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Multicomponent physical activity program to prevent body changes and metabolic disturbances associated with antiretroviral therapy and improve quality of life of people living with HIV: a pragmatic trial
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Santos, Elisabete Cristina Morandi dos

; Florindo, Alex Antonio

; Santos, Ardiles Vitor

; Picone, Camila de Melo

; Dias, Túlio Gamio

; Segurado, Aluisio Cotrim

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2021, Volume 76 elocation e2457

Resumo: En | Texto: En | PDF: En

OBJECTIVES: Comprehensive care for people living with human immunodeficiency virus (HIV) (PLH) includes the promotion of healthier habits, including physical activity (PA). This study aimed to describe a multicomponent pragmatic trial protocol to assess the effect of PA in preventing body changes and metabolic disturbances, improving the quality of life of PLH starting antiretroviral therapy (ART) and present cohort characteristics. METHODS: PLH undergoing ART for ≤4 months were recruited for a randomized trial. The intervention comprised three cardiorespiratory and/or strength training sessions per week at the clinic or in public spaces for 6 months under on-site or remote supervision, and educational sessions. Participants’ PA levels, cardiorespiratory fitness, anthropometric measures, strength, flexibility, quality of life, and laboratory monitoring (blood glucose and lipids, CD4 counts) at baseline and post-intervention will be compared. The pragmatic design aims to enable the assessment of intervention effectiveness in real-life conditions. RESULTS: At baseline, our cohort of 38 recently diagnosed patients (mean time since HIV diagnosis and duration of ART were 3 and 2.58 months, respectively) were predominantly male, young, with high schooling and good immune status (median CD4 count=498 cells/mm3). Twenty-two (57.9%) patients reported a PA below the World Health Organization recommendations. We found baseline normal anthropometric measures and metabolic parameters: below-average trunk flexion and elbow extension strength, poor handgrip strength and flexibility, and high quality of life scores in all except the physical domain. CONCLUSIONS: Understanding how effective PA is in preventing body changes and metabolic disturbances, and in improving the quality of PLH starting ART may help establish guidelines to better incorporate PA in HIV care.

https://doi.org/10.6061/clinics/2021/e2457 429 downloads

Twenty years of successful academic outreach at Núcleo de Medicina Tropical (NACE-NUMETROP/USP) in Santarém, Pará
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Said, Renato do Carmo

; Assy, João Guilherme Pontes Lima

; Silva, Kamila Vieira

; Brandão, Alisson dos Santos

; Pinheiro, Olívia Campos

; Esper, Helena Rangel

; Gryschek, Anna Luiza de Fátima Pinho Lins

; Bertolozzi, Maria Rita

; Amato, Valdir Sabbaga

; Boulos, Marcos

; Segurado, Aluísio Augusto Cotrim

; Gryschek, Ronaldo César Borges

; França, Francisco Oscar de Siqueira

Revista da Sociedade Brasileira de Medicina Tropical

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2021, Volume 54 elocation e0404-2020

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1590/0037-8682-0404-2020 184 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.

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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

Incidence and associated factors of type 2 diabetes mellitus onset in the Brazilian HIV/AIDS cohort study
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Cassenote, Alex J.F.

; Grangeiro, Alexandre

; Escuder, Maria M.

; Abe, Jair M.

; Santos, Raul D.

; Segurado, Aluisio C.

Brazilian Journal of Infectious Diseases

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2021, Volume 25 Nº 4 elocation 101608

Resumo: En | Texto: En | PDF: En

ABSTRACT Background: People living with HIV (PLH) under combined antiretroviral therapy (cART) are at risk of developing type 2 diabetes mellitus (T2DM). Objective: We examined the incidence of T2DM, associated factors and mean time to outcome in PLH under cART. Method: Data for this multicenter cohort study were obtained from PLH aged over 18, who started cART in 13 Brazilian sites from 2003 to 2013. Factors associated with incident T2DM were evaluated by Cox multiple regression models. Results: A total of 6724 patients (30,997.93 person-years) were followed from January 2003 to December 2016. A T2DM incidence rate of 17.3/1000 person-years (95%CI 15.8-18.8) was observed. Incidence of isolated hypertriglyceridemia and impaired fasting glucose (IFG) were 84.3 (95%CI 81.1-87.6) and 14.5/1000 person-years (95%CI 13.2-15.9), respectively. Mean time to T2DM onset was 10.5 years (95%CI 10.3-10.6). Variables associated with incident T2DM were age 40-50 [Hazard Ratio (HR) 1.7, 95%CI 1.4-2.1] and ≥ 50 years (HR 2.4, 95%CI 1.9-3.1); obesity (HR 2.1, 95%CI 1.6-2.8); abnormal triglyceride/HDL-cholesterol ratio (HR 1.8, 95%CI 1.51-2.2). IFG predicted T2DM (HR 2.6, 95%CI 1.7-2.5) and occurred on average 3.3 years before diabetes onset. Exposure to stavudine for ≥ 2 years was independently associated with incident T2DM [HR 1.6, 95%CI 1.0-2.2). Conclusion: Brazilian PLH under cART are at significant risk of developing T2DM and share risk factors for diabetes onset with the general population, such as older age, obesity, and having metabolic abnormalities at baseline. Moreover, stavudine use was independently associated with incident T2DM. Identifying PLH at a higher risk of T2DM can help caretakers trigger health promotion and establish specific targets for implementation of preventive measures.

https://doi.org/10.1016/j.bjid.2021.101608 34 downloads

Suspected vertical transmission of Chagas disease caused by DTU TcIV in an infection probably transmitted orally, during anoutbreak in the Brazilian Amazon
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Freitas, Vera Lúcia Teixeira de

; Esper, Helena Rangel

; Nakanishi, Erika Shimoda

; Piotto, Mariana Ramos

; Assy, João Guilherme Pontes Lima

; Berreta, Olívia Campos Pinheiro

; Said, Renato do Carmo

; Segurado, Aluisio Augusto Cotrim

; Carvalho, Noemia Barbosa

; França, Francisco Oscar de Siqueira

; Lopes, Marta Heloísa

Revista do Instituto de Medicina Tropical de São Paulo

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2021, Volume 63 elocation e48

Resumo: En | Texto: En | PDF: En

ABSTRACT This study describes difficulties in the monitoring of a child born during an oral outbreak of Chagas disease, in which there are several indications that the transmission occurred through the congenital route: 1. the mother was in the third trimester of pregnancy when she was infected; 2. She presented high parasitemia at the time of delivery; 3. In both, the mother and her daughter, T. cruzi was classified as DTU TcIV. The parasites were not found in the blood at birth and the infection was detected only three months later in an asymptomatic infant. As the mother and her child live in a highly endemic area, vector transmission could not be excluded during this period.

https://doi.org/10.1590/s1678-9946202163048 210 downloads

Setting up hospital care provision to patients with COVID-19: lessons learnt at a 2400-bed academic tertiary center in São Paulo, Brazil
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Perondi, Beatriz

; Miethke-Morais, Anna

; Montal, Amanda C.

; Harima, Leila

; Segurado, Aluisio C.

Brazilian Journal of Infectious Diseases

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Dez 2020, Volume 24 Nº 6 Páginas 570 - 574

Resumo: En | Texto: En | PDF: En

ABSTRACT As of August 30, 2020, Brazil ranked second among countries with the highest number of COVID-19 cases, with the city of São Paulo as the national epidemic epicenter. Local public healthcare institutions were challenged to respond to a fast-growing hospital demand, reengineering care provision to optimize clinical outcomes and minimize intra-hospital coronavirus infection. In this paper we describe how the largest public hospital complex in Latin America faced this unprecedented burden, managing severe COVID-19 cases while sustaining specialized care to patients with other conditions. In our strategic plan a 900-bed hospital was exclusively designated for COVID-19 care and continuity of care to those not infected with coronavirus ensured in other inpatient facilities. After 152 days, 4241 patients with severe COVID-19 were hospitalized, 70% of whom have already been discharged, whereas the remaining Institutes of the complex successfully maintained high complexity inpatient and urgent/emergency care to non-COVID-19 patients.

https://doi.org/10.1016/j.bjid.2020.09.005 313 downloads

Overcoming barriers to providing comprehensive inpatient care during the COVID-19 pandemic
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Miethke-Morais, Anna

; Perondi, Beatriz

; Harima, Leila

; Montal, Amanda C.

; Baldassare, Renato Madrid

; Moraes, Danielle P.

; Pedroso, Lucila

; Ramos, Marcelo C.A.

; Fusco, Solange R.G.

; Pereira, Antonio José

; Barros-Filho, Tarcísio E.P.

; Bonfá, Eloisa

; Utiyama, Edivaldo M.

; Segurado, Aluisio C.

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2020, Volume 75 elocation e2100

Resumo: En | Texto: En | PDF: En

https://doi.org/10.6061/clinics/2020/e2100 1240 downloads

Hepatitis B viremia in HIV-coinfected individuals under antiretroviral therapy
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Weissmann, Leonardo

; Picone, Camila de Melo

; Gouvêa, Michele Soares Gomes

; Ferreira, Paulo Roberto Abrão

; Viana, Mônica Salum Valverde Borsoi

; Pinho, João Renato Rebello

; Cassenote, Alex Jones Flores

; Segurado, Aluísio Cotrim

Brazilian Journal of Infectious Diseases

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Dez 2019, Volume 23 Nº 6 Páginas 441 - 450

Resumo: En | Texto: En | PDF: En

ABSTRACT Background: Antiretroviral therapy (ART) has decreased AIDS incidence and mortality, rendering comorbidities, such as hepatitis B more relevant for people living with human immunodeficiency virus (HIV). Since antiretroviral drugs may also inhibit hepatitis B virus (HBV) replication, analyzing the impact of ART on management of hepatitis B in this population is important. Objective: To assess HBV viremia among HIV/HBV coinfected individuals on ART and its associated factors. Method: For this cross-sectional study, HIV/HBV-coinfected individuals, aged over 18 years, who were on ART for over six months and receiving care at an outpatient clinic in São Paulo were recruited. Sociodemographic characteristics, information about viral exposure, clinical and laboratory data, including evaluation of liver fibrosis were obtained. Plasma HBV DNA was measured by polymerase chain reaction. Viral genome sequencing was conducted for genotyping and identification of drug resistance-conferring mutations if viral load exceeded 900 IU/mL. Results: Out of 2,946 patients who attended the clinic in 2015, 83 were eligible and 56 evaluated. Plasma HBV DNA was detected in 16 (28.6%) (95% CI: 18.0-41.3%), all on lamivudine and tenofovir treatment. HBV DNA detection was associated with lower education (p = 0.015), higher international normalized ratios (p = 0.045), history of an AIDS-defining illness [OR: 3.43 (95% CI: 1.10-11.50)], and HBeAg detection [OR: 6.60 (95% CI: 1.84-23.6)]. In contrast, a last CD4+ count above 500 cells/mm3 in the year prior to inclusion [OR: 0.18 (95% CI: 0.04-0.71)] and detection of anti-HBe [OR: 0.21 (95% CI: 0.04-0.99)] were negatively associated. Patients with HBV DNA above 900 IU/mL were infected with subgenotypes A1 (n = 3) and D2 (n = 1), and exhibited viral mutations associated with total resistance to lamivudine and partial resistance to entecavir. Conclusions: Despite being on ART, a significant proportion of HIV/HBV-coinfected individuals present HBV viremia. Characterization of factors that are associated with this finding may help professionals provide better management to these patients.

https://doi.org/10.1016/j.bjid.2019.10.002 374 downloads

HIV-infected youths transitioning from pediatric to adult outpatient care in a teaching tertiary care hospital in São Paulo city, Brazil
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Freitas, Angela Carvalho

; Avelino-Silva, Vivian Iida

; Gutierrez, Eliana Battaggia

; Marques, Heloisa Helena de Souza

; Durigon, Giuliana Stravinskas

; Segurado, Aluisio Cotrim

Brazilian Journal of Infectious Diseases

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Out 2019, Volume 23 Nº 5 Páginas 291 - 297

Resumo: En | Texto: En | PDF: En

ABSTRACT Background: HIV-infected children surviving until adulthood have been transitioning to adult outpatient health care service in Brazil since the late 2000's. Deterioration of clinical condition is expected during this period, as reported among youths with non-communicable chronic diseases. Despite their young age, they are long-term hosts of the virus, have prolonged exposure to antiretroviral therapy and have suffered from the social determinants and stigma of HIV infection since early childhood. Objectives: This study aimed to 1) describe demographic and clinical characteristics at the first appointment at adult care service following pediatric care of a cohort of Brazilian youths living with HIV since childhood; and 2) retrospectively address adherence and clinical variables in the last two years of pediatric follow-up. Methods: Descriptive study. Results: 41 consecutive patients referred to adult outpatient care from a pediatric HIV unit were enrolled, median age 19 years, and median lifetime CD4 + nadir 117 cell/mm3; 89% reported previous AIDS-defining conditions. At first laboratory assessment in adult care, only 46% had undetectable (<400 copies/ml) HIV viral load and the median CD4 + count was 250 cell/mm3. Conclusion: Youths living with HIV at the transition from pediatric to adult care had poor treatment adherence, low lifetime CD4 + cell nadir, low CD4 cell count and detectable HIV viral load. Health care providers should closely monitor these adolescents in a youth friendly environment, prepared for open communication about all aspects of their health.

https://doi.org/10.1016/j.bjid.2019.07.004 424 downloads

10.

Who and Where are the University of São Paulo Medical School Graduates?
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Gameiro, Gustavo Rosa

; Koyama, Leonardo Kenji Sakaue

; Cruz, Ana Luisa Ito Baptista da

; Cassenote, Alex Jones Flores

; Guilloux, Aline Gil Alves

; Segurado, Aluísio Augusto Cotrim

; Scheffer, Mário César

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2019, Volume 74 elocation e1147

Resumo: En | Texto: En | PDF: En

OBJECTIVE: To evaluate the impact of a complex-care-based medical school in the context of the Brazilian health care system on students’ career choices. METHODS: This was a retrospective cross-sectional study based on medical regulatory organization records. It included records for 7,419 physicians who graduated from FMUSP. Geographic data were analyzed using Kernel maps, and the statistical analysis was performed with SPSS® version 24.0. A p-value less than 0.05 was considered significant. RESULTS: Of the 7,419 physicians, 68.6% (95% CI 67.5-69.7) were male, and 20.7% (95% CI 19.8%-21.7%) had no medical specialty, compared to 46.4% nationwide. Internal medicine and surgery-based specialties were more popular, accounting for 39.4% (95% CI 38.3%-40.5%) and 16.8% (95% CI 15.5%-17.6%) of our study group, compared to the Brazilian averages of 25.9% and 13.5%. Our graduates also had a higher probability of staying in São Paulo City, especially when born outside the city. CONCLUSION: We believe that FMUSP remains an interesting model for studying the impact of a highly specialized center on the education and career choices of medical students.

https://doi.org/10.6061/clinics/2019/e1147 880 downloads

11.

Zika virus infection among symptomatic patients from two healthcare centers in Sao Paulo State, Brazil: prevalence, clinical characteristics, viral detection in body fluids and serodynamics
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Tozetto-Mendoza, Tania Regina

; Avelino-Silva, Vivian Iida

; Fonseca, Silvia

; Claro, Ingra Morales

; Paula, Anderson Vicente de

; Levin, Anna Sara

; Sabino, Ester Cerdeira

; Mendes-Correa, Maria Cassia

; Figueiredo, Walter Manso

; Felix, Alvina Clara

; Souza, Nathalia C. Santiago

; Costa, Angela Aparecida

; Inenami, Marta

; Silva, Rosangela M. Gasparetto da

; Levi, José Eduardo

; Romano, Camila Malta

; Paranhos-Baccalà, Glaucia

; Segurado, Aluisio Cotrim

; Mayaud, Philippe

Revista do Instituto de Medicina Tropical de São Paulo

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2019, Volume 61 elocation e19

Resumo: En | Texto: En | PDF: En

ABSTRACT Zika virus (ZIKV) clinical presentation and frequency/duration of shedding need further clarification. Symptomatic ZIKV-infected individuals identified in two hospitals in Sao Paulo State, Brazil, were investigated regarding clinical characteristics, shedding in body fluids, and serodynamics. Ninety-four of 235 symptomatic patients (Site A: 58%; Site B: 16%) had Real-Time PCR-confirmed ZIKV infection; fever, headache and gastrointestinal symptoms were less frequent, and rash was more frequent compared to ZIKV-negative patients. Real-Time PCR in serum had worse performance compared to plasma, while urine had the highest sensitivity. Shedding in genital fluids and saliva was rare. IgM positivity was the highest <14 days after the symptoms onset (86%), decreasing >28 days (24%); IgG positivity increased >14 days (96%) remaining positive in 94% of patients >28 days. ZIKV prevalence varied importantly in two neighboring cities during the same transmission season. Urine Real-Time PCR can improve diagnostic sensitivity; serum testing is less useful. Accurate serological tests are needed to improve diagnosis and surveillance.

https://doi.org/10.1590/s1678-9946201961019 2345 downloads

12.

Audiological and electrophysiological alterations in HIV-infected individuals subjected or not to antiretroviral therapy
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Matas, Carla Gentile

; Samelli, Alessandra Giannella

; Magliaro, Fernanda Cristina Leite

; Segurado, Aluisio

Brazilian Journal of Otorhinolaryngology

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Out 2018, Volume 84 Nº 5 Páginas 574 - 582

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

Resumo Introdução: O HIV e as infecções relacionadas a ele podem afetar vários locais do sistema auditivo. O uso de terapia antirretroviral altamente ativa pode causar efeitos colaterais, como ototoxicidade. Assim, não foram estabelecidos padrões consistentes de deficiência auditiva em adultos com HIV/Aids e os problemas que afetam o sistema auditivo dessa população justificam pesquisas futuras. Objetivos: Este estudo teve como objetivo comparar os dados audiológicos e eletrofisiológicos de pacientes HIV positivos com e sem Aids que recebiam terapia antirretroviral altamente ativa com os de indivíduos saudáveis. Método: Estudo transversal com 71 indivíduos (30-48 anos), divididos em grupos: Grupo de Pesquisa I: 16 indivíduos HIV-positivos sem Aids (não recebiam tratamento antirretroviral); Grupo de Pesquisa II: 25 indivíduos HIV-positivos com Aids (recebiam tratamento antirretroviral); Grupo Controle: 30 indivíduos saudáveis. Todos os indivíduos foram testados para limiares de condução aérea de tons puros a 0,25-8 kHz, altas frequências de 9-20 kHz, testes eletrofisiológicos (potencial evocado auditivo de tronco encefálico, potencial evocado auditivo de média latência, potencial cognitivo). Resultados: Os grupos de pesquisa I e II apresentaram limiares auditivos mais elevados em audiometria convencional e nas frequências altas quando comparados com o grupo controle, latência prolongada das ondas I, III, V e interpico I-V em resposta auditiva de tronco encefálico e latência prolongada de P300. Em relação às respostas de latência média, houve uma diminuição na amplitude da onda Pa do Grupo de pesquisa II em comparação com o grupo de pesquisa I. Conclusões: Ambos os grupos com HIV apresentaram limiares auditivos mais elevados quando comparados aos indivíduos saudáveis (o grupo exposto ao tratamento antirretroviral apresentou o pior limiar auditivo) e parecem ter menor velocidade de transmissão neuroelétrica ao longo da via auditiva nas regiões do tronco encefálico, subcortical e cortical.

Abstract Introduction: The Human Immunodeficiency Virus (HIV) and infections related to it can affect multiple sites in the hearing system. The use of High Activity Anti-Retroviral Therapy (HAART) can cause side effects such as ototoxicity. Thus, no consistent patterns of hearing impairment in adults with Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome have been established, and the problems that affect the hearing system of this population warrant further research. Objectives: This study aimed to compare the audiological and electrophysiological data of Human Immunodeficiency Virus-positive patients with and without Acquired Immune Deficiency Syndrome, who were receiving High Activity Anti-Retroviral Therapy, to healthy individuals. Methods: It was a cross-sectional study conducted with 71 subjects (30-48 years old), divided into groups: Research Group I: 16 Human Immunodeficiency Virus-positive individuals without Acquired Immunodeficiency Syndrome (not receiving antiretroviral treatment); Research Group II: 25 Human Immunodeficiency Virus-positive individuals with Acquired Immunodeficiency Syndrome (receiving antiretroviral treatment); Control Group: 30 healthy subjects. All individuals were tested by pure-tone air conduction thresholds at 0.25-8 kHz, extended high frequencies at 9-20 kHz, electrophysiological tests (Auditory Brainstem Response, Middle Latency Responses, Cognitive Potential). Results: Research Group I and Research Group II had higher hearing thresholds in both conventional and high frequency audiometry when compared to the control group, prolonged latency of waves I, III, V and interpeak I-V in Auditory Brainstem Response and prolonged latency of P300 Cognitive Potential. Regarding Middle Latency Responses, there was a decrease in the amplitude of the Pa wave of Research Group II compared to the Research Group I. Conclusions: Both groups with Human Immunodeficiency Virus had higher hearing thresholds when compared to healthy individuals (group exposed to antiretroviral treatment showed the worst hearing threshold) and seemed to have lower neuroelectric transmission speed along the auditory pathway in the brainstem, subcortical and cortical regions.

https://doi.org/10.1016/j.bjorl.2017.07.003 1061 downloads

13.

Potential effect of Zika virus infection on human male fertility?
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Avelino-Silva, Vivian Iida

; Alvarenga, Conrado

; Abreu, Carolina

; Tozetto-Mendoza, Tania Regina

; Canto, Cynthia Liliane Motta do

; Manuli, Erika Regina

; Mendes-Correa, Maria Cassia

; Sabino, Ester Cerdeira

; Figueiredo, Walter Manso

; Segurado, Aluísio Cotrim

; Mayaud, Philippe

Revista do Instituto de Medicina Tropical de São Paulo

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2018, Volume 60 elocation e64

Resumo: En | Texto: En | PDF: En

ABSTRACT Background: Zika virus (ZIKV) sexual transmission and prolonged viral shedding in semen have been previously reported, suggesting a strong viral affinity for genital tissues. A transient impact of ZIKV on male fertility was shown in animal and human studies. Methods: Adult male patients with confirmed ZIKV infection diagnosed in the city of Araraquara, Brazil during the epidemic season of 2016 were invited one year after the acute infection to respond to a questionnaire of genital symptoms and to provide a semen sample for molecular ZIKV testing and spermogram analysis, as well as a serum sample for hormonal testing. Results: 101 of 187 tested patients had positive ZIKV RT-PCR in plasma and/or urine samples (54%, 72 women and 29 men). Of 15 adult male participants for whom telephone contact was successful, 14 responded to the questionnaire of genital symptoms and six consented to provide a semen sample at a median of 12 months after the acute infection. We report abnormal spermogram results from patients one year after confirmed ZIKV infection. Conclusions: Our findings suggest a possible long-term detrimental effect of ZIKV infection on human male fertility that has to be further explored in well-characterized samples from cohort studies conducted in ZIKV-endemic areas.

https://doi.org/10.1590/s1678-9946201860064 1758 downloads

14.

Long-term virologic and immunologic responses on darunavir/ritonavir - containing regimens among highly antiretroviral therapy-experienced patients: 7-year follow-up of a prospective cohort study in São Paulo, Brazil
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Vidal, José E.

; Santos, Ariane M.R. dos

; Miranda, Érique J.F. Peixoto de

; Segurado, Aluísio C.

Brazilian Journal of Infectious Diseases

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Dez 2017, Volume 21 Nº 6 Páginas 680 - 681

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1016/j.bjid.2017.07.005 391 downloads

15.

Brazilian infectious diseases specialists: who and where are they?
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Cassenote, Alex Jones Flores

; Scheffer, Mario César

; Segurado, Aluísio Augusto Cotrim

Brazilian Journal of Infectious Diseases

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Abr 2016, Volume 20 Nº 2 Páginas 141 - 148

Resumo: En | Texto: En | PDF: En

Abstract Background The infectious diseases specialist is a medical doctor dedicated to the management of infectious diseases in their individual and collective dimensions. Objectives The aim of this paper was to evaluate the current profile and distribution of infectious diseases specialists in Brazil. Methods This is a cross-sectional study using secondary data obtained from institutions that register medical specialists in Brazil. Variables of interest included gender, age, type of medical school (public or private) the specialist graduated from, time since finishing residency training in infectious diseases, and the interval between M.D. graduation and residency completion. Maps are used to study the geographical distribution of infectious diseases specialists. Results A total of 3229 infectious diseases specialist registries were counted, with 94.3% (3045) of individual counts (heads) represented by primary registries. The mean age was 43.3 years (SD 10.5), and a higher proportion of females was observed (57%; 95% CI 55.3–58.8). Most Brazilian infectious diseases specialists (58.5%) practice in the Southeastern region. However, when distribution rates were calculated, several states exhibited high concentration of infectious diseases specialists, when compared to the national rate (16.06). Interestingly, among specialists working in the Northeastern region, those trained locally had completed their residency programs more recently (8.7 yrs; 95% CI 7.9–9.5) than physicians trained elsewhere in the country (13.6 yrs: 95% CI 11.8–15.5). Conclusion Our study shows that Brazilian infectious diseases specialists are predominantly young and female doctors. Most have concluded a medical residency training program. The absolute majority practice in the Southeastern region. However, some states from the Northern, Northeastern and Southeastern regions exhibit specialist rates above the national average. In these areas, nonetheless, there is a strong concentration of infectious diseases specialists in state capitals and in metropolitan areas.

https://doi.org/10.1016/j.bjid.2015.10.009 1787 downloads

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