% had to be hospitalized. The prevalence of SARS-CoV-2 positive serology was lower among patients who had received the seasonal influenza vaccine compared to the ones who did not. These findings may indicate that those individuals care more about health issues, and/or that they have a better access to health care and/or a better quality of health care service. The large proportion of patients who were unaware of having had contact with SARS-CoV-2 deserves attention, reflecting the scarcity of tests performed in the population.

https://doi.org/10.1590/s1678-9946202062091 1104 downloads

Sensitivity of the Wondfo One Step COVID-19 test using serum samples
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Santos, Vera Aparecida dos

; Rafael, Mayra Matias

; Sabino, Ester Cerdeira

; Duarte, Alberto José da Silva

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2020, Volume 75 elocation e2013

Resumo: En | Texto: En | PDF: En

https://doi.org/10.6061/clinics/2020/e2013 5396 downloads

Emergence of colistin resistance in the largest university hospital complex of São Paulo, Brazil, over five years
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Rossi, Flávia

; Girardello, Raquel

; Cury, Ana Paula

; Di Gioia, Thais Sabato Romano

; Almeida Jr, João Nóbrega de

; Duarte, Alberto José da Silva

Brazilian Journal of Infectious Diseases

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Fev 2017, Volume 21 Nº 1 Páginas 98 - 101

Resumo: En | Texto: En | PDF: En

Abstract Colistin resistance involving Gram-negative bacilli infections is a challenge for health institutions around of the world. Carbapenem-resistance among these isolates makes colistin the last therapeutic option for this treatment. Colistin resistance among Enterobacteriaceae, Acinetobacter spp., and Pseudomonas spp. was evaluated between 2010 and 2014 years, at Hospital das Clínicas, São Paulo, Brazil. Over five years 1346 (4.0%) colistin resistant Gram-negative bacilli were evaluated. Enterobacteriaceae was the most frequent (86.1%) pathogen isolated, followed by Acinetobacter spp. (7.6%), and Pseudomonas spp. (6.3%). By temporal analysis there was a trend for an increase of colistin resistance among Enterobacteriaceae, but not among non-fermentative isolates. Among 1346 colistin resistant isolates, carbapenem susceptibility was observed in 21.5%. Colistin resistance in our hospital has been alarmingly increased among Klebsiella pneumoniae isolates in both KPC positive and negative, thus becoming a therapeutic problem.

https://doi.org/10.1016/j.bjid.2016.09.011 1457 downloads

Depression is inversely associated with sexual satisfaction and physical function in men living with HIV/AIDS
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Raso, Vagner

; Tolea, Magdalena Ioana

; Casseb, Jorge Simão do Rosário

; Duarte, Alberto José da Silva

; Greve, Júlia Maria D'Andréa

MedicalExpress

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Dez 2016, Volume 3 Nº 6 elocation M160603

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

OBJETIVO: Analisar as associações entre depressão e aptidão e função físicas em homens vivendo com HIV/AIDS, e o papel da satisfação sexual nessas associações. MÉTODOS: Estudo transversal conduzido com 40 homens vivendo com HIV/AIDS (40,75 ± 8,68 anos [25-66 anos de idade]) divididos em dois grupos de acordo com o nadir de CD4+ (nadir baixo < 200 células/mm3; nadir alto ≥ 200 células/mm3). A depressão foi estimada pelo inventário de depressão de Beck. Os participantes auto-classificaram sua satisfação sexual. A aptidão física foi avaliada por meio da flexibilidade, força muscular e consumo de oxigênio de pico (VO2pico). A função física foi mensurada pelo tempo para levantar-se de uma posição sentada (TLPS), tempo para amarrar o tênis, e tempo para caminhar 3,33 m. RESULTADOS: A depressão foi inversamente associada com satisfação sexual (para nadir baixo e alto) e flexibilidade (para nadir baixo), e positivamente associada com tempo de caminhada (para nadir baixo e amostra total), e tempo para calçar e amarrar o tênis (amostra total). A satisfação sexual foi positivamente associada com força muscular (para nadir alto e amostra total), mas inversamente com TLPS (para nadir baixo e amostra total), tempo de caminhada (para nadir baixo e amostra total), e tempo para calçar e amarrar o tênis (para nadir alto e amostra total). CONCLUSÃO: Os dados sugerem que existe associação negativa entre depressão e função física independente do quadro clinico retrospectivo de homens vivendo com HIV/AIDS, e que parece existir, potencialmente, um papel para a satisfação sexual como explicação para essa associação.

OBJECTIVE: To assess the associations between depression and physical fitness and function in men living with HIV/AIDS and the role of sexual satisfaction in these associations. DESIGN: Cross-sectional study conducted with 40 males living with HIV/AIDS (40.75 ± 8.68 years [25-66 yrs. old]) divided in two groups based on CD4+ nadir (low nadir < 200 cells/mm3; high nadir ≥ 200 cells/mm3). METHODS: Depression was determined by the Beck Depression Inventory. Participants were asked to evaluate their satisfaction with sexual life and their physical fitness was assessed by flexibility, muscle strength and peak oxygen uptake (VO2peak). Physical function was measured by time taken to move from seated to standing position (TSSP), time to tie sneakers, and time to walk 3.33 m. RESULTS: Depression was inversely associated with sexual satisfaction (for low and high CD4+ nadir) and flexibility (for low CD4+ nadir), and positively associated with walking time (for low CD4+ nadir and total sample), and time to tie sneakers (for the total sample). Sexual satisfaction was positively associated with muscle strength (for low CD4+ nadir and total sample), but inversely with TSSP (for low CD4+ nadir and total sample), walking time (for low CD4+ nadir and total sample), and time to tie sneakers (for high CD4+ nadir and total sample). CONCLUSION: Findings suggest a negative association between depression and physical function regardless of retrospective clinical status of men living with HIV/AIDS and a potential role for sexual satisfaction in explaining this association.

https://doi.org/10.5935/medicalexpress.2016.06.03 1982 downloads

10.

DETERMINATION OF VIRAL TROPISM BY GENOTYPING AND PHENOTYPING ASSAYS IN BRAZILIAN HIV-1-INFECTED PATIENTS
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Arruda, Liã Bárbara

; Araújo, Marilia Ladeira de

; Martinez, Maira Luccia

; Gonsalez, Claudio Roberto

; Duarte, Alberto José da Silva

; Coakley, Eoin

; Lie, Yolanda

; Casseb, Jorge

Revista do Instituto de Medicina Tropical de São Paulo

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Jul 2014, Volume 56 Nº 4 Páginas 287 - 290

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

A aplicação clínica dos antagonistas de CCR5 envolve em primeiro lugar determinar o uso de co-receptor pela cepa viral infectante. Programas de bioinformática que prevêem o uso co-receptor poderiam fornecer um método alternativo para selecionar candidatos para o tratamento com os antagonistas do CCR5, particularmente em países com poucos recursos financeiros. Assim, o presente estudo teve por objetivo identificar a melhor abordagem utilizando ferramentas de bioinformática para determinar qual o tipo de co-receptor do HIV-1 que poderia ser usado na prática clínica. Sequências de DNA proviral e Trofile resultados a partir de 99 pacientes infectados pelo HIV-1 sob monitorização clínica foram avaliadas. Com base nos resultados do Teste Trofile, as variantes virais presentes eram R5 (81,1%), R5X4 (21,4%) e X4 (1,8%). Determinação do tropismo pela análise do Geno2pheno, com taxa de falso positivos de 10% apresentou desempenho mais adequado para esta amostragem: as cepas R5 e X4 foram encontradas em frequências de 78,5% e 28,4%, respectivamente, e foi de 78,6% a concordância entre os resultados fenotípicos e genotípicos. Mais estudos são necessários para esclarecer como a diversidade genética entre as cepas do vírus afeta abordagens baseadas na determinação do tropismo pelas ferramentas de bioinformática. Embora esta estratégia possa ser útil para o rastreio de pacientes em países em desenvolvimento, permanecem algumas limitações que restringem a aplicação mais ampla para utilização de testes de co-receptor na prática clínica.

The clinical application of CCR5 antagonists involves first determining the coreceptor usage by the infecting viral strain. Bioinformatics programs that predict coreceptor usage could provide an alternative method to screen candidates for treatment with CCR5 antagonists, particularly in countries with limited financial resources. Thus, the present study aims to identify the best approach using bioinformatics tools for determining HIV-1 coreceptor usage in clinical practice. Proviral DNA sequences and Trofile results from 99 HIV-1-infected subjects under clinical monitoring were analyzed in this study. Based on the Trofile results, the viral variants present were 81.1% R5, 21.4% R5X4 and 1.8% X4. Determination of tropism using a Geno2pheno[coreceptor] analysis with a false positive rate of 10% gave the most suitable performance in this sampling: the R5 and X4 strains were found at frequencies of 78.5% and 28.4%, respectively, and there was 78.6% concordance between the phenotypic and genotypic results. Further studies are needed to clarify how genetic diversity amongst virus strains affects bioinformatics-driven approaches for determining tropism. Although this strategy could be useful for screening patients in developing countries, some limitations remain that restrict the wider application of coreceptor usage tests in clinical practice.

https://doi.org/10.1590/S0036-46652014000400003 2308 downloads

11.

Rational use of blood calcium determinations
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Ferreira-Junior, Mario

; Lichtenstein, Arnaldo

; Sales, Maria Mirtes

; Taniguchi, Leandro Utino

; Aguiar, Francisco José Bueno de

; Fonseca, Luiz Augusto Marcondes

; Sumita, Nairo Massakazu

; Duarte, Alberto José da Silva

Sao Paulo Medical Journal

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2014, Volume 132 Nº 4 Páginas 243 - 248

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

CONTEXTO E OBJETIVO:Este trabalho foi motivado pelo recente aumento excessivo de solicitações de dosagem de cálcio no sangue, assim como de exames laboratoriais em geral, no complexo do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). Seu objetivo foi sugerir regras para a determinação de cálcio total e iônico nas nossas unidades de terapia intensiva, pronto-socorro, enfermarias e ambulatórios e contribuir para a melhoria da qualidade da assistência médica, com utilização mais adequada dos recursos humanos e financeiros.TIPO DO ESTUDO E LOCAL:Análise crítica de dados clínicos, laboratoriais e da literatura médica pertinente, realizada pelo grupo de estudos para o uso racional do laboratório clínico, vinculado à Divisão de Laboratório Central do HCFMUSP.MÉTODOS:O grupo de estudos reviu publicações científicas, estatísticas e dados clínico-laboratoriais relativos às solicitações de cálcio total e iônico nos ambientes das unidades de terapia intensiva, prontos-socorros, enfermarias e ambulatórios.RESULTADOS:A partir dessa análise crítica, foram construídos fluxogramas de decisão clínica que visam orientar a requisição desses testes.CONCLUSÕES:A utilização dos fluxogramas propostos pode ajudar a limitar a solicitação inadequada das dosagens de cálcio total e iônico, com consequente redução do número de exames, de riscos para os pacientes e de custos desnecessários.

CONTEXT AND OBJECTIVE:This study was motivated by the recent excessive increase in requests for blood calcium determinations and laboratory tests in general, in the Hospital das Clínicas complex of Faculdade de Medicina, Universidade de São Paulo (HCFMUSP). Its aim was to suggest rules for the determination of total and ionized calcium in our intensive care units, emergency department, wards and outpatient services, thus contributing towards improving the quality of medical care and achieving more appropriate use of human and financial resources.DESIGN AND SETTING:Critical analysis on clinical and laboratory data and the pertinent scientific literature, conducted by the study group for rational clinical laboratory use, which is part of the Central Laboratory Division, HCFMUSP.METHODS:The study group reviewed scientific publications, statistics and clinical and laboratory data concerning requests for total and ionized calcium determinations in the settings of intensive care units, emergency department, wards and outpatient services.RESULTS:From this critical analysis, clinical decision flow diagrams aimed at providing guidance for ordering these tests were constructed.CONCLUSIONS:Use of the proposed flow diagrams may help to limit the numbers of inappropriate requests for ionized and total calcium determinations, with consequent reductions in the number of tests, risks to patients and unnecessary costs.

https://doi.org/10.1590/1516-3180.2014.1324731 2574 downloads

12.

Association between muscle strength and the cardiopulmonary status of individuals living with HIV/AIDS
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Raso, Vagner

; Shephard, Roy J.

; Casseb, Jorge

; Duarte, Alberto José da Silva

; Silva, Paulo Roberto Santos

; Greve, Júlia Maria D'Andréa

Clinics

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2013, Volume 68 Nº 3 Páginas 359 - 364

Resumo: En | Texto: En | PDF: En

OBJECTIVE: The purpose of this study was to compare aerobic function [anaerobic threshold (%VO2-AT), respiratory compensation point (%VO2-RCP) and peak oxygen uptake (VO2peak)] between physically active patients with HIV/AIDS and matched controls and to examine associations between disease status, poor muscle strength, depression (as estimated by the profile of mood states questionnaire) and the aerobic performance of patients. METHODS: Progressive treadmill test data for %VO2-AT (V-slope method), RCP and (VO2peak) were compared between 39 male patients with HIV/AIDS (age 40.6±1.4 years) and 28 male controls (age 44.4±2.1 years) drawn from the same community and matched for habitual physical activity. Within-patient data were also examined in relation to CD4+ counts (nadir and current data) and peak isokinetic knee torque. RESULTS: AT, RCP and (VO2peak) values were generally similar for patients and controls.Within the patient sample, binary classification suggested that AT, RCP and (VO2peak) values were not associated with either the nadir or current CD4+ count, but treadmill test variables were positively associated with peak isokinetic knee torque. CONCLUSION: The aerobic performance of physically active patients with HIV/AIDS is generally well conserved. Nevertheless, poor muscle strength is observed in some HIV/AIDS patients, which is associated with lower anaerobic power and (VO2peak), suggesting the possibility of enhancing the aerobic performance of patients with weak muscles through appropriate muscle-strengthening activities.

https://doi.org/10.6061/clinics/2013(03)OA12 1972 downloads

13.

Differential expression of the costimulatory molecules CD86, CD28, CD152 and PD-1 correlates with the host-parasite outcome in leprosy
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Palermo, Maria de Lourdes

; Trindade, Maria Ângela Bianconcini

; Duarte, Alberto José da Silva

; Cacere, Camila Rodrigues

; Benard, Gil

Memórias do Instituto Oswaldo Cruz

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Dez 2012, Volume 107 Supl. 1 Páginas 167 - 173

Resumo: En | Texto: En | PDF: En

Leprosy is a spectral disease exhibiting two polar sides, namely, lepromatous leprosy (LL) characterised by impaired T-cell responses and tuberculoid leprosy in which T-cell responses are strong. Proper T-cell activation requires signalling through costimulatory molecules expressed by antigen presenting cells and their ligands on T-cells. We studied the influence of costimulatory molecules on the immune responses of subjects along the leprosy spectrum. The expression of the costimulatory molecules was evaluated in in vitro-stimulated peripheral blood mononuclear cells of lepromatous and tuberculoid patients and healthy exposed individuals (contacts). We show that LL patients have defective monocyte CD86 expression, which likely contributes to the impairment of the antigen presentation process and to patients anergy. Accordingly, CD86 but not CD80 blockade inhibited the lymphoproliferative response to Mycobacterium leprae. Consistent with the LL anergy, there was reduced expression of the positive signalling costimulatory molecules CD28 and CD86 on the T-cells in these patients. In contrast, tuberculoid leprosy patients displayed increased expression of the negative signalling molecules CD152 and programmed death-1 (PD-1), which represents a probable means of modulating an exacerbated immune response and avoiding immunopathology. Notably, the contacts exhibited proper CD86 and CD28 expression but not exacerbated CD152 or PD-1 expression, suggesting that they tend to develop a balanced immunity without requiring immunosuppressive costimulatory signalling.

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14.

Efeitos da radiação solar crônica prolongada sobre o sistema imunológico de pescadores profissionais em Recife (PE), Brasil
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Bezerra, Sarita Maria de Fátima Martins de Carvalho

; Sotto, Mirian Nakagami

; Orii, Noemia Mie

; Alves, Cleiton

; Duarte, Alberto José da Silva

Anais Brasileiros de Dermatologia

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Abr 2011, Volume 86 Nº 2 Páginas 222 - 233

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

FUNDAMENTOS: Existe um consenso de que a exposição à radiação ultravioleta determina alterações n o sistema imunológico da pele, o que permite que se avente a hipótese de que a exposição prolongada e crônica ao Sol pode representar uma das maiores agressões ambientais à saúde humana. Entre as várias ocupações que requerem, necessariamente, exposição prolongada e crônica ao Sol está a de pescador. No entanto, a experiência clínica dermatológica, amealhada ao longo de vários anos de exercício da Medicina, não parece confirmar essa hipótese. OBJETIVO: Avaliar efeitos clínicos, histológicos e imunológicos da exposição crônica e prolongada à radiação ultravioleta em pescadores. MÉTODOS: Em estudo prospectivo, transversal, observacional, foram caracterizadas lesões dermatológicas, marcadores imunológicos e alterações histológicas de pescadores e subpopulações de linfócitos comparadas a grupo-controle. Empregaram-se testes de Mann-Whitney, exato de Fisher, Wilcoxon em nível de 0,05. RESULTADOS: Houve diferenças entre os grupos exposto e protegido em elastose (p = 0,03), ectasia de vasos dérmicos (p = 0,012) e número de células nas camadas epidérmicas entre os cones (p = 0,029). Foram mais comuns em pescadores CD45RO, CD68+ e mastócitos na pele (p = 0,040, p < 0,001 e p = 0,001); CD3CD8CD45RO no sangue (p = 0,016). CONCLUSÃO: As alterações sugerem que exposição crônica e prolongada ao sol promove tolerância à radiação ultravioleta, protetora da imunossupressão.

BACKGROUND: Among the various occupations which necessarily require long-term and chronic sun exposure is that of a fisherman. However, clinical experience in dermatology earned over several years of medical practice does not seem to confirm this hypothesis. OBJECTIVE: To evaluate clinical, histological and immunological effects of long-term and chronic exposure to ultraviolet radiation in fishermen. METHODS: A prospective, cross-sectional and observational study characterized skin lesions, immunological markers and histological alterations in fishermen, as well as lymphocyte subpopulations compared to a control group. Mann-Whitney, Fisher's and Wilcoxon statistical tests were used at a significance level of 0.05. RESULTS: There were significant differences between the exposed group and the group protected due to elastosis (p = 0.03), ectasia of dermal vessels (p = 0.012) and number of cells in the epidermal layers between cones (p = 0.029). Most common among fishermen were CD45RO, CD68 + and mastocytes in the skin (p = 0.040, p <0.001, p = 0.001) and CD3CD8CD45RO in the blood (p = 0.016). CONCLUSION: The alterations suggest that long-term and chronic sun exposure promotes tolerance to ultraviolet radiation, which protects against immunosuppression.

14225 downloads

15.

Improvement of an HPLC method to determine urinary δ-aminolevulinic acid
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Alves, Atecla Nunciata Lopes

; Sumita, Nairo Massakazu

; Fortini, Alexandre Soriano

; Pacheco Neto, Maurilio

; Mendes, Maria Elizabete

; Duarte, Alberto José da Silva

Jornal Brasileiro de Patologia e Medicina Laboratorial

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Jun 2010, Volume 46 Nº 3 Páginas 171 - 174

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

INTRODUÇÃO E OBJETIVO: A proposta deste estudo foi avaliar e aprimorar uma metodologia de cromatografia líquida de alta eficiência (CLAE)(11, 12), a fim de determinar o ácido δ-aminolevulínico urinário (ALA-U) utilizando volumes reduzidos de amostra. MÉTODO: O método baseia-se na formação de um composto fluorescente e posterior corrida cromatográfica de 15 minutos. RESULTADOS: O método apresentou linearidade, precisão e recuperação adequadas. Os resultados para as amostras de urina testadas foram 1,2 ± 0,9 mg/l (média ± desvio padrão) de ALA-U. CONCLUSÃO: O método foi considerado adequado para análises de rotina de ALA-U.

OBJECTIVE: The purpose of this study was to evaluate and improve a high performance liquid chromatography (HPLC) methodology to determine urinary δ-aminolevulinic acid (ALA-U) with small volumes of sample. METHOD: The method was based on the formation of a fluorescent compound and subsequent 15-minute chromatographic run. RESULTS: The method shows suitable linearity, precision and recovery. Urine samples showed 1.2 ± 0.9 mg/l (media ± standard deviation) of ALA-U. CONCLUSION: The method was considered suitable for the routine analysis of ALA-U.

2681 downloads

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