2023.2
1 - The aorta at the center. J Vasc Bras. 2023 Sep 4;22:e20230089. doi: 10.1590/1677-5449.202300892.
Brito-Queiroz A(1), Mulatti GC(2), Dos Santos VP(3).
Afiliação
(1) Universidade Federal da Bahia, Hospital Ana Nery, Centro de Doenças da Aorta, Salvador, BA, Brasil.
(2) Universidade de São Paulo, Hospital das Clínicas, Departamento de Cirurgia Vascular Endovascular, São Paulo, SP, Brasil.
(3) Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Departamento de Anestesiologia e Cirurgia, Salvador, BA, Brasil.
Medical progress and the huge accumulated volume of knowledge and techniques prompted the creation of medical specialties and the division of medicine into different areas, which is also the case of the surgical specialties. To a certain extent, this subdivision is even more extreme with regard to aortic surgery. Surgeons who have very different training, experience, and skills learn to manage the same vessel, but in different anatomic regions. Routinely, cardiac surgeons are more accustomed to dealing with the aortic root and the ascending aorta, for which a sternotomy is the most common approach. In turn, vascular surgeons have greater expertise with the descending thoracic aorta and abdominal aorta, where endovascular techniques constitute the main strategy. Endovascular techniques for all segments of the aorta have developed rapidly and the state of the art in radiology, anesthesiology, intensive care, genetics, and cardiology has advanced apace. Vascular surgery has undergone major changes over recent years, with the rapid rise of endovascular techniques. At the end of the 1980s and start of the 90s, vascular surgeons all over the world were responsible for some of the most important developments ever achieved in aortic surgery. Parodi, in Argentina, and Volodos, in Ukraine, were responsible for founding the principles of endovascular aortic surgery, constructing the first endografts by hand.1,2 The same principles that were initially employed in cases with favorable anatomy in the descending thoracic aorta and infrarenal aorta were then applied over the years that followed to treat practically any segment of the aorta, from the root to its bifurcation into the iliac arteries. However, the division of the aorta into ascending and descending segments and division of the professionals who work on each segment is arbitrary and it is not rare for diseases to fail to “respect” this segmentation, involving more than one region or areas where the expertise of different specialties intersects. The best example of this is the diseases that involve the aortic arch. The aortic arch is a transition zone between the ascending aorta and the thoracic descending aorta. The Stanford classification of aortic dissections is the most widely used worldwide and was first described in 1970. It classifies dissections involving the ascending aorta as type A and dissections restricted to the descending aorta after the origin of the left subclavian artery as type B.3 This left a gap in the medical literature on aortic surgery that persisted for years.4 This gap is not merely theoretical. Since this is a complex region that has not been entirely mastered by heart surgery, by vascular surgery, or by endovascular surgery, it is an area that was neglected for some time. In many parts of the world, vascular surgeons and heart surgeons work on opposite sides, each seeking solutions for the aortic arch alone, and also for many other situations in which diseases of the aorta involve many segments, demanding a wider and more complementary approach. Examples of the importance of a multidisciplinary approach to the aorta are type A dissections that cause remote ischemia. In up to 40% of type A dissection cases there is also malperfusion of organs, causing an important increase in mortality among these patients. Some groups now start by treating the ischemia, dealing with the ascending aorta in a later intervention. Involving the vascular surgery team from the initial management of these cases and taking a case-by-case approach is therefore essential to provide the best possible care for these patients.5 In 2019 the European Society for Vascular Surgery and the European Association for Cardio-Thoracic Surgery published a consensus setting out the principal guidelines for diseases of the aorta involving the aortic arch. The first three recommendations were as follows: decision making by an aortic team is recommended; centralization of care is recommended; and treatment of elective cases is recommended to be performed in specialized centers providing open and endovascular, cardiac and vascular surgery at a single center.6 The importance of collaboration within a team that includes vascular surgeons, cardiac surgeons, cardiologists, radiologists, anesthetists, intensive care specialists, and, when necessary, rheumatologists, nephrologists, and geneticists would appear to be evident. The literature shows that the individual experience of the surgeon and, primarily, the institution has a positive impact on patient outcomes and many authors have demonstrated improvement of results after implementation of centers dedicated to diseases of the aorta.7,8 In Brazil, experience with these models is limited and implementation involves changes that are not restricted to logistic and structural issues in hospitals or operating rooms. The most important change in this setting is cultural. For many years, there was limited dialog and interaction between surgeons and clinicians, and also between cardiac and vascular surgeons. For a long period, the aortic arch was neglected by many groups, but it has now been recognized as a bridge linking the two specialties. Without doubt, the surgeons and specialists who work in these teams and centers for treatment of the aorta will be involved in the next round of developments in surgery for this artery. Care must be based not only on anatomy, but also on collaboration, seeking solutions for diseases that are almost always complex and severe. Consolidation of these models will only be achieved through flexibility in decision-making, laying pride aside, and with dialog, modernization, and the understanding that care cannot be centralized in a specialist or a specialty, but that the aorta and the patient must be at the center of care.
2 - Regulatory T cells control Staphylococcus aureus and disease severity of cutaneous leishmaniasis. J Exp Med. 2023 Dec 4;220(12):e20230558. doi: 10.1084/jem.20230558.
Singh TP(1)(2), Farias Amorim C(1), Lovins VM(2), Bradley CW(1), Carvalho LP(3)(4), Carvalho EM(3)(4), Grice EA(2), Scott P(1).
Afiliação
(1) Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA.
(2) Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
(3) Servico de Imunologia, Complexo Hospitalar Universitario Professor Edgard Santos, Universidade Federal da Bahia , Salvador, Brazil.
(4) Laboratorio de Pesquisas Clinicas do Instituto de Pesquisas Goncalo Moniz, Fiocruz Salvador, Brazil.
Resumo
Cutaneous leishmaniasis causes alterations in the skin microbiota, leading to pathologic immune responses and delayed healing. However, it is not known how these microbiota-driven immune responses are regulated. Here, we report that depletion of Foxp3+ regulatory T cells (Tregs) in Staphylococcus aureus-colonized mice resulted in less IL-17 and an IFN-γ-dependent skin inflammation with impaired S. aureus immunity. Similarly, reducing Tregs in S. aureus-colonized and Leishmania braziliensis-infected mice increased IFN-γ, S. aureus, and disease severity. Importantly, analysis of lesions from L. braziliensis patients revealed that low FOXP3 gene expression is associated with high IFNG expression, S. aureus burden, and delayed lesion resolution compared to patients with high FOXP3 expression. Thus, we found a critical role for Tregs in regulating the balance between IL-17 and IFN-γ in the skin, which influences both bacterial burden and disease. These results have clinical ramifications for cutaneous leishmaniasis and other skin diseases associated with a dysregulated microbiome when Tregs are limited or dysfunctional.
3 - Diagnosis and treatment of eating disorders in children and adolescents. J Pediatr (Rio J). 2023 Dec 26:S0021-7557(23)00155-9. doi: 10.1016/j.jped.2023.12.001.
Robatto AP(1), Magalhães Cunha C(1), Moreira LAC(2).
Afiliação
(1) Universidade Federal da Bahia, Faculdade de Medicina, Departamento de Pediatria, Salvador, BA, Brazil.
(2) Ambulatório de Transtornos Alimentares do C- HUPES (ATAH), Departamento de Pediatria, Salvador, BA, Brazil. Electronic address: luizacabus@hotmail.com.
Resumo
OBJECTIVES: To provide a narrative review of the main eating disorders (ED), specifically focusing on children and adolescents. This review also aims to help the pediatrician identify, diagnose, and refer children and adolescents affected by this medical condition and inform them about the multidisciplinary treatment applied to these disorders. DATA SOURCE: The research was conducted in the Scientific Electronic Library Online (SciELO), Medical Literature Analysis and Retrieval System Online (Medline) databases via PubMed and Embase. Consolidated Guidelines and Guidebooks in the area were also included in the review to support the discussion of ED treatment in childhood and adolescence. DATA SYNTHESIS: ED are psychiatric condition that usually begins in adolescence or young adulthood but can occur at any time of life, including in childhood, which has been increasingly frequent. Pediatricians are the first professionals to deal with the problem and, therefore, must be well trained in identifying and managing these disorders, which can be severe, and determine physical complications and quality of life of patients and their families. CONCLUSION: ED has shown an increase in prevalence, as well as a reduction in the age of diagnosed patients, requiring adequate detection and referral by pediatricians. The treatment requires a specialized multidisciplinary team and is generally long-lasting for adequate recovery of affected individuals.
4 - Food packaging and endocrine disruptors. J Pediatr (Rio J). 2023 Oct 29:S0021-7557(23)00126-2. doi: 10.1016/j.jped.2023.09.010.
de Paula LCP(1), Alves C(2).
Afiliação
(1) Hospital de Clínicas da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Residência de Endocrinologia e Endocrinologia Pediátrica, Porto Alegre, RS, Brazil.
(2) Universidade Federal da Bahia, Faculdade de Medicina, Hospital Universitário Prof. Edgard Santos, Serviço de Endocrinologia Pediátrica, Salvador, BA, Brazil.
Resumo
OBJECTIVES: Narrative review evaluating food contamination by endocrine disruptors present in food packaging. DATA SOURCE: The terms "endocrine disruptors" and "food packaging" were used in combination in the PubMed, MEDLINE and SciELO databases, evaluating studies, in humans, published in Portuguese, English, French and Spanish between 1990 and 2023. DATA SYNTHESIS: Packaging, especially those made from plastic or recycled material, is an important source of food contamination by endocrine disruptors. Bisphenols and phthalates are the endocrine disruptors most frequently associated with food contamination from packaging. However, many unknown substances and even those legally authorized can cause harm to health when exposure is prolonged or when substances with additive effects are mixed. Furthermore, the discarding of packaging can cause contamination to continue into the environment. CONCLUSION: Although packaging materials are essential for the transport and storage of food, many of them are associated with chemical contamination. As it is not possible to exclude them from our routine, it is important to develop research aimed at identifying the endocrine disruptors present in them, including the effects of chronic exposure; and that regulatory agencies and industry come together to reduce or prevent this risk. Additionally, consumers must be instructed on how to purchase products, handle them and prepare them to reduce the migration of chemical substances into food.
5- Validation of the hospital resources assessment scale for the preservation of urinary continence in the elderly. Rev Bras Enferm. 2023 Nov 27;76(5):e20220805. doi: 10.1590/0034-7167-2022-0805.
Góes RP(1), Pedreira LC(1), Tavares JPA(2), Oliveira SDS(1), Souza EO(1)(3), Santos FCD(1)(4).
Afiliação
(1) Universidade Federal da Bahia. Salvador, Bahia, Brazil.
(2) Universidade de Aveiro. Aveiro, Portugal.
(3) Universidade do Estado da Bahia. Salvador, Bahia, Brazil.
(4) Empresa Brazileira de Servicos Hospitalares, Hospital Universitário Professor Edgard Santos. Salvador, Bahia, Brazil.
Resumo
OBJECTIVES: to validate the internal structure of the Hospital Resources Assessment Scale for the Preservation of Urinary Continence in the Elderly. METHODS: validation study of the internal structure of a scale constructed based on the Donabedian conceptual model and an integrative review, with prior content validation. The scale was applied to the target population, and 124 nurses responded to the questionnaire. Exploratory Factor Analysis was performed using the FACTOR software, employing multiple techniques. RESULTS: a factorial model with 11 items organized into two dimensions (support for human resources and material resources) was obtained. The "physical structure" dimension was removed from the initial model and adopted as a complementary checklist to the instrument, as it was not possible to obtain a factorable model with this dimension. CONCLUSIONS: we provide a valid scale that can measure indicators, identifying weaknesses and/or strengths related to hospital resources for the preservation of urinary continence in the elderly.
6 - Genetic Ancestry, Race, and Severity of Acutely Decompensated Cirrhosis in Latin America. Gastroenterology. 2023 Sep;165(3):696-716. doi: 10.1053/j.gastro.2023.05.
Farias AQ(1), Curto Vilalta A(2), Momoyo Zitelli P(1), Pereira G(3), Goncalves LL(4), Torre A(5), Diaz JM(6), Gadano AC(7), Mattos AZ(8), Mendes LSC(9), Alvares-da-Silva MR(10), Bittencourt PL(11), Benitez C(12), Couto CA(13), Mendizabal M(14), Toledo CL(15), Mazo DFC(16), Castillo Barradas M(17), Uson Raposo EM(2), Padilla-Machaca PM(18), Zarela Lozano Miranda A(19), Malé-Velázquez R(20), Castro Lyra A(21), Dávalos-Moscol MB(22), et al.; ACLARA Study Collaborators.
Afiliação
(1) The Department of Gastroenterology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.
(2) European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain.
(3) Gastroenterology and Hepatology Unit, Bonsucesso Federal Hospital, Ministry of Health, Rio de Janeiro, Brazil; Estácio de Sá University, School of Medicine, Rio de Janeiro, Brazil.
(4) Gastroenterology and Hepatology Unit, Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil.
(5) Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán," Mexico City, Mexico.
(6) European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain; Liver Unit and Department of Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
(7) Liver Unit and Department of Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
(8) Federal University of Health Sciences of Porto Alegre, and Gastroenterology and Hepatology Unit, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil.
(9) Hospital de Base do Distrito Federal, Brasilia, Brazil.
(10) Gastrointestinal and Liver Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
(11) Hospital Português da Bahia, Salvador, Brazil.
(12) Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
(13) Instituto Alfa de Gastroenterologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
(14) Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina.
(15) Universidad Austral de Chile, Hospital Valdivia, Valdivia, Chile.
(16) Division of Gastroenterology, University of Campinas, Campinas, Brazil.
(17) Servicio de Gastroenterología y Hepatología, Hospital de Especialidades Centro Médico Nacional La Raza Instituto Mexicano del Seguro Social, Mexico City, Mexico.
(18) Hospital Nacional Guillermo Almenara, and Universidad Nacional de San Marcos, Lima, Peru.
(19) Unidad de Hígado, Hospital Nacional Arzobispo Loayza, Lima, Peru.
(20) Instituto de Salud Digestiva y Hepática, Guadalajara, Mexico.
(21) Hospital Universtário Professor Edgard Santos, Salvador, Brazil; Hospital São Rafael, Salvador, Brazil.
(22) Hospital Nacional Edgardo Rebagliati Martins-EsSalud, Lima, Peru.
Resumo
BACKGROUND & AIMS: Genetic ancestry or racial differences in health outcomes exist in diseases associated with systemic inflammation (eg, COVID-19). This study aimed to investigate the association of genetic ancestry and race with acute-on-chronic liver failure (ACLF), which is characterized by acute systemic inflammation, multi-organ failure, and high risk of short-term death. METHODS: This prospective cohort study analyzed a comprehensive set of data, including genetic ancestry and race among several others, in 1274 patients with acutely decompensated cirrhosis who were nonelectively admitted to 44 hospitals from 7 Latin American countries. RESULTS: Three hundred ninety-five patients (31.0%) had ACLF of any grade at enrollment. Patients with ACLF had a higher median percentage of Native American genetic ancestry and lower median percentage of European ancestry than patients without ACLF (22.6% vs 12.9% and 53.4% vs 59.6%, respectively). The median percentage of African genetic ancestry was low among patients with ACLF and among those without ACLF. In terms of race, a higher percentage of patients with ACLF than patients without ACLF were Native American and a lower percentage of patients with ACLF than patients without ACLF were European American or African American. In multivariable analyses that adjusted for differences in sociodemographic and clinical characteristics, the odds ratio for ACLF at enrollment was 1.08 (95% CI, 1.03-1.13) with Native American genetic ancestry and 2.57 (95% CI, 1.84-3.58) for Native American race vs European American race CONCLUSIONS: In a large cohort of Latin American patients with acutely decompensated cirrhosis, increasing percentages of Native American ancestry and Native American race were factors independently associated with ACLF at enrollment.
7 - Clinical presentation, causative drugs and outcome of patients with autoimmune features in two prospective DILI registries. Liver Int. 2023 Aug;43(8):1749-1760. doi: 10.1111/liv.15623.
García-Cortés M(1)(2), Ortega-Alonso A(1)(2), Matilla-Cabello G(1), Medina-Cáliz I(1), Castiella A(3)(4), Conde I(5), Bonilla-Toyos E(1)(6), Pinazo-Bandera J(1), Hernández N(7), Tagle M(8), Nunes V(9), Parana R(10), Bessone F(11), Kaplowitz N(12), Lucena MI(1)(2)(6), Alvarez-Alvarez I(1)(2)(6), Robles-Díaz M(1)(2), Andrade RJ(1)(2).
Afiliação
(1) Servicios de Aparato Digestivo and Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Universidad de Málaga, Málaga, Spain.
(2) Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
(3) Servicio de Gastroenterología, Hospital Universitario de Donostia, San Sebastián, Spain.
(4) Servicio de Gastroenterología, Hospital de Mendaro, Mendaro, Spain.
(5) Servicio de Aparato Digestivo, Hospital Universitari i Politècnic La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
(6) Platform ISCIII for Clinical Research and Clinical Trials UICEC-IBIMA, Málaga, Spain.
(7) Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
(8) Universidad Peruana Cayetano Heredia, Lima, Peru.
(9) Hospital Universitario Prof. Edgard Santos, Salvador de Bahia, Brazil. Universidad Federal de Bahia, Bahia, Brazil.
(10) Hospital Provincial del Centenario, Facultad de Medicina, Universidad Nacional de Rosario, Rosario, Argentina.
(11) University of Southern California Research Center for Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Resumo
BACKGROUND & AIMS: Idiosyncratic drug-induced liver injury (DILI) with autoimmune features is a liver condition with laboratory and histological characteristics similar to those of idiopathic autoimmune hepatitis (AIH), which despite being increasingly reported, remains largely undefined. We aimed to describe in-depth the features of this entity in a large series of patients from two prospective DILI registries. METHODS: DILI cases with autoimmune features collected in the Spanish DILI Registry and the Latin American DILI Network were compared with DILI patients without autoimmune features and with an independent cohort of patients with AIH. RESULTS: Out of 1,426 patients with DILI, 33 cases with autoimmune features were identified. Female sex was more frequent in AIH patients than in the other groups (p = .001). DILI cases with autoimmune features had significantly longer time to onset (p < .001) and resolution time (p = .004) than those without autoimmune features. Interestingly, DILI patients with autoimmune features who relapsed exhibited significantly higher total bilirubin and transaminases at onset and absence of peripheral eosinophilia than those who did not relapse. The likelihood of relapse increased over time, from 17% at 6 months to 50% 4 years after biochemical normalization. Statins, nitrofurantoin and minocycline were the drugs most frequently associated with this phenotype. CONCLUSIONS: DILI with autoimmune features shows different clinical features than DILI patients lacking characteristics of autoimmunity. Higher transaminases and total bilirubin values with no eosinophilia at presentation increase the likelihood of relapse in DILI with autoimmune features. As the tendency to relapse increases over time, these patients will require long-term follow-up.
8 - Challenges in Assessing Stroke Incidence in Low- and Middle-Income Countries. J Am Heart Assoc. 2023 Sep 5;12(17):e031292. doi: 10.1161/JAHA.123.031292.
Oliveira-Filho J(1).
Afiliação
(1) Hospital Universitario Professor Edgard Santos, Universidade Federal da Bahia Salvador Brazil.
Resumo
Stroke affects an estimated 77 million individuals per year globally. 1 Despite advances in stroke prevention and a decrease in age‐adjusted stroke incidence in the past decade, the burden of this deadly disease is unevenly distributed, affecting more frequently and severely low‐ and middle‐income countries. 1 The first step in studying the determinants of a disease is knowing its incidence, but access to quality data on stroke occurrence is often scarce in low‐resource settings. Data from these regions are therefore welcome. In the study published in this issue of Journal of the American Heart Association (JAHA) by Núñez et al, 2 the authors underwent a careful search for high‐quality data focused on stroke incidence over time in Latin America and the Caribbean (LAC). The main findings were an increase in stroke incidence over time in young individuals (aged <55 years), especially in women, whereas in older individuals (aged >55 years) stroke incidence decreased over time. The findings were robust across different regions of LAC and seemed to diverge even more when comparing ages <45 with >45 years. Although the reasons for this apparent dichotomy are unknown, the results should at least inform decision makers that renewed efforts for stroke prevention are needed tailored to a younger population. Both the message (in which risk factors are more important for the young) and the mode of delivery (social media, applications) probably require new strategies. Other studies have focused on determinants of cardiovascular health globally. In the Global Burden of Disease Study of 7.86 million stroke events, the global incidence of stroke was 81.72 per 100 000 person‐years in 2020. 1 In the study by Núñez et al, 2 stroke incidence showed wide variations between regions of LAC, and in all but 1 of the extracted studies stroke incidence rates were higher, varying from 81.8 to 185.8 per 100 000 person‐years. Determinants of this higher stroke incidence probably reflect issues such as access to medical care, access to free or subsidized medications, and socioeconomic status. In a large case‐control study of 13 447 stroke victims and 13 472 controls, 90% of stroke burden was attributable to modifiable risk factors such as hypertension, diabetes, smoking, alcohol use, physical activity, obesity, and dyslipidemia. 3 Psychosocial factors were independently associated with a 2.2‐fold increased stroke risk. All of these factors are expected to be worse in low‐income settings, but the relative contribution of each factor is unknown. In the study by Núñez et al, 2 a strong effect of age was seen on relative temporal trend ratios. Why did younger patients suffer from increasing stroke incidence, whereas older patients showed the opposite trend? Young patients are particularly susceptible to drug abuse (tobacco, alcohol, and illicit drugs), which has been steadily increasing in LAC regions. 4 , 5 , 6 In a meta‐analysis of 25 studies in LAC, tobacco use was inversely related with income, in which middle‐income individuals had a 1.23‐fold increased tobacco use and low‐income individuals had a 1.62‐fold increased tobacco use when compared with high‐income individuals. 4 Adherence to cerebrovascular risk factor prevention is also worse in younger versus older individuals. In a survey of 2761 households in 3 Latin American countries, individuals aged >65 years were 5 times more likely to seek medical attention when compared with younger patients with chronic health conditions. 7 The study by Núñez et al 2 has limitations. Although most of the LAC population lives in low‐income areas, all of the reviewed studies were carried out in upper‐middle‐ or high‐income countries, which probably reflects a higher investment in research in higher‐income regions. Thus, generalizability to lower resource‐settings is not ideal, although one might expect the effects of age and sex to be magnified in these regions. The challenges for future studies of stroke incidence and its predictors are enormous in LAC but are urgently needed. Local governments should invest time and resources to tackle this global epidemic if future generations are likely to lead healthy and productive lives.
9 - Long-term outcomes of highly experienced people with HIV undergoing salvage therapy with raltegravir. Medicine (Baltimore). 2023 Oct 6;102(40):e35407. doi: 10.1097/MD.0000000000035407.
Patiño Escarcina JE(1), Netto EM(2), Brites C(1)(2).
Afiliação
(1) Faculty of Medicine, Federal University of Bahia, Salvador, Brazil.
(2) LAPI - Infectious Disease Research Laboratory, Complexo Hospitalar Universitário Profesor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.
Resumo
Raltegravir and other third-line drugs have shown promise in improving outcomes in treatment-experienced patients. However, the efficacy and tolerability of these agents vary. This study assessed real-life virologic success, long-term survival, and adverse events in patients receiving raltegravir or other third-line drugs as salvage regimens. This retrospective cohort study included adults who experienced treatment failure (human immunodeficiency syndrome-1 RNA plasma viral load >1000 copies/mL) and subsequently initiated raltegravir or other third-line drugs (darunavir/ritonavir, maraviroc, or etravirine). Propensity score matching methods were employed to account for differences at the time of switching from failing antiretroviral therapy regimens. The matched subset was analyzed using the Kaplan-Meier method and Generalized Wilcoxon tests to evaluate the probability of achieving virologic suppression (plasma viral load <50 copies/mL). Mortality rates, toxicity, treatment interruption, virologic failure, and loss to follow-up were determined using Poisson regression. One hundred and sixty-eight patients initiating salvage regimens were included, with 123 receiving raltegravir and 45 other third-line drugs. Propensity score matching resulted in a subset of 90 patients, 45 in each group. During the follow-up period, there were no significant differences observed between the groups in terms of virologic suppression (77.8% vs 82.2%, P = .73), mortality rates (4.04 vs 6.18 persons per 100 person-years [p-y]; P = .67), drug toxicity (0.00 vs 2.06 persons per 100 p-y; P = .49), treatment interruption (8.07 vs 0.00 persons per 100 p-y; P = .06), virologic failure (2.02 vs 4.12 persons per 100 p-y; P = .61), and loss of follow-up (6.05 vs 4.12 persons per 100 p-y; P = .70). Our findings indicate comparable survival and virological success rates between raltegravir and other drugs used in salvage regimens. Similar rates of drug toxicity, treatment interruption, virologic failure, and loss of follow-up were also observed. These results suggest that raltegravir may be a viable option for salvage therapy, demonstrating outcomes comparable to other third-line drugs in real life.
10 - Subclinical neural hearing alterations in school children with type 1 diabetes mellitus. Acta Otorrinolaringol Esp (Engl Ed). 2023 Nov-Dec;74(6):365-371. doi: 10.1016/j.otoeng.2023.04.001.
Braite N(1), da Cruz Fernandes L(2), Rissatto Lago MR(3), de Andrade CLO(3), Alves CAD(4).
Afiliação
(1) Department of Life Science, State University of Bahia, Salvador, Bahia, Brazil. Electronic.
(2) Department of Speech Therapy, Institute of Health Sciences, Federal University of Bahia, Salvador, Bahia, Brazil.
(3) Department of Life Science, State University of Bahia, Salvador, Bahia, Brazil.
(4) Pediatric Endocrinology Unit, University Hospital Prof. Edgard Santos, Federal University of Bahia, Salvador, Bahia, Brazil.
Resumo
BACKGROUND AND OBJECTIVES: Evidence has shown a cause-and-effect relationship between type 1 diabetes mellitus and auditory and cognitive dysfunctions. This study aimed to investigate the effect of type 1 diabetes mellitus (T1DM) on central auditory and cognitive functions in school-age children and adolescents. METHODS: The study sample consisted of 101 children and adolescents, 50 with T1DM, of both sexes, aged between 7 and 18 years. All participants were selected for a structured interview on hearing, behavioral, and cognitive health and assessment of brainstem auditory evoked potentials (BAEP) and event-related potentials (P300). RESULTS: Significant differences were observed in memory (p=0.002) and attention (p=0.021) complaints between participants with and without T1DM. In the BAEP responses, there were differences between wave III latencies in the right (p=0.017) and left (p=0.019) ears and in wave V latencies in the left ear (p=0.001) between the evaluated groups. In addition, there was an association between BAEP findings and metabolic control in the T1DM group in the left ear in waves III (p=0.006) and V (p=0.005) and in the right ear in wave V (p=0.026). No differences were observed in the latencies of P300 between the evaluated groups. CONCLUSION: This study demonstrated the existence of a subclinical finding in the central auditory pathway, offering an increased risk for retrocollear alterations, which may be a consequence of poor metabolic control.
11 - COVID-19 in multiple myeloma patients: frequencies and risk factors for hospitalization, ventilatory support, intensive care admission and mortality -cooperative registry from the Grupo Brasileiro de Mieloma Multiplo (GBRAM). Hematol Transfus Cell Ther. 2023 Sep 13:S2531-1379(23)00171-2. doi: 10.1016/j.htct.2023.08.002.
Garnica M(1), Crusoe EQ(2), Ribeiro G(3), Bittencourt R(4), Magalhães RJP(5), Zanella KR(6), Hallack Neto AE(7), Lima JS(8), Solo CB(9), Souza EG(3), Fernandes AM(10), Maiolino A(11), Hungria V(12).
Afiliação
(1) Universidade Federal do Rio de Janeiro (UFRJ), Brazil; Tranplant Unit, Complexo Hospitalar de Niterói (DASA - CHN), Brazil.
(2) Hospital Universitário Professor Edgar Santos (HUPES), Universidade Federal da Bahia, razil.
(3) Universidade Federal de Minas Gerais, Brazil.
(4) Universidade federal do Rio Grande do Sul, Brazil.
(5) Universidade Federal do Rio de Janeiro (UFRJ), Brazil.
(6) Clinica Viver- CEPHON, Florianópolis, Brazil.
(7) Universidade Federal de Juiz de Fora, Brazil.
(8) IHOC/Curitiba, Curitiba, Brazil.
(9) HC - UFPR, Curitiba, Brazil.
(10) Clinica CEHON- Juazeiro, Brazil.
(11) Universidade Federal do Rio de Janeiro (UFRJ), Brazil; Américas Centro de Oncologia Integrado, Brazil.
(12) Hematology, Santa Casa Medical School, Brazil; São Germano Clinic, Brazil.
Resumo
INTRODUCTION: This study evaluated outcomes and risk factors for COVID-19 in 91 Brazilian multiple myeloma (MM) patients between April 2020 and January 2022. RESULTS: Of the 91 MM patients diagnosed with COVID-19, 64% had comorbidities and 66% required hospitalization due to COVID-19, with 44% needing ventilatory support and 37% intensive care. Age (OR 2.02; 95%CI 1.02 - 7.7) and hypertension OR 4.5; 95%CI 1.3 - 15.5) were independently associated with hospitalization and certain MM therapies (corticosteroids and monoclonal drugs) were associated with ventilatory support (OR 4.3; 95%CI 1.3 - 14 and OR 5.7; 95%CI 1.8 - 18, respectively), while corticosteroids and immunomodulatory drugs were linked to ICU admission (OR 5.1; 95% CI 1.4 - 18 and OR 3.4; 95%CI 1.1 - 10, respectively). The overall mortality rate was 30%, with the highest rate observed in the ICU (73%). Additionally, the ECOG performance status was linked to increased mortality (OR 11.5; 95%CI 1.9 - 69). The MM treatment was delayed in 63% of patients who recovered from COVID-19. CONCLUSIONS: The findings highlight the need for preventing COVID-19 and prioritizing vaccination among MM patients, as they have high rates of severe outcomes in the event of COVID-19. It is also essential to monitor the potential clinical impacts of COVID-19 on MM patients in the long-term. Given the limited resources available in treating MM patients in Brazil during the COVID-19 pandemic, outcomes might be worse in this population.
12 - Prevalence of subclinical systolic dysfunction in Takayasu's arteritis and its association with disease activity: a cross-sectional study. Adv Rheumatol. 2023 Aug 18;63(1):41. doi: 10.1186/s42358-023-00322-2.
de Lourdes Castro de Oliveira Figueirôa M(1), Costa MCM(2), Costa MCM(2), Lobo PR(3), Sanches LV(3), Martins KMA(3), Sousa APMD(4), Pedreira ALS(4), Barreto Santiago M(4).
Afiliação
(1) Department of Rheumatology, Prof. Edgard Santos University Hospital/UFBA, Salvador, Rua Dr. Augusto Viana, s/n - Canela, BA, 40110-060, Brazil.
(2) Department of Internal Medicine, Prof. Edgard Santos University Hospital/UFBA, Salvador, Brazil.
(3) Department of Echocardiography, Prof. Edgard Santos University Hospital/UFBA, Salvador, Brazil.
(4) Department of Rheumatology, Prof. Edgard Santos University Hospital/UFBA, Salvador, Rua Dr. Augusto Viana, s/n - Canela, BA, 40110-060, Brazil.
Resumo
BACKGROUND: Takayasu's arteritis (TA) is a vasculitis that affects the aorta and its branches and causes stenosis, occlusion, and aneurysms. Up to 60% of TA patients are associated with cardiac involvement which confers a poor prognosis. Global longitudinal strain (GLS) analysis is an echocardiographic technique that can detect the presence of subclinical systolic dysfunction. Hence, this study aimed to describe the prevalence of subclinical systolic dysfunction in patients with TA using the GLS method and to correlate this finding with disease activity using the ITAS-2010 (Indian Takayasu Activity Score). METHODS: Thirty patients over 18 years of age who met the American College of Rheumatology (ACR) 1990 criteria for TA were included. The sample was submitted for medical record review, clinical and echocardiographic evaluation, and application of ITAS-2010. The cutoff for systolic dysfunction was GLS > - 20%. RESULTS: Of the 30 patients analyzed, 25 (83.3%) were female, and the mean age was 42.6 years (± 13.2). The median time since diagnosis was 7.5 years [range, 3-16.6 years], and the type V angiographic classification was the most prevalent (56.7%). Regarding echocardiographic findings, the median ejection fraction (EF) was 66% [61-71%] and the GLS was - 19.5% [-21.3 to -15.8%]. Although half of the participants had reduced GLS, only two had reduced EF. Eleven patients (33.%) met the criteria for activity. An association was found between disease activity and reduced GLS in eight patients (P = 0.02) using the chi-square test. CONCLUSION: GLS seems to be an instrument capable of the early detection of systolic dysfunction in TA. The association between GLS and disease activity in this study should be confirmed in a study with a larger sample size.
13 - Occupational stressors and mental illness in healthcare work: An intersection between gender, race, and class. Am J Ind Med. 2023 Dec 21. doi: 10.1002/ajim.23558.
de Sousa CC(1), Araújo TM(2), Maturino MM(2).
Afiliação
(1) University Hospital Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil.
(2) State University of Feira de Santana, Feira de Santana, Brazil.
Resumo
BACKGROUND: Previous studies have supported the relevance of using broad and complex approaches, including multiple explanatory categories, to analyze mental disorders in the working population. This study aimed to assess the direct and indirect effects of gender, race, social class, and occupational stressors on mental health. METHODS: A cross-sectional study used a random sample of 3343 health workers. The effort-reward imbalance (ERI) scale measured occupational stressors. The World Health Organization Self-Reporting Questionnaire (SRQ-20) evaluated common mental disorders (CMDs) as outcomes. The role of gender, race/color, and class determinants (level of schooling and income) in the relationship between occupational stressors and CMD was assessed. Structural equation modeling was used to determine associations and effects. RESULTS: Occupational stressors were directly associated with CMD and mediated the relationship between income and CMD. Gender was directly associated with occupational stressors, income, and domestic overload. Race was associated with education and with CMD through indirect paths mediated by class indicators. Class indicators contributed to increasing exposure to occupational stressors and the occurrence of CMD. CONCLUSION: The results highlight the relevance of gender, race/color, and class in understanding the unequal distribution of work stressors and mental illness in health workers.
14 - Clinical profile of vitiligo patients and relationship with immuno-inflammatory markers. An Bras Dermatol. 2023 Nov 18:S0365-0596(23)00235-0. doi: 10.1016/j.abd.2023.03.007.
Mascarenhas MRM(1), Oliveira MC(2), Oliveira LF(2), Magalhães AS(2), Machado PRL(2).
Afiliação
(1) Dermatology Service, Hospital Universitário Professor Edgard Santos, Salvador, BA, Brazil.
(2) Dermatology Service, Hospital Universitário Professor Edgard Santos, Salvador, BA, Brazil.
Resumo
BACKGROUND: Vitiligo is the most common pigmentary disorder and is considered a chronic, cumulative, multifactorial disease. The crucial role of cytotoxic CD8+ T lymphocytes and the IFNγ/CXCL10 axis has been demonstrated in its pathogenesis. OBJECTIVE: To evaluate the clinical profile and immuno-inflammatory markers in patients with vitiligo in a reference medical center. METHODS: Cross-sectional study in which all patients with vitiligo seen at the medical center the from 2019 to 2022 were evaluated, to outline the clinical profile. Moreover, cardiovascular risk biomarkers (neutrophil/lymphocyte ratio and C-reactive protein levels) were measured, as well as cytokines and chemokines (TNFα, IFNγ, IL10, IL15 and CXCL10) in the serum of a subgroup of 30 patients. RESULTS: There was a predominance of females, with a mean age of 43 years. Most were phototypes IV or V (71.3%), without comorbidities (77.55%), and without a family history of vitiligo (70.41%). Higher levels of neutrophil/lymphocyte ratio, C-reactive protein, and inflammatory cytokines/chemokines were documented in vitiligo patients when compared to the control group (non-significant). As relevant data, the highest values of CXCL10 were detected in patients with vitiligo versus controls, as well as in patients with disease of shorter duration (p<0.05). STUDY LIMITATIONS: The number of assessed patients was small due to recruitment difficulties caused by the COVID-19 pandemic. CONCLUSION: The present data contribute to confirming the relevant role of the IFNγ/CXCL10 axis in the pathogenesis of vitiligo, highlighting CXCL10 as a possible activity marker.
15 - Development and Validation of a Transgender Health Care Humanization Scale. Transgend Health. 2023 Oct 4;8(5):444-449. doi: 10.1089/trgh.2021.0176.
da Silva ACG(1)(2), Lins-Kusterer L(1)(2), Luz E(1)(2), Brites C(1)(2).
Afiliação
(1) LAPI-Laboratório de Pesquisa em Infectologia, Federal University of Bahia, Hospital Universitário Professor Edgard Santos, Salvador, Brazil.
(2) Post-Graduation Program in Medicine and Health, School of Medicine, Federal University of Bahia, Salvador, Brazil.
Resumo
PURPOSE: Stigma and discrimination against transgender people can lead to their segregation. Fighting stigma and discrimination is a crucial strategy to expand access to health services. The goals of the present study were to develop and validate a transgender health care humanization scale (THcH scale) to evaluate the perception of humanization in health care for transgender individuals. METHODS: This cross-sectional study included 340 health care providers aged ≥18 years. Participants answered a structured questionnaire when attending HIV/AIDS scientific meetings or at their place of work. An exploratory factor analysis was conducted, using a polychoric matrix and robust diagonally weighted least squares extraction method. The number of retained factors was defined through the parallel analysis technique, with random permutation of the observed data and the use of Robust Promin rotation. RESULTS: The interpretability of correlation matrix items was suggested by the Bartlett's sphericity tests (1633.7, df=91; p<0.001) and Kaiser-Meyer-Olkin Test (0.875). The factor structure showed adequate adjustment indices (χ2=44,200, df=52; root mean square error of approximation p<0.05; comparative fit index=0.968; Tucker-Lewis index=0.945; goodness-of-fit index = 0.995). Only one factor was retained by parallel analysis, explained by 54.17% of the variance of the construct and confirmed by the following indices: unidimensional congruence=0.902, explained common variance=0.828, and mean of item residual absolute loadings=0.279. Good reliability was confirmed by Cronbach's alpha test (0.899). CONCLUSION: The THcH scale showed good psychometric properties. This self-report questionnaire, which can be completed in 5 min, may be useful in scientific research and could guide health care providers in expansion of a Health Humanization Policy and in deconstructing prejudice against transgender people in health care settings.
16 - The leprosy reaction is associated with salivary anti-Porphyromonas gingivalis IgA antibodies. AMB Express. 2023 Jul 7;13(1):70. doi: 10.1186/s13568-023-01576-1.
Falcão MML(1)(2), Passos-Soares JS(3)(4), Machado PRL(5), Gomes-Filho IS(3), de Carvalho LP(6), de Campos EJ(7), Calheira MC(8), de Miranda PM(8), Santos RPB(8), Rocha Filho JTR(6), de Farias APF(8)(6), Peixoto T(9), Nascimento RM(6), Seymour GJ(10), Trindade SC(3)(8).
Afiliação
(1) Department of Health, State University of Feira de Santana, Feira de Santana, Brazil.
(2) Postgraduate Program in Immunology, Federal University of Bahia, Salvador,
(3) Department of Health, State University of Feira de Santana, Feira de Santana, Brazil.
(4) Preventive Dentistry Department, Federal University of Bahia, Salvador, Brazil.
(5) Immunology Service, University Hospital Prof. Edgar Santos Federal University of Bahia, Salvador, Brazil.
(6) Immunology and Molecular Biology Laboratory, Federal University of Bahia, Salvador, Brazil.
(7) Oral Biochemistry Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil.
(8) Postgraduate Program in Immunology, Federal University of Bahia, Salvador, Brazil.
(9) School of Dentistry, Federal University of Bahia, Salvador, Brazil.
(10) School of Dentistry, The University of Queensland, Brisbane, Australia.
Resumo
The aim of the study was to evaluate the association between salivary anti-Porphyromonas gingivalis IgA antibodies and the leprosy reaction. The levels of salivary anti - P. gingivalis IgA antibodies, together with salivary flow and pH were measured in individuals diagnosed with leprosy and associated with the development of the leprosy reaction. Saliva was collected from 202 individuals diagnosed with leprosy at a reference leprosy treatment center, 106 cases with the leprosy reaction and 96 controls without the leprosy reaction. Anti - P. gingivalis IgA was evaluated by indirect immunoenzyme assay. Non-conditional logistic regression analysis was employed to estimate the association between antibody levels and the leprosy reaction. There was a positive statistically significant association between the levels of anti - P. gingivalis IgA and the presence of the leprosy reaction, controlling for confounders: age, sex, level of education and alcoholic beverage consumption: ORajusted: 2.55; IC 95%: 1.34-4.87. Individuals with leprosy who had high levels of salivary anti - P. gingivalis IgA had approximately twice as many chances of developing the leprosy reaction. The findings suggest a possible relationship between salivary anti - P. gingivalis IgA antibodies and the leprosy reaction.
17 - Dogs Harbor Leishmania braziliensis and Participate in the Transmission Cycle of Human Tegumentary Leishmaniasis. Pathogens. 2023 Jul 27;12(8):981. doi: 10.3390/pathogens12080981.
Lago J(1)(2), Fraga D(3), Coelho L(3), Jesus MS(3), Leite B(3), Werneck GL(4)(5), Arruda S(3)(6), Lago E(1), Carvalho EM(1)(3)(6), Bacellar O(1)(6).
Afiliação
(1) Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil.
(2) Post-Graduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador 40026-010, BA, Brazil.
(3) Gonçalo Moniz Institute (IGM), Fiocruz, Salvador 40296-710, BA, Brazil.
(4) Department of Epidemiology, State University of Rio de Janeiro, Rio de Janeiro 20950-000, RJ, Brazil.
(5) Institute for Public Health Studies, Federal University of Rio de Janeiro, Rio de Janeiro 22290-240, RJ, Brazil.
(6) Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério da Ciência e Tecnologia e Inovação (MCTI), CNPq, Salvador 40110-160, BA, Brazil.
Resumo
Dogs play an important role in transmission of Leishmania infantum, but epidemiologic and clinical studies of canine tegumentary leishmaniasis (CTL) are scarce. In an endemic area of human American tegumentary leishmaniasis (ATL) caused by Leishmania braziliensis, we determine the prevalence and incidence of both CTL and subclinical (SC) L. braziliensis infection in dogs and evaluated if the presence of dogs with CTL or SC L. braziliensis infection is associated with the occurrence of human ATL. SC infection in healthy animals and CTL in animals with ulcers were determined by PCR on biopsied healthy skin or on ulcers or by detecting antibodies against soluble leishmania antigen. We compared the occurrence of human ATL in homes with dogs with CTL or SC infection with control homes without dogs or with dogs without CTL or SC infection. The prevalence of SC infection was 35% and of CTL 31%. The incidence of SC infection in dogs was 4.6% and of CTL 9.3%. The frequency of ATL in humans was 50% in homes with infected dogs and 13% in homes without L. braziliensis infection in dogs. CTL and SC infection is highly prevalent, and dogs may participate in the transmission chain of L. braziliensis.
18 - Predictors of Neurodevelopment in Microcephaly Associated with Congenital Zika Syndrome: A Prospective Study. Children (Basel). 2023 Nov 21;10(12):1831. doi: 10.3390/children10121831.
Mattos AM(1)(2), Rastely-Junior VN(1), Pires MM(2), Aguilar JP(3), Lessa MSA(3), Regis C(1), Wanderley M(1), Leony J(1), Bouzon J(2), Ballalai V(1), Vieira C(1), Carvalho GBS(1), Almeida JRM(4), Nery N Jr(3)(5), Leal R(2), Costa F(3)(5)(6), Ko AI(6), Reis MG(5)(6), Oliveira-Filho J(2).
Afiliação
(1) Hospital Geral Roberto Santos, Salvador 40301-110, Brazil.
(2) Post-Graduate Program in Health Sciences, Federal University of Bahia, Salvador 40170-110, Brazil.
(3) Post-Graduate Program in Public Health, Institute of Collective Health (ISC), Federal University of Bahia, Salvador 40170-110, Brazil.
(4) Hospital Professor Edgard Santos, Federal University of Bahia, Salvador 40170-110, Brazil.
(5) Gonçalo Moniz Institute, Foundation Oswaldo Cruz, Salvador 40296-710, Brazil.
(6) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA.
Resumo
The municipality of Salvador, situated in Brazil, distinguished itself as the epicenter of the emergence of microcephaly related to congenital manifestations of Zika syndrome. Despite the anticipated significant developmental setbacks in these children, research has indicated a varied range of outcomes, with certain instances even reflecting minimal developmental delay. Our objective was to pinpoint determinants that could forecast developmental anomalies in children diagnosed with microcephaly associated with congenital Zika syndrome (CZS). METHODOLOGY: A forward-looking clinical and neurodevelopmental examination was conducted focusing on neonates diagnosed with microcephaly with CZS, birthed between September 2015 and April 2016 at the Hospital Geral Roberto Santos, in Salvador city. That infants were monitored up to their third year by a multiprofessional team. Child development was assessed using the composite Bayley III score. Undertaken by two blinded experts, cranial CT scan analysis was performed during the neonate period for the detection of brain abnormalities and to quantify ventricle enlargement, measured by Evans' index (EI). RESULTS: Fifty newborns were evaluated with a median head circumference of 28 cm (interquartile range 27-31 cm). EI was associated with neurodevelopmental delay at three years and remained significant after adjustment for head circumference. A 0.1-point increase in EI was associated with a delay of 3.2 months in the receptive language (p = 0.016), 3.4 months in the expressive language (p = 0.016), 3.4 months in the cognitive (p = 0.016), 2.37 months in the gross motor (p = 0.026), and 3.1 months in the fine motor (p = 0.021) domains. CONCLUSIONS: EI predicted neurodevelopmental delay in all Bayley domains in children with microcephaly associated with CZS.
19 - Detection of IgG Anti-Giardia duodenalis Antibodies in Sera by Indirect Immunofluorescence and Western Blotting Assays. Acta Parasitol. 2023 Dec 14. doi: 10.1007/s11686-023-00753-3.
Santos SA(1), de Souza JN(2), Pacheco FTF(3), Santos MC(2), Dos Santos Novais D(2), Suzart VN(2), Dos Santos Guedes I(2), Neves MH(2), Gomes MA(4), Soares NM(1)(2), Teixeira MCA(5)(6).
Afiliação
(1) Programa de Pós-Graduação em Farmácia, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
(2) Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, 40170-115, Brazil.
(3) Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
(4) Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.
(5) Programa de Pós-Graduação em Farmácia, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
(6) Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, 40170-115, Brazil.
Resumo
INTRODUCTION: Serological assays are alternative laboratory tools for the diagnosis of parasitic infections. The aim of this work was to evaluate the performance of the indirect fluorescent antibody test (IFAT) and Western blotting (WB) for the detection of IgG anti-Giardia antibodies in human sera.METHODOLOGY: Sera from individuals infected with Giardia duodenalis, other parasites or non-parasitized were selected for serological assays. Ninety-seven sera were tested by IFAT at 1:20 and 1:40 dilutions and of these, 40 samples were also analyzed by WB. RESULTS: The sensitivity and specificity of the IFAT was 97% and 46.9% at 1:20 sera dilution, and 39.4% and 59.4% at 1:40 sera dilution. The low molecular weight polypeptides fractions of 25 kDa, 27-31 kDa and 45-55 kDa were the most frequently identified by the sera of individuals infected with G. duodenalis, along with low cross-reactivity, presenting an individual sensitivity of 42.8%, 50.0% and 57.1%, and specificity of 83.3%, 83.3% and 91.7%, respectively. The highest overall sensitivity of WB (85.7%) was based on the immunoreactivity of sera with at least one of those proteins. The concordance between the detection of G. duodenalis in feces by microscopy and the WB results was considered substantial (Kappa = 0.61). CONCLUSION: Constant exposure to Giardia infection throughout a lifetime can maintain high levels of specific antibodies in serum, even without active infection. Moreover, proteins found in intestinal amoebas may hinder the serological diagnosis of giardiasis in endemic areas due to cross-reactivity, which can be partially solved using Giardia low molecular weight proteins.
20 - Arketamine for bipolar depression: Open-label, dose-escalation, pilot study. J Psychiatr Res. 2023 Aug;164:229-234. doi: 10.1016/j.jpsychires.2023.06.028.
Bandeira ID(1), Leal GC(2), Correia-Melo FS(3), Souza-Marques B(2), Silva SS(2), Lins-Silva DH(3), Mello RP(2), Vieira F(2), Dorea-Bandeira I(3), Faria-Guimarães D(3), Carneiro B(2), Caliman-Fontes AT(2), Kapczinski F(4), Miranda-Scippa Â(5), Lacerda ALT(6), Quarantini LC(7).
Afiliação
(1) Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil; Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, United States.
(2) Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil; Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil.
(3) Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.
(4) Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.
(5) Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil.
(6) Laboratório Interdisciplinar de Neurociências Clínicas, Universidade Federal de São Paulo, São Paulo, Brazil; Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil; Instituto Sinapse de Neurociências Clínicas, Campinas, Brazil.
(7) Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil; Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil.
Resumo
There are significantly fewer options for the treatment of bipolar depression than major depressive disorder, with an urgent need for alternative therapies. In this pilot study, we treated six subjects with bipolar disorder types I and II (according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria) who had been in a current depressive episode for at least four weeks. Four subjects were female (66.66%), and the mean age was 45.33 (±12.32). Subjects received adjunct treatment with two arketamine intravenous infusions one week apart-0.5 mg/kg first and then 1 mg/kg. The mean baseline Montgomery-Åsberg Depression Rating Scale (MADRS) total score was 36.66, which decreased to 27.83 24h after the first infusion of 0.5 mg/kg of arketamine (p = 0.036). In respect of the 1 mg/kg dose, the mean MADRS total score before the second infusion was 32.0, which dropped to 17.66 after 24h (p < 0.001). Arketamine appears to have rapid-acting antidepressant properties, consistent with previous animal studies on major depression. All individuals tolerated both doses, exhibiting nearly absent dissociation, and no manic symptoms. To the best of our knowledge, this pilot trial is the first to test the feasibility and safety of the (R)-enantiomer of ketamine (arketamine) for bipolar depression.
21 - Screening for Mutations in Hereditary Cancer Susceptibility Genes in a Region with High Endogamy in Brazil. Glob Med Genet. 2023 Dec 8;10(4):376-381. doi: 10.1055/s-0043-1777449.
Oliveira P(1), Correa P(2), Acosta A(2), Freitas J(3), Machado-Lopes T(4), Bomfim-Palma T(4), Ribeiro-Dos-Santos Â(5), Santos S(5), Nascimento R(4), Nascimento I(4), Abe-Sandes K(3).
Afiliação
(1) Department of Biology, State University of Feira de Santana, Bahia, Brazil.
(2) Medical Genetics Service, University Hospital Prof. Edgard Santos, Salvador, Bahia, Brazil.
(3) Department of Life Sciences, State University of Bahia, Bahia, Brazil.
(4) Laboratory of Immunology and Molecular Biology, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil.
(5) Laboratory of Human and Medical Genetics, Institute of Biological Sciences, Federal University of Pará, Pará, Brazil.
Resumo
Introduction Cancer is a multifactorial disease dependent on the influence of genetic and environmental factors. About 10% of cancers are associated with germline mutations, which predispose to a higher risk of developing cancer. Currently, the use of panels that identify susceptibility and/or association genes cancer has been increasingly used, both in clinical practice and in scientific research. Objective To investigate genetic mutations in patients with a profile for hereditary cancer in individuals from a region of northeast Brazil, where there is a high frequency of endogenous and consanguineous marriages. Methods A set of 17 genes ( BRCA1 , BRCA2 , APC , TP53 , PTEN , RET , VHL , RB1 , CDKN2 , CDH1 , CHEK2 , MLH1 , MSH2 , MSH6 , MUTYH , XPA , and XPC ) associated with cancer and hereditary syndromes were analyzed. Fifteen patients with a hereditary cancer profile were evaluated. Results The pathogenic variant found was c.1187G > A (p.Gly396Asp), rs36053993 in the MUTYH gene in a male patient diagnosed with melanoma at the age of 43 years and a family history for this tumor. This gene encodes an important enzyme related to DNA repair and has been associated with other types of cancer, this is the first report of an association with melanoma, the biological plausibility of this association is given once the MUTYH protein is expressed in the skin tissue and is responsible for repairing damage caused, for example, by sun exposure. Conclusion The results of this study suggest that this mutation may be important for the hereditary predisposition to melanoma, but a broader investigation of this mutation is needed.
22 - Case report: Cyclophosphamide pulse therapy for chronic recalcitrant erythema nodosum leprosum. Front Med (Lausanne). 2023 Oct 25;10:1272404. doi: 10.3389/fmed.2023.1272404.
Machado GU(1), Amparo T(2), Bulhões F(2), Machado PRL(1)(3).
Afiliação
(1) Serviço de Imunologia, Hospital Universitário Prof. Edgar Santos, Universidade Federal da Bahia, Salvador, Brazil.
(2) Serviço de Dermatologia, Hospital Universitário Prof. Edgar Santos, Universidade Federal da Bahia, Salvador, Brazil.
(3) Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, Brazil.
Resumo
Chronic recalcitrant erythema nodosum leprosum (ENL) or type 2 reaction (T2R) is a severe condition found in approximately 50% of multibacillary leprosy subjects. T2R is associated with important morbidities and may lead to several disabilities, not only due to nerve damage but also due to the prolonged use of corticosteroids, thalidomide, or immunosuppressors. We describe here four leprosy patients with chronic recalcitrant ENL treated with cyclophosphamide pulse therapy. All subjects had been on prednisone and thalidomide therapy for at least 30 months but showed inflammatory activity when doses were reduced. Pulse therapy with 1.0 g of cyclophosphamide was used every 4-6 weeks for a minimum of three applications. After pulse therapy, all cases presented total or partial regression of symptoms, and we were able to taper thalidomide and prednisone doses, with better control of ENL, avoiding further hospital admissions and disabilities. No side effects were observed during or after infusion therapy. Cyclophosphamide pulse therapy may be useful and safe to control chronic recalcitrant ENL.
23 - Brazilian autoimmune encephalitis network (BrAIN): antibody profile and clinical characteristics from a multicenter study. Front Immunol. 2023 Oct 25;14:1256480. doi: 10.3389/fimmu.2023.1256480.
de Freitas Dias B(1), Fieni Toso F(1), Slhessarenko Fraife Barreto ME(1), de Araújo Gleizer R(1), Dellavance A(2), Kowacs PA(3), Teive H(4), Spitz M(5), Freire Borges Juliano A(6), Januzi de Almeida Rocha L(7), Braga-Neto P(8), Ribeiro Nóbrega P(8), Oliveira-Filho J(9), Maciel Dias R(10), de Oliveira Godeiro Júnior C(11), Martins Maia F(12), Barbosa Thomaz R(1), Santos ML(13), Sousa de Melo E(14), da Nóbrega Júnior AW(15), Lin K(15), Graziani Povoas Barsottini O(16), Endmayr V(17)(18), Coelho Andrade LE(19), Höftberger R(17)(18), Almeida Dutra L(1).
Afiliação
(1) Hospital Israelita Albert Einstein, São Paulo, Brazil.
(2) Research and Development Division, Fleury Group, São Paulo, Brazil.
(3) Instituto de Neurologia de Curitiba, Curitiba, Brazil.
(4) Hospital Universitário da Universidade Federal do Paraná, Curitiba, Brazil.
(5) Hospital Universitário Pedro Ernesto da Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil.
(6) Hospital Universitário Presidente Dutra, São Luís do Maranhão, Brazil.
(7) Hospital Universitário Professor Alberto Antunes, EBSERH, Universidade Federal do Alagoas, Maceió, Brazil.
(8) Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil.
(9) Hospital Universitário Professor Edgard Santos, Salvador, Brazil.
(10) Instituto Hospital de Base do Distrito Federal, Brasília, Brazil.
(11) Hospital Universitário Onofre Lopes, Natal, Brazil.
(12) Graduate Program in Medical Sciences, Universidade de Fortaleza, Fortaleza, Brazil.
(13) Hospital Pequeno Príncipe, Curitiba, Brazil.
(14) Hospital das Clínicas da Universidade Federal de Pernambuco, Recife, Brazil.
(15) Universidade Federal de Santa Catarina, Florianópolis, Brazil.
(16) Neurology and Ataxia Unit, Department of Neurology, Universidade Federal de Saão Paulo, São Paulo, Brazil.
(17) Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria.
(18) Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
(19) Immunology Division, Fleury Group, São Paulo, Brazil.
Resumo
BACKGROUND: The frequency of antibodies in autoimmune encephalitis (AIE) may vary in different populations, however, data from developing countries are lacking. To describe the clinical profile of AIE in Brazil, and to evaluate seasonality and predictors of AIE in adult and pediatric patients. METHODS: We evaluated patients with possible AIE from 17 centers of the Brazilian Autoimmune Encephalitis Network (BrAIN) between 2018 and 2022. CSF and serum were tested with TBAs and CBAs. Data on clinical presentation, complementary investigation, and treatment were compiled. Seasonality and predictors of AIE in adult and pediatric populations were analyzed. RESULTS: Of the 564 patients, 145 (25.7%) were confirmed as seropositive, 69 (12.23%) were seronegative according to Graus, and 58% received immunotherapy. The median delay to diagnosis confirmation was 5.97 ± 10.3 months. No seasonality variation was observed after 55 months of enrolment. The following antibodies were found: anti-NMDAR (n=79, 54%), anti-MOG (n=14, 9%), anti-LGI1(n=12, 8%), anti-GAD (n=11, 7%), anti-GlyR (n=7, 4%), anti-Caspr2 (n=6, 4%), anti-AMPAR (n=4, 2%), anti-GABA-BR (n=4, 2%), anti-GABA-AR (n=2, 1%), anti-IgLON5 (n=1, 1%), and others (n=5, 3%). Predictors of seropositive AIE in the pediatric population (n=42) were decreased level of consciousness (p=0.04), and chorea (p=0.002). Among adults (n=103), predictors of seropositive AIE were movement disorders (p=0.0001), seizures (p=0.0001), autonomic instability (p=0.026), and memory impairment (p=0.001). CONCLUSION: Most common antibodies in Brazilian patients are anti-NMDAR, followed by anti-MOG and anti-LGI1. Only 26% of the possible AIE patients harbor antibodies, and 12% were seronegative AIE. Patients had a 6-month delay in diagnosis and no seasonality was found. Findings highlight the barriers to treating AIE in developing countries and indicate an opportunity for cost-effect analysis. In this scenario, some clinical manifestations help predict seropositive AIE such as decreased level of consciousness, chorea, and dystonia among children, and movement disorders and memory impairment among adults.
24 - Multiomic profiling of cutaneous leishmaniasis infections reveals microbiota-driven mechanisms underlying disease severity. Sci Transl Med. 2023 Oct 18;15(718):eadh1469. doi: 10.1126/scitranslmed.adh1469.
Farias Amorim C(1), Lovins VM(2), Singh TP(1), Novais FO(3), Harris JC(2), Lago AS(4), Carvalho LP(4)(5), Carvalho EM(4)(5), Beiting DP(1), Scott P(1), Grice EA(2).
Afiliação
(1) Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
(2) Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
(3) Department of Microbial Infection and Immunity, College of Medicine, Ohio State University, Columbus, OH 43210, USA.
(4) Laboratório de Pesquisas Clínicas do Instituto de Pesquisas Gonçalo Muniz-Fiocruz, Salvador, Bahia 40296-710, Brazil.
(5) Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Bahia 40110-060, Brazil.
Resumo
Leishmania braziliensis is a parasitic infection that can result in inflammation and skin injury with highly variable and unpredictable clinical outcomes. Here, we investigated the potential impact of microbiota on infection-induced inflammatory responses and disease resolution by conducting an integrated analysis of the skin microbiome and host transcriptome on a cohort of 62 patients infected with L. braziliensis. We found that overall bacterial burden and microbiome configurations dominated with Staphylococcus spp. were associated with delayed healing and enhanced inflammatory responses, especially by IL-1 family members. Quantification of host and bacterial transcripts on human lesions revealed that high lesional S. aureus transcript abundance was associated with delayed healing and increased expression of IL-1β. This cytokine was critical for modulating disease outcomes in L. braziliensis-infected mice colonized with S. aureus, given that its neutralization reduced pathology and inflammation. These results highlight how the human microbiome can shape disease outcomes in cutaneous leishmaniasis and suggest pathways toward host-directed therapies to mitigate the inflammatory consequences.
25 - Anorectal Function and Clinical Characteristics Associated with Faecal Incontinence in Patients with Crohn's Disease. J Crohns Colitis. 2023 Aug 21;17(8):1252-1261. doi: 10.1093/ecco-jcc/jjad048.
de Codes LMG(1), de Jesus ACC(2), de Codes JJG(3), Ferreira RF(2), da Silva Beda Sacramento C(4), da Cruz IDM(5), de Castro Ribeiro Fidelis F(5), de Carvalho AL(5), Motta MP(4), de Oliveira Alves C(4), Netto EM(6), Santana GO(7).
Afiliação
(1) Medicine and Health Science Postgraduate Program, Universidade Federal da Bahia, Salvador, Brazil; Department of Surgery, Hospital Universitário Professor Edgard Santos, Salvador, Brazil.
(2) Department of Life Sciences, Universidade do Estado da Bahia, Salvador, Brazil.
(3) Hospital Ana Nery, Salvador, Brazil.
(4) Department of Gastroenterology, Hospital Universitário Professor Edgard Santos, Salvador, Brazil.
(5) Department of Surgery, Hospital Universitário Professor Edgard Santos, Salvador, Brazil.
(6) Medicine and Health Science Postgraduate Program, Universidade Federal da Bahia, Salvador, Brazil.
(7) Medicine and Health Science Postgraduate Program, Universidade Federal da Bahia, Salvador, Brazil; Department of Life Sciences, Universidade do Estado da Bahia, Salvador, Brazil.
Resumo
BACKGROUND AND AIMS: Faecal incontinence is an important complaint reported by patients with Crohn's disease [CD] and it is associated with several disease-related mechanisms, including anorectal functional disorders. This study aimed to assess the anorectal function and clinical characteristics to identify parameters associated with faecal incontinence in CD patients. METHODS: This is a cross-sectional study of 104 patients with CD, aged 18 years or older, from a referral centre between August 2019 and May 2021. Patients responded to a specific questionnaire, and underwent medical record review, proctological examination and anorectal functional assessment with anorectal manometry. RESULTS: Of the 104 patients, 49% were incontinent. Patients with incontinence had a lower mean resting pressure [43.5 vs 53.1 mmHg; p = 0.038], lower mean squeeze pressure [62.1 vs 94.1 mmHg; p = 0.036] and lower maximum rectal capacity [140 vs 180 mL; p < 0.001]. Faecal incontinence was also associated with disease activity [p < 0.001], loose stools [p = 0.02], perianal disease [p = 0.006], previous anoperineal surgery [p = 0.048] and number of anorectal surgeries [p = 0.036]. CONCLUSIONS: This is the largest reported study describing manometric findings of Crohn's disease patients with and without faecal incontinence. Our results identified an association between faecal incontinence and functional disorders, in addition to clinical features in these patients. Functional assessment with anorectal manometry may help choose the best treatment for faecal incontinence in patients with CD.
26 - Electric hand warmer versus observation to avoid discomfort during scalp cooling for chemotherapy-induced alopecia prevention: a randomized study. Sci Rep. 2023 Nov 9;13(1):19555. doi: 10.1038/s41598-023-46840-3.
Landeiro LCG(1), Lopes Paim Miranda D(2), Mathias Machado R(3), Dienstmann R(4), Costa E Silva M(4), da Silva CF(5), de Castro ALR(5), Dos Santos APT(5), Bomfim VHV(6), Teixeira Machado B(6), Viviane Carvalho Rodrigues Gonçalves M(5), Freitas Muniz Teixeira A(5), Jamile Santiago Costa M(5), de Oliveira Dantas Viana P(5), Almeida P(7), de Cerqueira Mathias CM(5).
Afiliação
(1) Grupo Oncoclínicas- Bahia, Av. Milton Santos, 123 - Ondina, Salvador, BA, 40170-110, Brazil.
(2) Complexo Hospitalar Universitário Professor Edgard Santos (C-HUPES) - Universidade Federal da Bahia (UFBA), Savador, BA, Brazil.
(3) Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, BA, Brazil.
(4) OC Precision Medicine - Grupo Oncoclínicas, São Paulo, SP, Brazil.
(5) Grupo Oncoclínicas- Bahia, Av. Milton Santos, 123 - Ondina, Salvador, BA, Brazil.
(6) Faculdade de Medicina da Bahia, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.
(7) Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador, BA,
(8) Brazil.
Resumo
Chemotherapy-induced alopecia (CIA) is a challenge in the management of cancer patients. Scalp cooling (SC) leads to reduction in CIA, however it is associated with significant adverse events, leading to 3-13% discontinuation rates. This pilot study evaluated the role of Electric Hand Warmers (EHW) on thermal (TC), sensorial (SCo) and general comfort (GC) in patients with breast cancer (BC) undergoing chemotherapy and SC to reduce CIA. Patients were randomly assigned to EHW use or observation. TC, SCo and GC were evaluated after each chemotherapy infusion. Favorable outcomes in both TC and SCo defined a positive result on GC. We analysed the impact of age, alopecia, chemotherapy regimen and EHW use in the different comfort scales using a Logistic Regression (LR) model. Forty women with early breast cancer were randomly assigned to EHW (n = 20) or observation (n = 20) during neo(adjuvant) chemotherapy. Median age was 53 years. In the EHW arm, favorable thermal response was reported by 79% versus 50% in the control arm (odds ratio [OR] 3.79, p < 0.001). SCo was satisfactory in 82% in the EHW arm versus 74% in the control arm (OR 1.62, p = 0.1). Overall, 73% in the EHW arm had favorable GC versus 44% in the control arm (OR 3.4, p < 0.001). Age, alopecia, and chemotherapy regimen did not impact on comfort measures. Conclusion: Our study suggests that the use of an EHW has a consistent favorable impact on TC and GC of BC patients under SC technology to prevent CIA.
27 - Prostaglandin E2 contributes to L. braziliensis survival and therapeutic failure in cutaneous leishmaniasis. Emerg Microbes Infect. 2023 Dec;12(2):2261565. doi: 10.1080/22221751.2023.2261565.
Nascimento MT(1)(2)(3), Viana DL(1), Peixoto FC(1)(3), Arruda SM(4), Carvalho EM(1)(2)(3)(5), Carvalho LP(1)(2)(3)(5).
Afiliação
(1) Laboratório de Pesquisas Clínicas, LAPEC, Instituto Gonçalo Moniz - Fiocruz, Salvador, Brazil.
(2) Serviço de Imunologia, SIM, Complexo Universitário Professor Edgar Santos, COM-HUPES, Salvador, Brazil.
(3) Programa de Pós-Graduação em Ciências da Saúde, PPgCS, Universidade Federal
(4) da Bahia, Salvador, Brazil.
(5) Laboratório Avançado de Saúde Pública, LASP, Instituto Gonçalo Moniz - Fiocruz, Salvador, Brazil.
(6) Instituto de Ciência e Tecnologia em Doenças Tropicais, INCT-DT, Salvador, Brazil.
Resumo
Patients with cutaneous leishmaniasis (CL) present an exacerbated inflammatory response associated with tissue damage and ulcer development. In recent years, higher rates of failure to pentavalent antimoniate therapy have been observed, yet the underlying reason remains poorly understood. We hypothesize that the eicosanoid PGE2 favours the establishment of infection by L. braziliensis, which contributes to therapeutic failure. The aim of the present study was to investigate the influence of PGE2 on the survival of L. braziliensis in macrophages and rates of therapeutic failure in CL patients. PGE2, an eicosanoid derived from the metabolism of arachidonic acid by the COX-2 enzyme, plays several roles in immune response. We found that increased PGE2 decreases the microbicidal function of macrophages and is associated with disease severity and therapeutic failure. Additionally, the neutralization of COX-2 by NS398, a selective NSAID, increases the ability of macrophages to kill L. braziliensis and protects against the pathological inflammatory response. Our data suggest that NS398 may serve as an adjunct treatment for CL patients.
28 - Mortality, health-related quality of life, and depression symptoms in younger and older men and women undergoing hemodialysis. Int J Artif Organs. 2023 Sep;46(8-9):492-497. doi: 10.1177/03913988231183724.
da Silva FA(1)(2), Silva Martins MT(2)(3), Gutiérrez-Peredo GB(2), Kraychete AC(2)(4), Penalva CC(1), Lopes MB(2)(5), Matos CM(2)(4), Lopes AA(6)(7).
Afiliação
(1) NEPHRON Clinic, Salvador, BA, Brazil.
(2) Postgraduate Program in Medicine and Health, Federal University of Bahia (UFBA), Salvador, BA, Brazil.
(3) Clinic of Renal Disease and Hypertension (CLINIRIM), Salvador, BA, Brazil.
(4) Institute of Nephrology and Dialysis (INED), Salvador, BA, Brazil.
(5) Nephrology Department at Hospital São Rafael, D'Or Institute for Research and Education (IDOR), Salvador, Bahia, Brazil.
(6) Unit of Clinical Epidemiology and Evidence Based Medicine, Professor Edgard Santos University Hospital, UFBA, Salvador, BA, Brazil.
(7) Department of Internal Medicine, Federal University of Bahia, Salvador, BA, Brazil.
Resumo
BACKGROUND AND OBJECTIVE: Some studies on maintenance hemodialysis (MHD) patients report a longer survival, albeit with poorer health-related quality of life (HRQoL), and more depression symptoms in women than in men. Whether these gender differences vary with age is uncertain. We tested the associations of gender with mortality, depression symptoms, and HRQoL in MHD patients of different age groups. METHODS: We used data from 1504 adult MHD patients enrolled in the PROHEMO, a prospective cohort in Salvador, Brazil. The KDQOL-SF was used for the component summaries of the mental (MCS) and physical (PCS) HRQoL scales. Depression symptoms were assessed by the complete version of the Center for Epidemiological Studies Depression Screening Index (CES-D). To test for gender differences, extensively adjusted linear models were used for depression and HRQoL scores, and Cox models for death hazard ratio (HR).RESULTS: Women reported worse HRQoL than men, particularly for ages ⩾60 years. In the age group ⩾60 years, the adjusted difference (AD) in score was -3.45; 95% CI: -6.81, -0.70 for MCS -3.16; -5.72, -0.60 for PCS. Older (⩾60 years) women also had more depression symptoms (AD 4.98; 2.33, 7.64). Mortality was slightly lower in women than in men with an adjusted HR of 0.89 (0.71, 1.11) and consistent across age categories. CONCLUSIONS: In a sample of Brazilian MHD patients, women had a slightly lower mortality, albeit with more depression symptoms and poorer HRQoL than men, particularly among older patients. This study highlights the need to investigate gender inequalities for MHD patients across different cultures and populations.
29 - Factors associated with decision time to seek care in the face of ischemic stroke. Rev Esc Enferm USP. 2023 Aug 25;57:e20230075. doi: 10.1590/1980-220X-REEUSP-2023-0075en.
Muniz LS(1), Moraes MA(2), Sales RS(2), Ribeiro LS(2), Cunha BS(2), Jesus PAP(3), Sampaio EES(2), Baccin CRA(4), Teles CAS(5), Mussi FC(2).
Afiliação
(1) Empresa Brasileira de Serviços Hospitalares, Hospital Universitário Professor Edgard Santos, Salvador, BA, Brazil.
(2) Universidade Federal da Bahia, Faculdade de Enfermagem, Salvador, BA, Brazil.
(3) Universidade Federal da Bahia, Instituto de Ciências da Saúde, Salvador, BA, Brazil.
(4) Universidade Federal da Paraíba, Faculdade de Enfermagem, João Pessoa, PB, Brazil.
(5) Universidade Estadual de Feira de Santana, Instituto Gonçalo Moniz, Fiocruz.
(6) Salvador, BA, Brazil.
Resumo
OBJECTIVE: To verify the association between sociodemographic, clinical, environmental, cognitive, and emotional factors and the decision time of people with ischemic stroke to seek a health service after the onset of symptoms or wake up stroke. METHOD: Cross-sectional study carried out from March to October 2019, with 304 patients, in a public hospital, a reference in neurology. Data obtained through interview and from medical records. Decision time was analyzed as a geometric mean. In the bivariate and multivariate analyses, linear regression was used and the Akaike Information Criterion was used to select the best model. Statistical significance of 5% was adopted. RESULTS: The geometric mean of decision time was 0.30h (95% CI 0.23-0.39). The final model explained this time in 41%, showing an increase of 0.5 min for people with arterial hypertension; 10.8 min for those who waited for symptoms to improve; 1.4 min for those who were alone at the onset of symptoms; 3.9 min for those at home; 3.2 min for the ones at work; and 2.1 for those on the street/public space. CONCLUSION: The mean decision time for seeking a health service was high and influenced by clinical, environmental, cognitive, and emotional variables. The results guide nurses regarding health education.
30 - Factors associated with diet quality among Brazilian individuals with cardiovascular diseases. J Hum Nutr Diet. 2023 Oct;36(5):1713-1726. doi: 10.1111/jhn.13184.
Brito L(1), Sahade V(2), Weber B(3), Bersch-Ferreira ÂC(4), Marcadenti A(5), Torreglosa C(4), Kovacs C(6), Moreira ASB(7), Torres RS(8), Marinho H(9), ..., Kumbier M(38), Daltro C(39).
Afiliação
(1) Programa de Pós-Graduação em Medicina e Saúde da UFBA, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Empresa Brasileira de Serviços Hospitalares (EBSERH), Salvador, Bahia, Brazil.
(2) Departamento de Nutrição da Escola de Nutrição da UFBA, Salvador, Bahia, Brazil.
(3) Hospital do Coração (HCor), São Paulo, Brazil.Hospital do Coração, São Paulo, Brazil.
(4) Instituto de Pesquisa, Hospital do Coração, São Paulo, Brazil.
(5) Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
(6) Instituto Nacional de Cardiologia (INC), Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.
(7) Fundação Pública Estadual Hospital das Clínicas Gaspar Viana, Belém, Pará, Brazil.
(8) Instituto Nacional de Pesquisas da Amazônia, Hospital Universitário Francisca Mendes, Manaus, Amazonas, Brazil. Universidade do Vale do Itajaí (UNIVALI), Itajaí, Santa Catarina, Brazil.
(9) Hospital Escola da Universidade Federal de Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil.(10)Ambulatório de Lípides, Universidade Federal de São Paulo (UNIFESP), São
(11) COTENUT, Porto Alegre, Rio Grande Sul, Brazil.
(12) Programa de Pós-Graduação em Medicina e Saúde da UFBA, Departamento de Nutrição da Escola de Nutrição da UFBA, Salvador, Bahia, Brazill.
31 - Alpha-lipoic acid does not improve olfactory training results in olfactory loss due to COVID-19: a double-blind randomized trial. Braz J Otorhinolaryngol. 2023 Oct 30;90(1):101356. doi: 10.1016/j.bjorl.2023.101356.
Figueiredo LP(1), Paim PVDSL(2), Cerqueira-Silva T(3), Barreto CC(4), Lessa MM(4).
Afiliação
(1) Universidade Federal da Bahia (UFBA), Programa de Pós-Graduação em Ciências da Saúde, Salvador, BA, Brazil.
(2) Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Salvador, BA, Brazil.
(3) Instituto Gonçalo Moniz, Fiocruz, Salvador, BA, Brazil.
(4) Universidade Federal da Bahia (UFBA), Hospital Universitário Professor Edgard Santos (HUPES), Serviço de Otorrinolaringologia, Salvador, BA, Brazil.
Resumo
OBJECTIVES: Olfactory loss is a recognized long-term dysfunction after Coronavirus Disease 2019 (COVID-19) infection. This investigation aimed to assess the effect of alpha-lipoic acid as an adjuvant treatment of olfactory training on the improvement of smell loss in post-COVID-19 patients. METHODS: This randomized controlled trial included 128 adult outpatients who had persistent smell loss for more than 3-months after COVID-19 infection. The participants were randomly allocated into two groups: the intervention treatment group, which received alpha-lipoic acid associated to olfactory training, and comparison treatment group, which received placebo pills associated to olfactory training. The participants were followed-up for 12-weeks. Olfactory dysfunction was assessed in terms of Visual Analog Scale (VAS), and the Connecticut Chemosensory Clinical Research Center (CCCRC) test for the Brazilian population. RESULTS: A total of 100 participants completed the follow-up period and were analyzed in this study. Both groups have improved CCCRC score (p = 0.000), olfactory threshold (p = 0.000), identification score (p = 0.000) and VAS score (p = 0.000) after 12-weeks follow-up. No significant differences were determined between the intervention and comparison treatment groups in CCCRC score (p = 0.63), olfactory threshold (p = 0.50), identification score (p = 0.96) and VAS score (p = 0.97). In all these criteria, comparison treatment group went slightly worse. At the endpoint of the study, the frequency of anosmia reduced to 2% in the intervention treatment group and to 7.8% in the comparison treatment group. Also, 16.8% of the intervention group' subjects, and 15.7% of comparison treatment group's patients reached normosmia. CONCLUSIONS: Overall, there was a strongly significant difference in olfactory function between baseline and endpoint for both groups. However, based on the lack of significant difference between the intervention treatment and the comparison treatment groups in terms of olfactory changes, our study appoints that the alpha-lipoic acid is not better than olfactory training alone to treat olfactory loss after COVID-19.
32 - PRIMARY TOTAL HIP ARTHROPLASTIES UNDER BRAZILIAN PUBLIC HEALTH SYSTEM (2012-2021). Acta Ortop Bras. 2023 Sep 22;31(spe3):e268117. doi: 10.1590/1413-785220233103e268117.
Torres TMN(1), Martins BK(2), da Silva AA(2), de Assunção CAA(2), de Mattos ESR(1)(3), Guedes A(1)(3)(4).
Afiliação
(1) Universidade Federal da Bahia, Complexo Hospitalar Universitário Professor Edgard Santos, Programa de Residência Médica em Ortopedia e Traumatologia, Empresa Brasileira de Serviços Hospitalares, Salvador, BA, Brazil.
(2) Secretaria de Saúde do Estado da Bahia, Hospital Regional de Santo Antonio de Jesus, Programa de Residência Médica em Ortopedia e Traumatologia do Santo Antonio de Jesus, BA, Brazil.
(3) Universidade Federal da Bahia, Unidade do Sistema Neuro-Músculo-Esquelético, Empresa Brasileira de Serviços Hospitalares, Salvador, BA, Brazil.
(4) Universidade Federal da Bahia, Faculdade de Medicina da Bahia, Departamento de Cirurgia Experimental e Especialidades Cirúrgicas, Salvador, BA, Brazil.
Resumo
OBJECTIVES: To describe the regional distribution of hospital admission authorizations (HAA), hospitalization costs (HC), the average length of stay (LOS), and mortality rates (MR) related to primary total hip arthroplasties (THA) funded by the Brazilian Health Unic System (SUS) from 2012 to 2021. METHODS: Descriptive cross-sectional study using secondary data of public domain obtained from the Department of Informatics of SUS (DATASUS) database website. RESULTS: A total of 125,463 HAA were released with HC of 552,218,181.04 BRL in the evaluated period. The average LOS was of 6.8 days. MR was 1.62%. CONCLUSION: The regional distribution of HAA was 65,756 (52%) in the Southeast; 33,837 (27%) in the South; 14,882 (12%) in the Northeast; 9,364 (8%) in Midwest; and 1,624 (1%) in North - in 2020 there was a sharp decrease of the released HAA, probably due to the COVID-19 pandemic. HC was 293,474,673.20 BRL in the Southeast; 144,794,843.11 BRL in the South; 61,751,644.36 BRL in the Northeast; 45,724,353.80 BRL in the Midwest; and 6,472,666.57 BRL in the North. The average LOS was 6.7 in the Southeast; 5.3 in the South; 9.2 in the Northeast; 7.6 in the Midwest; and, 13.6 in the North. MR was as follows: Southeast=1.88%; South=1.07%; Northeast=1.83%; Midwest=1.44%; and North=1.47%. Evidence Level III; Retrospective Comparative Study .
33 - MTOR gene variants are associated with severe COVID-19 outcomes: A multicenter study. Int Immunopharmacol. 2023 Dec;125(Pt B):111155. doi: 10.1016/j.intimp.2023.111155.
Tosta BR(1), de Almeida IM(1), da Cruz Pena L(1), Dos Santos Silva H(1), Reis-Goes FS(2), Silva NN(2), Cruz JVA(1), Dos Anjos Silva M(1), de Araújo JF(1), Rodrigues JL(1), Oliveira G(3), Figueiredo RG(4), Vaz SN(5), Montaño-Castellón I(5), Santana D(5), de Lima Beltrão FE(6), Carneiro VL(7), Campos GS(8), Brites C(5), Fortuna V(2), Figueiredo CA(1), Trindade SC(9), Ramos HE(10), Costa RDS(11).
Afiliação
(1) Laboratório de Imunofarmacologia e Biologia Molecular, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Brazil.
(2) Laboratório de Imunologia e Biologia Molecular, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Brazil.
(3) Instituto Couto Maia, Salvador, Bahia, Brazil.(4)Universidade Estadual de Feira de Santana, Bahia, Brazil.
(4) Hospital Universitário Professor Edgard Santos, Universidade Federal da
(5) Bahia, Bahia, Brazil.
(6) Hospital Universitário Lauro Wanderley, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil.
(7) Departamento de Ciências da Vida, Universidade do Estado da Bahia, Bahia, Brazil.
(8) Laboratório de Virologia, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Brazil.
(9) Laboratório de Imunologia e Biologia Molecular, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Brazil; Universidade Estadual de Feira de Santana, Bahia, Brazil.Programa de Pós-Graduação em Processos Interativos de Órgãos e Sistema,
(10) Instituto de Saúde e Ciência, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
(11) Laboratório de Imunofarmacologia e Biologia Molecular, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Brazil.
Resumo
BACKGROUND: The worst outcomes linked to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been attributed to the cytokine storm, which contributes significantly to the immunopathogenesis of the disease. The mammalian target of rapamycin (mTOR) pathway is essential for orchestrating innate immune cell defense including cytokine production and is dysregulated in severe Coronavirus Disease 2019 (COVID-19) individuals. The individual genetic background might play a role in the exacerbated immune response. OBJECTIVE: In this study, we aimed to investigate the association between MTOR genetic variants and COVID-19 outcomes. METHODS: This study enrolled groups of individuals with severe (n = 285) and mild (n = 207) COVID-19 from Brazilian states. The MTOR variants, rs1057079 and rs2536, were genotyped. A logistic regression analysis and Kaplan-Meier survival curves were performed. We applied a genotyping risk score to estimate the cumulative contribution of the risk alleles. Tumor necrosis factor (TNF) and interleukin-6 (IL-6) plasma levels were also measured. RESULTS: The T allele of the MTOR rs1057079 variant was associated with a higher likelihood of developing the most severe form of COVID-19. In addition, higher levels of IL-6 and COVID-19 death was linked to the T allele of the rs2536 variant. These variants exhibited a cumulative risk when inherited collectively. CONCLUSIONS: These results show a potential pathogenetic role of MTOR gene variants and may be useful for predicting severe outcomes following COVID-19 infection, resulting in a more effective allocation of health resources.
34 - High Prevalence of Anal Sexually Transmitted Infections among Men Who Have Sex with Men and Transgender Women Attending a Clinic for Prevention of Anal Cancer in Salvador, Brazil. Pathogens. 2023 Oct 30;12(11):1297. doi: 10.3390/pathogens12111297.
Luz I(1)(2), Vinhaes E(1), Cruz I(3), Travassos AG(4), Luz E(1)(2), Netto EM(1)(2), Brites C(1)(3)(5).
Afiliação
(1) Fundação Bahiana de Infectologia, Salvador 40110-060, Brazil.
(2) Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador 40110-060, Brazil.
(3) Hospital Universitário Professor Edgard Santos, UFBA-EBSERH, Salvador 40110-060, Brazil.
(4) School of Medicine, Universidade Estadual da Bahia, Salvador 40110-060, Brazil.
(5) School of Medicine, Universidade Federal da Bahia, Salvador 40110-060, Brazil.
Resumo
Men who have sex with men (MSM) and transgender women (TGW) are highly vulnerable to anal sexually transmitted infections (STIs). Objectives-to evaluate the prevalence of anal STIs among MSM and TGW attending a referral clinic for anal cancer prevention. Methods-MSM and TGW attending a medical visit for high-resolution anoscopy in Salvador, Brazil, from February 2021 to June 2022 were screened for HPV, gonorrhea, and chlamydial infection by PCR of anal swab and by serum VDRL titration for syphilis screening. They also responded to a questionnaire on sociodemographic characteristics and sexual behavior. Results-we evaluated 141 participants: 117 (82.9%) MSM, 9 (6.4%) bisexual men (BSM), and 15 (10.6%) TGW. Most (111/141, 78.7%) were older than 30 years, 89 (63.1%) had over 12 years of education, and 124 (87.9%) had a family income of up to five minimum wages. At least one STI was detected in 112 (79.4%) of the participants (86.7% among TGW). HIV infection was detected in 102 (72.3%) participants; HIV frequency was higher in BSM (7/9, 88.9%) and in MSM (89/116, 76.1%) than in TGW (5/15, 33.3%). A lower income (p = 0.004) was predictive of anal STIs, while syphilis was significantly more frequent among participants with HIV (29.1% vs. 5,3%, for HIV positive and negative, respectively, p = 0.002). Presenting at least one active STI was also associated with having had group sex in the last year (p = 0.03) and with use of sexualized drugs (p = 0.02). Conclusions-MSM and TGW present a high vulnerability to anal STIs. Number of sexual partners, use of sexualized drugs, and lower income are predictive of a higher risk of acquiring an STI in such populations.
35 - Clinical Profile and Diagnosis of Recurrent Cutaneous Leishmaniasis. Open Forum Infect Dis. 2023 Jul 22;10(8):ofad387. doi: 10.1093/ofid/ofad387.
Arruda S(1)(2), Agra-Duarte G(1), Lago J(3), Oliveira L(3), Zacarias E(1), Carvalho LP(1)(3)(4)(5), Machado PRL(3)(4)(5), de Oliveira CI(1)(4)(5), Carvalho EM(1)(3)(4)(5).
Afiliação
(1) Instituto Gonçalo Moniz, Fiocruz, Salvador, Brasil.
(2) Department of Pathology, Universidade Estadual da Bahia, Salvador, Brasil.
(3) Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brasil.
(4) Department of Medicine, Programa de Pós-graduação em Ciências da Saúde (PPGCS) da Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Brasil.
(5) Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Salvador, Brazil.
Resumo
This case-control study compared the clinical profile, parasite load, polymerase chain reaction positivity, and response to therapy in patients with recurrent cutaneous leishmaniasis (RCL) with primary cutaneous leishmaniasis (CL). The RCL patients had milder diseases with lower parasite loads, a lower number of lesions, and more self-healing diseases than primary CL patients.
36 - Risk factors for cancer in patients with primary biliary cholangitis and autoimmune hepatitis and primary biliary cholangitis overlap syndrome. Ann Hepatol. 2023 Jul-Aug;28(4):101105. doi: 10.1016/j.aohep.2023.101105.
Braga MH(1), Cançado GGL(2), Bittencourt PL(3), Couto CA(4), Guedes LV(1), Lima AMC(4), Ferraz MLG(5), Villela-Nogueira CA(6), Nardelli MJ(4), Faria LC(4), Gomes NMF(5), Oliveira EMG(7), Rotman V(6), Oliveira MB(8), da Cunha SMCF(9), Cunha-Silva M(10), Mendes LSC(11), Ivantes CAP(12), Codes L(13), de Almeida E Borges VF(14), Pace FHL(15), Pessoa MG(1), Signorelli IV(16), Coral GP(17), Filho JG(4), Chagas AL(1), Terrabuio DRB(1), Cançado ELR(1); Members of the Brazilian Cholestasis Study Group Consortium.
Afiliação
(1) Departamento de Gastroenterologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
(2) Instituto Alfa de Gastroenterologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Hospital da Polícia Militar de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
(3) Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil; Hospital Português, Salvador, Bahia, Brazil.
(4) Instituto Alfa de Gastroenterologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
(5) Disciplina de Gastroenterologia, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil.
(6) Hospital Universitário Clementino Fraga Filho e Departamento de Clínica Médica da Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
(7) Centro Universitário Lusíada - UNILUS, Santos, São Paulo, Brazil.
(8) Ambulatório Municipal de Hepatites Virais de São José dos Campos, São José dos Campos, São Paulo, Brazil.
(9) Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
(10) Divisão de Gastroenterologia (Gastrocentro), Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil.
(11) Hospital de Base do Distrito Federal, Brasília, Distrito Federal, Brazil.
(12) Serviço de Gastroenterologia, Hepatologia e Transplante Hepático, Hospital Nossa Senhora das Graças, Curitiba, Paraná, Brazil.
(13) Hospital Português, Salvador, Bahia, Brazil.
(14) Instituto de Gastroenterologia, Endoscopia e Proctologia, Uberlândia, Minas Gerais, Brazil; Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil.
(15) Serviço de Gastroenterologia e Hepatologia, Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.
(16) Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil.
(17) Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
Resumo
INTRODUCTION AND OBJECTIVES: Primary biliary cholangitis (PBC) and autoimmune hepatitis (AIH) and PBC overlap syndrome (AIH/PBC) have been associated with a higher risk of hepatocellular carcinoma (HCC) and extra-hepatic malignancy (EHM). This study aims to assess potential risk factors associated with cancer development in PBC and AIH/PBC. MATERIALS AND METHODS: The Brazilian Cholestasis Study Group database was reviewed to compare clinical and laboratory features of PBC patients with HCC and EHM with those without cancer. RESULTS: Among the 752 PBC patients enrolled, 64 of them with AIH/PBC, 87 cancers were identified in 72 patients, including 20 cases of HCC and 67 of EHM. Patients with HCC had a higher prevalence of cirrhosis (95% vs. 32.5% of those subjects without cancer, p≤0.001), smoking (55% vs. 12.3%, p≤0.001), CREST syndrome (30% vs 7.6%, p=0.003) and prior azathioprine (30% vs 8%, p= 0.005) and prednisone (35% vs 14%, p= 0.018) use, whereas patients with EHM had a higher prevalence of smoking (42.3% vs 12.4% of those subjects without cancer, p= <0.001), AMA positivity (96.6% vs 80.1%, p≤0.001), azathioprine therapy (21% vs 7.9%, p= 0.01) and concurrent other autoimmune diseases. In multivariate analysis, cirrhosis, obesity and prior azathioprine therapy were independent risk factors for HCC, while Sjogren syndrome and psoriasis were associated with EHM. Fibrates reduced EHM risk.CONCLUSIONS: The prevalence of EHM is higher when compared to HCC in PBC patients. Cirrhosis, obesity, prior azathioprine use, and concurrent autoimmune diseases were significantly associated with cancer in PBC.
37- Outcomes of recurrent stroke in patients with atrial fibrillation according to presumed etiology. Arq Neuropsiquiatr. 2023 Jul;81(7):616-623. doi: 10.1055/s-0043-1769124.
Pedreira BB(1)(2), Zachrison KS(3), Singhal A(1), Yan Z(1), Oliveira-Filho J(2), Schwamm LH(1).
Afiliação
(1) Harvard Medical School, Massachusetts General Hospital, Department of Neurology, Boston, United States.
(2) Universidade Federal da Bahia, Hospital Universitario Professor Edgard Santos, Programa de Pós-Graduação em Ciências da Saúde, Salvador BA, Brazil.
(3) Harvard Medical School, Massachusetts General Hospital and Boston, Department of Emergency Medicine, Boston, United States.
Resumo
BACKGROUND: Atrial fibrillation (AF) is a potent risk factor for stroke. The presence of competing etiologies can modify disease outcomes and demand different treatment strategies. OBJECTIVES: The primary purpose of the study was to examine the differences in outcomes for patients with AF admitted with a recurrent stroke, stratified according to the presumed etiology of the stroke. METHODS: We analyzed AF patients admitted for a recurrent ischemic stroke in an academic comprehensive stroke center. Recurrent strokes were categorized as "Cardioembolic", meaning AF without any competing mechanism, versus "Undetermined" etiology due to competing mechanisms. We used logistic regression to test the association between recurrent stroke etiology and favorable outcome (discharge home), after accounting for important covariates. RESULTS: We included 230 patients, with a mean age 76.9 (SD ± 11.3), 52.2% male, median National Institute of Health Stroke Scale (NIHSS) score of 7 (IQR 2-16). Patients with cardioembolic stroke (65.2%) had higher median NIHSS 8.5 (3-18) versus 3 (1-8) and were more likely to be treated with reperfusion therapies. The favorable outcome was reached by 64 patients (27.8%), and in-hospital mortality was 15.2% overall. After adjustment, there was no difference in outcome between patients with cardioembolic versus undetermined stroke etiology (odds ratio for discharge home: 1.41; 95% CI: 0.65-3.15). CONCLUSIONS: In this single-center sample of AF patients with history of stroke, there was no difference in discharge outcomes between those with cardioembolic and those with undetermined stroke etiology. This question warrants examination in larger samples to better understand the importance of the stroke mechanism and secondary prophylaxis.
38 - Influence of atherosclerosis risk factors on the anatomical distribution of peripheral arterial disease in patients with chronic limb-threatening ischemia: a cross-sectional study. J Vasc Bras. 2023 Jul 17;22:e20230014. doi: 10.1590/1677-5449.202300141.
Dos Santos VP(1), Cerutti CI(1), Alencar MJC(1), Queiroz AB(1), Ferreira LM(1), Fidelis C(1), de Araújo JS(1), Alves CAS(1).
Afiliação
(1) Universidade Federal da Bahia - UFBA, Hospital Universitário Professor Edgard Santos - HUPES, Salvador, BA, Brasil.
Resumo
BACKGROUND: Atherosclerosis risk factors can have different impacts on cardiovascular diseases and on the anatomical distribution of Peripheral Arterial Disease (PAD). OBJECTIVES: To study the influence of atherosclerosis risk factors on the anatomical distribution of PAD in patients with chronic limb-threatening ischemia (CLTI).METHODS: We performed an observational, cross-sectional, and analytical study that included 476 hospitalized patients with CLTI due to PAD. We compared the presence of atherosclerosis risk factors (age, gender, diabetes mellitus, smoking, and hypertension) in patients with PAD involving three different anatomic areas (aortoiliac, femoropopliteal, and infrapopliteal). Multivariate analysis was performed to identify associations between atherosclerosis risk factors and PAD distribution. RESULTS: The mean age of the 476 patients was 69 years, 249 (52%) were men, and 273 (57%) had diabetes. Seventy-four percent (353) had minor tissue loss. Multivariate analysis identified three risk factors associated with PAD anatomical distribution (gender, smoking, and DM). Women had a 2.7 (CI: 1.75-4.26) times greater chance of having femoropopliteal disease. Smokers had a 3.6-fold (CI: 1.54-8.30) greater risk of aortoiliac disease. Diabetic patients were 1.8 (CI: 1.04-3.19) times more likely to have isolated infrapopliteal occlusive disease. CONCLUSIONS: The study showed that gender, DM, and smoking impact on the anatomical distribution of PAD in patients with CLTI. Diabetic patients were more likely to have only infrapopliteal disease, women had a greater risk of femoropopliteal PAD, and smokers had a greater risk of aortoiliac occlusive disease.
39 - Identification of a second genetic alteration in patients with SHOX deficiency individuals: a potential explanation for phenotype variability. Eur J Endocrinol. 2023 Sep 1;189(3):387-395. doi: 10.1093/ejendo/lvad128.
Dantas NCB(1), Funari MFA(2), Lerário AM(3), Andrade NLM(1), Rezende RC(1), Cellin LP(1), Alves C(4), Crisostomo LG(5), Arnhold IJP(2), Mendonca B(2), Scalco RC(1)(6), Jorge AL(1).
Afiliação
(1) Unidade de Endocrinologia Genetica, Laboratorio de Endocrinologia Celular e Molecular LIM/25, Disciplina de Endocrinologia, Faculdade de Medicina da Universidade de Sao Paulo, 01246-903 Sao Paulo, SP, Brazil.
(2) Unidade de Endocrinologia do Desenvolvimento, Laboratorio de Hormonios e Genetica Molecular LIM/42, Disciplina de Endocrinologia, Faculdade de Medicina da Universidade de Sao Paulo, 05403-900 Sao Paulo, SP, Brazil.
(3) Department of Internal Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Michigan, Ann Arbor, MI 48105, United States.
(4) Pediatric Endocrinology Unit, Hospital Universitario Prof. Edgard Santos, Faculdade de Medicina, Universidade Federal da Bahia, 40026-010 Salvador, BA, Brazil.
(5) Department of Pediatrics, Centro Universitário Sao Camilo, 04263-200 Sao Paulo SP, Brazil.
(6) Disciplina de Endocrinologia, Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo, 01221-020 Sao Paulo SP, Brazil.
Resumo
OBJECTIVE: Our study aimed to assess the impact of genetic modifiers on the significant variation in phenotype that is observed in individuals with SHOX deficiency, which is the most prevalent monogenic cause of short stature. DESIGN AND METHODS: We performed a genetic analysis in 98 individuals from 48 families with SHOX deficiency with a target panel designed to capture the entire SHOX genomic region and 114 other genes that modulate growth and/or SHOX action. We prioritized rare potentially deleterious variants.RESULTS: We did not identify potential deleterious variants in the promoter or intronic regions of the SHOX genomic locus. In contrast, we found eight heterozygous variants in 11 individuals from nine families in genes with a potential role as genetic modifiers. In addition to a previously described likely pathogenic (LP) variant in CYP26C1 observed in two families, we identified LP variants in PTHLH and ACAN, and variants of uncertain significance in NPR2, RUNX2, and TP53 in more affected individuals from families with SHOX deficiency. Families with a SHOX alteration restricted to the regulatory region had a higher prevalence of a second likely pathogenic variant (27%) than families with an alteration compromising the SHOX coding region (2.9%, P = .04). CONCLUSION: In conclusion, variants in genes related to the growth plate have a potential role as genetic modifiers of the phenotype in individuals with SHOX deficiency. In individuals with SHOX alterations restricted to the regulatory region, a second alteration could be critical to determine the penetrance and expression of the phenotype.
40 - Outcome of Second Primary Malignancies Developing in Multiple Myeloma Patients. Cancers (Basel). 2023 Sep 1;15(17):4359. doi: 10.3390/cancers15174359.
Avivi I(1), Vesole DH(2), Davila-Valls J(3), Usnarska-Zubkiewicz L(4), Olszewska-Szopa M(4), Milunovic V(5), Baumert B(6), Osękowska B(6), Kopińska A(7), Gentile M(8), Puertas-Martinez B(9), Robak P(10), Crusoe E(11), Rodriguez-Lobato LG(12), Gajewska M(13), et al.
Afiliação
(1) Department of Hematology, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
(2) Hackensack University Medical Center, New Jersey Medical School, Rutgers University, Hackensack, NJ 07601, USA.
(3) Hospital Nuestra Señora de Sonsoles, 05004 Ávila, Spain.
(4) Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, 50-556 Wroclaw, Poland.
(5) Division of Hematology, Clinical Hospital Merkur, 10000 Zagreb, Croatia.
(6) Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland.
(7) Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, 40-032 Katowice, Poland.
(8) Hematology Unit AO of Cosenza, Cosenza and Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy.
(9) Instituto de Investigación Biomédica de Salamanca (IBSAL), Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, University Hospital of Salamanca, 37007 Salamanca, Spain.
(10) Department of Hematology, Copernicus Memorial Hospital, Medical University of Lodz, 90-752 Lodz, Poland.
(11) Universidade Federal da Bahia, Hospital Universitário Professor Edgar Santos, Serviço de Hematologia, Salvador 40110-909, BA, Brazil.
(12) Amyloidosis and Multiple Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, IDIBAPS, 08036 Barcelona, Spain.
(13) Department of Internal Medicine and Hematology, Military Institute of Medicine, 04-141 Warsaw, Poland.
Resumo
BACKGROUND: There is an increased risk of second primary malignancies (SMPs) in patients with multiple myeloma (MM). This multinational 'real-world' retrospective study analyzed the characteristics and outcomes of MM patients that developed SPMs.RESULTS: 165 patients were analyzed: 62.4% males; 8.5% with a prior cancer; 113 with solid SPMs, mainly ≥stage 2; and 52 with hematological SPM (hemato-SPM), mainly MDS/AML. Patients with hemato-SPM were younger (p = 0.05) and more frequently had a prior AutoHCT (p = 0.012). The time to SPM was shorter in the older (>65 years) and more heavily pretreated patients. One hundred patients were actively treated at the time of SPM detection. Treatment was discontinued in 52, substituted with another anti-MM therapy in 15, and continued in 33 patients. Treatment discontinuation was predominant in the patients diagnosed with hemato-SPM (76%). The median OS following SPM detection was 8.5 months, and the main cause of death was SPM. A poor ECOG status predicted a shorter OS (PS 3 vs. 0, HR = 5.74, 2.32-14.21, p < 0.001), whereas a normal hemoglobin level (HR = 0.43, 0.19-0.95, p = 0.037) predicted longer OS. CONCLUSIONS: With the continuing improvement in OS, a higher proportion of MM patients might develop SPM. The OS following SPM diagnosis is poor; hence, frequent surveillance and early detection are imperative to improve outcomes.
41 - Discussing clozapine adverse effects and monitoring strategies: a focus on ethnic diversity. Braz J Psychiatry. 2023 Oct 4. doi: 10.47626/1516-4446-2023-3289.
Caliman-Fontes AT(1), Leal GC(1), Gadelha A(2), Quarantini LC(1).
Afiliação
(1) Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil. Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
(2) Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil.
Resumo
We read with great interest the article by Goldani et al.,1 which found that clozapine did not increase neutropenia risk in a sample of 5,847 psychiatric patients – 1,038 on clozapine – from Hospital de Clínicas de Porto Alegre. The study design was retrospective; data were collected from electronic medical records (EMR). Cox regression analysis identified ethnicity (specifically non-Hispanic white) and absolute neutrophil count (ANC) > 2,000/µL during the first year of monitoring as protective factors against neutropenia. Presence of severe medical conditions was a risk factor, while clozapine use was not. These data hold considerable significance; nonetheless, we have some concerns about the conclusions drawn therefrom. First, we have reservations about its external validity to inform updates of nationwide monitoring strategies. Porto Alegre is the capital of Rio Grande do Sul, a southern state of Brazil, with most of its population descending from European immigrants. More than 85% of the Goldani et al. sample comprised white non-Hispanics. This is not representative of the Brazilian population – with only 43% of white ethnicity and over 50% of self-declared black or mixed ethnicity according to the last national survey, conducted in 20212 –, which could lead to bias, such as a different incidence of benign ethnic neutropenia (BEN). BEN is knowingly associated with African, Arabian and Mediterranean ancestry, and could potentially lead to lower ANC at baseline and/or after treatment initiation.3 The absolute risk of low ANC consistently showed higher numerical values in the clozapine group. Limitations related to study design – retrospective, EMR-based – and power should be taken into account when interpreting the results as a lack of association between clozapine and moderate neutropenia. We have concerns over the possible clinical translation to psychiatric practice of such statements. Despite these issues, we agree with the article’s fundamental conclusions. Agranulocytosis is indeed a relatively infrequent adverse event – with a reported incidence of 0.9%4 – and excessive precaution should not preclude the prescription of clozapine to patients in need. In a recent review of monitoring strategies worldwide, countries with the highest rates of clozapine usage5 were among those with the least stringent monitoring guidelines.6 These findings reinforce the idea that modifying monitoring strategies could enhance access to clozapine treatment. On the other extreme, there have been claims that monitoring should be restricted to the first months of clozapine administration.4 Against this suggestion stands evidence that, though less frequent, late-onset hematological effects of clozapine should still be a concern, with little more than 10% of agranulocytosis occurring after the second year of treatment.7 Taking all this into account, we support evidence-based flexibilizations of the monitoring strategy to improve accessibility and prescription of clozapine to at-risk populations, while acknowledging the risk of neutropenia arising from this prescription. In this regard, we believe that additional data from a more ethnically representative sample of the diverse Brazilian population is needed to support more generalizable treatment monitoring guidelines – which should also consider specificities when defining ANC thresholds, such as for patients with BEN.
42 - Chronic Coronary Syndrome In Brazil: We Need To Know More. Arq Bras Cardiol. 2023 Dec;120(10):e20230723. doi: 10.36660/abc.20230723.
Latado AL(1)(2), Braga JCV(2).
Afiliação
(1) Universidade Federal da Bahia - Faculdade de Medicina da Bahia, Salvador, BA - Brasil.
(2) Universidade Federal da Bahia - Hospital Universitário Professor Edgard Santos/EBSERH, Salvador, BA - Brasil.
Resumo
Chronic coronary syndrome (CCS) is a heterogeneous group of diseases encompassing obstructive and non-obstructive coronary atherosclerotic disease with or without previous myocardial infarction (MI) or coronary revascularization, in addition to the disease diagnosed only by non-invasive tests.1 According to data from the Global Burden of Disease (GBD) Study, the total number of people living with ischemic heart disease in Brazil, whether symptomatic or not, increased from 1.48 million to more than 4 million between 1990 and 2019.2 Population growth, aging, and the increase in diagnosis are the main justifications for this phenomenon.2,3 Although remaining the main cause of death, mortality from ischemic heart disease has decreased over the last three decades in practically all of Brazil, although some regional variations have been described.2-4 Men are more affected than women, and an inverse relationship is described between the mortality rate from ischemic heart disease and the educational or economic level of the regions.3,5 Despite the growing existence of national data on ischemic heart disease, regional or local cohorts to assess its long-term prognosis are scarce, even more so if we consider the need for frequent updates regarding emerging treatment strategies.In the article Two-Year Follow-Up of Chronic Ischemic Heart Disease Patients in a Specialized Center in Brazil of this edition,6 the authors describe the clinical-demographic profile and prognosis of patients with chronic ischemic heart disease (CIHD), followed at a tertiary cardiology care center, the Instituto do Coração (InCor), in São Paulo, Brazil. The registry was prospective, recruited participants between 2016 and 2018, and had a median follow-up time of 2.4 years. Six hundred twenty-five patients were included, but only 533 had follow-up evaluations. The sample had a median age of 66, a third of women, and a high prevalence of morbidities, including 87% of previous cardiovascular events/procedures. The study revealed a small improvement in lipid control during follow-up, especially in LDL cholesterol, but without an apparent correspondence with the prescribed therapy since statins had a similar proportion of prescriptions at the final and baseline moments. The authors draw attention to the low prescription of additional lipid-lowering agents. However, there is no description of the frequency of use of potent statins at the maximum dose, which is recommended before combining other medications. At this point, it would also be important to describe local practice, as the Unified Health System provides simvastatin free of charge, but atorvastatin only through a bureaucratic process, which limits its use. In a public service in the same state, only 3% of outpatient prescriptions were for atorvastatin 80mg/d.7 Interpretation of these findings is limited. The study evaluated participants at baseline and each year of follow-up, preferably in face-to-face visits, although these were not guaranteed. Furthermore, there was a high loss to follow-up (11.5%), and there is no description of whether this was associated with risk factors, which may compromise the reliability of information. Furthermore, prescription does not mean treatment adherence. Regarding clinical outcomes, Moreira et al.6 found a 7% incidence of death, MI, or CVA (primary outcome) at the end of follow-up. This finding should be compared to the results of other cohorts and generate reflections, although methodological differences and regional variations may justify differences in the incidence of outcomes. The international multicenter registry CLARIFY8 found 8% cardiovascular death or MI (primary outcome) in a 5-year follow-up of patients with CCS. The secondary outcome, composed of cardiovascular death, non-fatal MI, and non-fatal stroke, closer to the primary outcome of study by Moreira et al.6, occurred in 9.5%. The CLARIFY cohort evaluated over 30,000 individuals in 45 countries of varying socioeconomic levels. In addition to different follow-up times, the CLARIFY study adjudicated the primary outcome. In the Brazilian REACT registry (2021), 5076 patients were followed for one year, of which two-thirds were in secondary prevention. The incidence of fatal and non-fatal atherosclerotic cardiovascular events was estimated at 5.46 per 100 patient-years.9 The sample profile revealed similarities with the study,6 however, methodological differences make comparisons difficult. Another interesting finding of the study6 was the reduction in angina over the 2.4-year follow-up, with an increase in the percentage of asymptomatic patients at the final evaluation.6 This data was also found in the CLARIFY registry when evaluating 7212 individuals with CCS and angina pectoris, who underwent optimized medical therapy and showed a 40% reduction in anginal symptoms in one year.10 The absence or improvement of angina was associated with a lower incidence of major cardiovascular outcomes, such as death from cardiovascular causes and non-fatal MI,10 which supports recommendations for optimized pharmacological therapy as a primary strategy in patients with CCS.11 The study6has limitations related to convenience sampling, sample size, relatively short follow-up times, and eminently exploratory inferential statistics. Loss to follow-up was high, and the lack of adjudication of events may reduce internal validity. However, the study information is important, contemporary, and useful in characterizing patients with SCC and their medium-term prognosis. It signals the need for similar studies at regional or national multicenter research to obtain information on the effectiveness of therapies and the clinical evolution of patients with SCC.
43 - Discharge outcomes as predictors of social participation in the community after a stroke: a cohort study. Int J Rehabil Res. 2023 Dec 1;46(4):325-330. doi: 10.1097/MRR.0000000000000599.
Souza FR(1), Sales M(1), Laporte LR(2), Melo A(1)(3), Ribeiro NMDS(1)(4).
Afiliação
(1) Grupo de Pesquisa em Atenção Integral a pessoas com doenças raras e doenças crônicas, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brasil.
(2) Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brasil.
(3) Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brasil.
(4) Departamento de fisioterapia, Instituto Multidisciplinar de Reabilitação e Saúde, Universidade Federal da Bahia, Salvador, Bahia, Brasil.
Resumo
The mapping of possible predictors of restrictions in the social participation of people after stroke in the community can be an essential tool to support the development of rehabilitation strategies even in the hospital environment. This study aimed to identify whether mobility, functional balance and dependence on functionality at hospital discharge can predict restrictions on social participation 1 year after stroke in the community. This is a hospital-based cohort study, with individuals over 18 years old admitted with a diagnosis of acute stroke included. People with dementia, previous functional limitations and cancer patients were omitted. Mobility, balance and functional independence were the predictor variables at hospital discharge, and the outcome of interest was social participation assessed 1 year after a stroke in the community. Forty-eight patients were included after a 1-year follow-up. The degree of functional independence at hospital discharge ( β = 0.813; P < 0.01) was the independent predictor of social participation, specifically the locomotion ( β = 0.452; P < 0.001) and social cognition ( β = 0.462; P < 0.001) related to functional independence. Mobility ( β = 0.040; P = 0.777) and functional balance ( β = 0.060; P = 0.652) did not show an independent association. Cognitive functional independence was a predictor of daily activities ( β = 0.786; P < 0.001), social roles ( β = 0.390; P = 0.014) and satisfaction (β = 0.564; P < 0.001) of social participation. The degree of functional independence of people after a stroke at hospital discharge was able to predict the level of social involvement in the community one year after
44 - Introduction of chikungunya virus in coastal northeast Brazil. Lancet Microbe. 2023 Oct;4(10):e764. doi: 10.1016/S2666-5247(23)00176-3.
Postigo-Hidalgo I(1), Jo WK(1), Pedroso C(2), Brites C(2), Drexler JF(3).
Afiliação
(1) Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Virology, 10117 Berlin, Germany.
(2) Hospital Universitário Professor Edgard Santos, Universidade Federal de Bahia, Salvador, Brazil.
(3) Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Virology, 10117 Berlin, Germany; German Centre for Infection Research (DZIF), associated partner Charité-Universitätsmedizin Berlin, Berlin, Germany.
Resumo
We read the article by William M de Souza and colleagues with great interest.1 Their study traces chikungunya virus (CHIKV) since its introduction in Brazil around 2013, and highlights spatial variability in viral spread. Among other laboratory tests, they consider people with CHIKV IgG or IgM antibodies as having confirmed infections. However, alphaviral antigenic relatedness2 can compromise serological diagnosis of past CHIKV infections. In northeast Brazil, the 600 000-inhabitant city of Feira de Santana, located in the hinterland of the Brazilian state Bahia, is a CHIKV hot spot.3 To probe CHIKV introduction into coastal northeast Brazil, we analysed CHIKV-specific antibodies in 2074 serum samples from asymptomatic patients attending the HIV outpatient clinic at Hospital Universitário Professor Edgard Santos, Salvador, for antiretroviral therapy and CD4 cell count monitoring from 2007 to 2021. Salvador is about 100 km from Feira de Santana and the biggest city in northeast Brazil with about 3 million inhabitants, ecologically highly suitable for Aedes-borne infections as illustrated by the explosive spread of Zika virus.4 Our results showed that CHIKV IgG ELISA detection rates increased during 2014 onwards compared with 2007–13; from 2·0% (n=12; 95% CI 2·0–3·4) to 18·0 % (n=262; 17·9–20·0; χ2, p<0·0001). The increase in IgG seroprevalence and the detection of two epidemic CHIKV waves paralleled notified cases from Bahia, suggesting robustness of our data (appendix p 1). Using a custom-made pan-alphavirus immunofluorescence IgG assay (IFA) for ELISA-positive sera, we found cross-reactivity with Mayaro virus (MAYV), Ross River virus (RRV), and O’nyong’nyong virus (ONNV) at lower dilution steps (1:10) in serum samples from both periods (appendix p 2). Endpoint titration improved specificity but was not enough to diagnose CHIKV confidently, as cross-reactivity with ONNV or MAYV was still present at higher dilutions (1:100) and no reactivity overall was detectable at 1:1000 serum dilution (appendix p 2). All ELISA-positive samples before 2014 were negative by CHIKV-specific plaque reduction neutralisation tests (PRNT)50; in contrast, 30 (78·9%, 95% CI 63·6–88·9; Fisher's exact test p<0·0001) of a randomly selected subset of 38 post-2014 ELISA-positive samples were positive by CHIKV PRNT50 at a median endpoint titre of 1:102 (range 1:23–540). Likewise, post-2013 samples yielded significantly higher CHIKV IgG ELISA ratios (Welch's t-test p=0·029), which is consistent with the onset of CHIKV circulation and false-positive ELISA results pre-2014. One IgG ELISA-reactive sample from 2016 yielding equal IFA reactivity patterns for CHIKV, ONNV, and MAYV at 1:10 serum dilution showed a MAYV-specific PRNT titre of 1:180, whereas no neutralisation of CHIKV was detected (appendix p 3). Comparing all ELISA results validated by PRNT (appendix p 3), we found a low positive predictive value (60·0%, 95% CI 45·2–73·6) and a high negative predictive value (96·0%, 78·9–99·9) for IgG ELISA. Those data were consistent with high false-positive ELISA rates in febrile patients from Salvador during low CHIKV circulation.5 In addition to cross-reactivity of alphaviral immune responses, false-positive ELISA results in our cohort could be due to HIV-induced polyclonal B-cell activation.6 Altogether, our data emphasise the necessity of confirmation of results from less specific tests such as ELISA by PRNT—while acknowledging lower sensitivity of the latter—particularly beyond epidemics, since IFA testing also did not yield unambiguous results. Our results suggest CHIKV introduction into Salvador during late 2013 to 2014 followed by gradually increased circulation, which is consistent with the first notified chikungunya case from Bahia during September, 2014 (appendix p 1). Our data align with the authors’ data on spatial spread variance, and underline the necessity of addressing serological cross-reactivity for precise alphavirus infection diagnostics, particularly in areas of co-endemicity of different alphaviruses, such as MAYV and CHIKV in Latin America.2 We declare no competing interests. This study was supported by the DFG project COALITION (project number DR 810/6-1), the European Union's Horizon 2020 Research and Innovation Program through the ZIKAlliance project (grant number 734548), and the Host Switching Pathogens, Infectious Outbreaks and Zoonosis (HONOURS) innovative training network (grant number 721367). All samples were collected and tested under permit number 1.408.499 issued by the Federal University of Bahia research ethics board Climério de Oliveira.
45 - EVALUATION OF OUTCOMES IN INTERVENTION RANDOMIZED CLINICAL TRIALS - DISTAL RADIUS FRACTURES. Acta Ortop Bras. 2023 Sep 8;31(spe3):e267872. doi:10.1590/1413-785220233103e267872.
Meira DA(1), Moriyama LE(2), Santos CCS(3), Moreira FD(4), Guedes A(4)(5), de Mattos ESR(4)(6).
Afiliação
(1) Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil.
(2) Fundação Universidade Federal da Grande Dourados, Faculdade de Medicina, Dourados, MS, Brazil.
(3) Universidade Federal da Bahia, Faculdade de Medicina da Bahia, Salvador, BA, Brasil.
(4) Universidade Federal da Bahia, Complexo Hospitalar Universitário Professor Edgard Santos, Programa de Residência Médica em Ortopedia e Traumatologia, Empresa Brasileira de Serviços Hospitalares, Salvador, BA, Brazil.Universidade Federal da Bahia, Faculdade de Medicina da Bahia, Departamento de Cirurgia Experimental e Especialidades Cirúrgicas, Salvador, BA, Brazil.
(5) Universidade Federal da Bahia, Unidade do Sistema Neuro-Músculo-Esquelético,
(6) Empresa Brasileira de Serviços Hospitalares, Salvador, BA, Brazil.
Resumo
OBJECTIVES: Describe the frequency and types of outcomes in randomized clinical trials (RCT) of intervention for distal radius fractures, analyze how confusing outcome presentations can lead to misinterpretations, and suggest strategies to improve the reader's understanding of the decision-making process. METHODS: A retrospective study was conducted through a systematized search on the PubMed® database in the last 10 years, in which only intervention RCT was included for distal radius fractures, and outcomes were analyzed. RESULTS: Of the primary outcomes analyzed in the 75 selected articles, 46.6% were classified as clinical outcomes, 20% as surrogate, 30.6% as composite, 1.3% as complex scales, and 1.3% as safety outcomes. 34.7% of the articles did not report adverse events. CONCLUSION: The presentation of outcomes with little clinical relevance represented more than half of the sample (53.4%) - such studies can harm the reader since they confuse the interpretation of scientific evidence; the Core Outcome Measures in Effectiveness Trials (COMET) initiative could help health professionals in understanding and selecting the most appropriate therapeutic interventions for patients. Level of Evidence III; Retrospective comparative study .
46 - T cell-and non T cell-mediated delayed hypersensitivity to dupilumab. J Eur Acad Dermatol Venereol. 2023 Sep;37(9):e1180-e1182. doi: 10.1111/jdv.19182.
de Magalhães AR(1)(2), Machado GU(2), Lefèvre MA(3), Garreau AC(4), Nicolas JF(3)(4), Vocanson M(4), Mosnier A(3), Pralong P(5), Nosbaum A(3)(4).
Afiliação
(1) Serviço de Dermatologia, Universidade Federal da Bahia, Complexo Hospitalar Universitário Professor Edgard Santos, Salvador, Bahia, Brazil.
(2) Serviço de Imunologia, Universidade Federal da Bahia, Complexo Hospitalar Universitário Professor Edgard Santos, Salvador, Bahia, Brazil.
(3) CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France.
(4) Service d'Allergologie et Immunologie Clinique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France.
(5) Department of Dermatology, Allergology and Photobiology, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France.
Resumo
Dupilumab, a human monoclonal antibody (mAb) targeting the α-subunit of the interleukin 4 receptor, is the first biological therapy for the treatment of atopic dermatitis (AD).1 njection site reactions affect 15.9% of treated patients, usually mild and not leading to drug discontinuation.2, 3 Each injection consists of the subcutaneous administration of 300 mg of the mAb with excipients, including polysorbate 80. We report two cases of delayed reactions to dupilumab responsible for severe local inflammation at the injection sites and discontinuation of treatment. For one case, readministration with slow infusion rate was possible. Although the clinical presentation of the two cases was very similar and evocative of a delayed skin allergy, only one corresponded to a typical type IV hypersensitivity reaction with the presence of circulating dupilumab-specific T cells. We report the cases of a 52-year-old (Patient 1) and a 56-year-old (Patient 2) female patients, followed for severe AD with multiple previous treatment failures. After the first subcutaneous injections of dupilumab (two injections of 300 mg) on both sides of the abdomen, they presented a local reaction in the following 24 hours, characterized by itchy, painful and infiltrated inflammatory plaques on both injection sites, of maximum diameter of 10 cm at 48 h (Figure 1), with resolution in 8 days. Two weeks later, the lesions recurred 24 h after the second dose (Figure 1). The first patient had presented a similar reaction 1 year before, after injection of tralokinumab, 10 months after the start of treatment. The diagnosis of delayed hypersensitivity to dupilumab was made and skin tests were performed which confirmed the diagnosis by showing a strong positive intradermal test (IDT) of the pure and 1/10 diluted dupilumab preparation (Figure 1). Polysorbate 80, a described allergen present as excipient, was also tested by prick test and IDR, both negative. To better understand the mechanisms underlying the delayed allergic reactions in the two patients we performed an ex-vivo molecular analysis of dupilumab-induced skin inflammation (by qRT-PCR of a skin biopsy of the positive IDT and control skin) and in vitro T cell proliferation assays (Figure 2). In Patient 1, the molecular analysis of the skin lesion showed a classical type IV DTH reaction with a mixed type 1 (CD4+, CD8+, TNF-α, INF-γ) and type 2 (IL-4, IL-5, IL-13) profile (Figure 2a). The lymphocyte transformation test (LTT) was strongly positive, confirming the presence of dupilumab-specific T lymphocytes (Figure 2b). In Patient 2, a pattern of activation of innate immunity was seen in the skin lesion, with predominance of IL1β (Figure 2a). There was no evidence of CD4+ and CD8+ T cell infiltration and of type 1, type 2 or type 17 inflammation. The LTT was negative for dupilumab confirming that the immune reaction was not T cell-dependent (Figure 2b). These are the first two cases of delayed hypersensitivity to dupilumab documented by standardized skin tests, immunobiological assays (LTT) and molecular investigation of the skin lesions. Only one other case was published in 2019, with a similar clinical presentation, but without delayed test readings.4The immune-allergological investigations suggest the existence of different mechanisms for these two injection-site reactions: (i) a type IV allergic hypersensitivity for the first patient, with potential cross-reaction to tralokinumab and failure of dupilumab reintroduction. It is known that protein therapies can induce T lymphocyte responses (helper or regulatory T cells), a prerequisite for the production of anti-drug antibodies, a frequent phenomenon in patients receiving biotherapies.5 Data from Case 1 suggest that these therapeutic protein-specific T cells may have pro-inflammatory properties leading to delayed hypersensitivity. We hypothesize that Patient 1 was sensitized to T-cell epitopes in the tralokinumab primary sequence with cross-reactivity with dupilumab6; (ii) an Arthus-like reaction, that is, an immune complex-mediated reaction produced under conditions of excess antigens, for the second patient. Indeed, the clinical and allergological (IDT) characteristics of the dupilumab-induced skin reaction strongly suggest an immune-mediated reaction. However, T cells are not involved. The main argument in favour of an Arthus reaction is the strong increase in IL-1b, an innate cytokine that is mandatory for the development of tissue inflammation in Arthus disease.7, 8 In this patient, the very slow infusion of dupilumab was well tolerated. Thus, differentiating T-cell from non-T-cell-mediated delayed hypersensitivity may be useful in adjusting the management of biotherapies, limiting their permanent discontinuation.9, 10.
47 - Weight gain in patients starting Dolutegravir-based ART according to baseline CD4 count after 48 weeks of follow up. Braz J Infect Dis. 2023 Sep-Oct;27(5):102807. doi: 10.1016/j.bjid.2023.102807.
Cardoso-Neto ÉC(1), Netto EM(1), Brites C(2).
Afiliação
(1) Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brazil.
(2) Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brazil; Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brazil.
Resumo
BACKGROUND: Excessive weight gain is a current concern among People Living with HIV (PLHIV) starting ART. OBJECTIVES: To evaluate the weight gain after 48-weeks of ART in naive patients, according with baseline CD4 count. METHODS: PLHIV starting 3TC + TDF + DTG with at least 48-weeks of follow up in two AIDS referral centers were stratified by baseline CD4 count (lower or higher than 200 cells/mm3). Data on CD4 count, HIV viral load, weight/Body Mass Index (BMI), lipids and glucose levels were collected at baseline, 24 and 48 weeks of treatment. For analysis purpose, patients were categorized according to their BMI progression. RESULTS: A total of 270 patients were included in the study. Mean CD4 count were 78.3 ± 61.7 and 536.7 ± 273 cells/mm3 for low and high CD4 count groups, respectively (p < 0.001). Baseline BMI was significantly lower in low CD4 group (21.7 vs. 23.6 Kg/m2, p < 0.001). Patients in low CD4 group gained more weight than those in high CD4 group (11.2 ± 8.5 kg vs. 2.2 ± 4.2 Kg, p = 0.004). Overall weight gain was higher in women, regardless group (13.1 ± 7.9 Kg vs. 1.4 ± 3.6 Kg for women and men, respectively, p < 0.001). The proportion of overweight/obesity significantly increased in low CD4 group. Viral suppression rate was high for both groups. At week 48 the overall proportion of overweight/obesity was like that reported for the Brazilian population. CONCLUSIONS: Weight gain in the present study indicates a "return to health" phenomenon. Excessive weight gain was more frequent in women.
48 - Seroprevalence and indexes of IgG antibodies for SARS-CoV-2 infection among People Living With HIV, tuberculosis patients and healthcare workers, in Salvador, Brazil. Braz J Infect Dis. 2023 Sep-Oct;27(5):102811. doi: 10.1016/j.bjid.2023.102811.
de Santana DS(1), Netto EM(2), Vaz SN(2), Dantas PH(1), Brites C(3).
Afiliação
(1) Universidade Federal da Bahia (UFBA/EBSERH), Hospital Universitário Professor Edgard Santos, Laboratório de Pesquisa em Infectologia, Salvador, BA, Brazil.
(2) Universidade Federal da Bahia (UFBA/EBSERH), Hospital Universitário Professor Edgard Santos, Laboratório de Pesquisa em Infectologia, Salvador, BA, Brazil; Fundação Bahiana de Infectologia, Salvador, BA, Brazil.
(3) Universidade Federal da Bahia (UFBA/EBSERH), Hospital Universitário Professor Edgard Santos, Laboratório de Pesquisa em Infectologia, Salvador, BA, Brazil; Fundação Bahiana de Infectologia, Salvador, BA, Brazil.
Resumo
INTRODUCTION: COVID-19 can trigger different clinical presentations in distinct population groups, some of which are considered at higher risk of SARS-CoV-2 infection. Little is known about the susceptibility of certain populations to the infection. OBJECTIVES: We aimed to determine the prevalence of COVID-19 among People Living With HIV/AIDS (PLWH) attending a tertiary public hospital in Salvador, Brazil, patients with active pulmonary tuberculosis and Hospital's Healthcare Workers (HCW), and to compare their SARS-CoV-2 antibody levels. METHODS: In this observational study we included 2294 participants from June 9, 2020 to August 10, 2021. IgG SARS-CoV-2 antibodies from all participants (275 PLWH, 42 with active tuberculosis and 1977 healthcare workers) were measured. Prevalence of COVID-19 and antibodies indexes were compared across groups. RESULTS: We detected a higher prevalence of COVID-19 in patients with active tuberculosis (42.9%) than in PLWH (22.5%) or HCW (11.7%). Previously vaccinated participants with a COVID-19 history had median higher IgG antibody indexes (8.2; IQR: 5.5‒10) than those vaccinated who did not have COVID-19 until the time of this study (4.1; IQR: 1.6‒6.2, p < 0.001). CONCLUSION: Prevalence of previous SARS-CoV-2 infection was higher among tuberculosis patients than that found in HCW and PLWH, but antibodies levels were similar across groups.
49 - NKG2D promotes CD8 T cell-mediated cytotoxicity and is associated with treatment failure in human cutaneous leishmaniasis. PLoS Negl Trop Dis. 2023 Aug 21;17(8):e0011552. doi: 10.1371/journal.pntd.0011552.
Sacramento LA(1), Farias Amorim C(1), Campos TM(2), Saldanha M(3), Arruda S(3), Carvalho LP(2)(3)(4), Beiting DP(1), Carvalho EM(2)(3)(4), Novais FO(5), Scott P(1).
Afiliação
(1) Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
(2) Serviço de Imunologia, Complexo Hospitalar Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.
(3) Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.
(4) Instituto Nacional de Ciências e Tecnologia-Doenças Tropicais, Salvador, Brazil.
(5) Department of Microbial Infection and Immunity, College of Medicine, The Ohio State University, Columbus,Ohio, United States of America.
Resumo
Cutaneous leishmaniasis exhibits a spectrum of clinical presentations dependent upon the parasites' persistence and host immunopathologic responses. Although cytolytic CD8 T cells cannot control the parasites, they significantly contribute to pathologic responses. In a murine model of cutaneous leishmaniasis, we previously found that NKG2D plays a role in the ability of cytolytic CD8 T cells to promote disease in leishmanial lesions. Here, we investigated whether NKG2D plays a role in human disease. We found that NKG2D and its ligands were expressed within lesions from L. braziliensis-infected patients and that IL-15 and IL-1β were factors driving NKG2D and NKG2D ligand expression, respectively. Blocking NKG2D reduced degranulation by CD8 T cells in a subset of patients. Additionally, our transcriptional analysis of patients' lesions found that patients who failed the first round of treatment exhibited higher expression of KLRK1, the gene coding for NKG2D, than those who responded to treatment. These findings suggest that NKG2D may be a promising therapeutic target for ameliorating disease severity in cutaneous leishmaniasis caused by L. braziliensis infection.
50 - Virologic response to antiretroviral therapy in people with HIV and tuberculosis in high tuberculosis burden countries. AIDS. 2023 Oct 1;37(12):1837-1842. doi: 10.1097/QAD.0000000000003521.
De Castro N(1)(2), Chazallon C(1), Brites C(3), Messou E(4)(5)(6), Khosa C(7), Laureillard D(8)(9), Chau GD(10), Pilotto JH(11), Eholié S(4)(6), Delaugerre C(12)(13)(14), Molina JM(2)(13)(14), Wittkop L(15)(16)(17), Grinsztejn B(18), Marcy O(1).
Afiliação
(1) University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France.
(2) Infectious Diseases Department, AP-HP-Hôpital Saint-Louis Lariboisière, Paris, France.
(3) Laboratório de Pesquisa em Doenças Infecciosas, Hospital Universitário Prof Edgar Santos, Bahia, Brazil.
(4) Programme PACCI/ANRS Research Center.
(5) Centre de Prise en Charge de Recherche et de Formation, CePReF-Aconda-VS, Abidjan, Cote D'Ivoire.
(6) Département de Dermatologie et d'Infectiologie, UFR des Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Cote d'Ivoire.
(7) Instituto Nacional de Saúde, Marracuene, Mozambique.
(8) Department of Infectious and Tropical Diseases, Nimes University Hospital, Nimes.
(9) Research Unit 1058, Pathogenesis and Control Chronical Infections, INSERM, French Blood Center, University of Montpellier, Montpellier, France.
(10) Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam.
(11) Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz, Rio de Janeiro, Brazil.
(12) Virology department, APHP-Hôpital Saint-Louis.
(13) INSERM U944.
(14) Université Paris Cité, Paris.
(15) University Bordeaux, INSERM, Institut Bergonié, Bordeaux.
(16) INRIA SISTM team, Talence.
(17) CHU de Bordeaux, Service d'information médicale, INSERM, Institut Bergonié, Bordeaux, France.
(18) National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Resumo
OBJECTIVE: We sought to compare virologic outcomes on antiretroviral therapy (ART) between people with HIV (PWH) also treated for tuberculosis in the different countries who participated to two randomized trials. DESIGN: Pooled analysis of two randomized clinical trials. METHODS: In the phase II Reflate TB and phase III Reflate TB2 trials conducted in Brazil, Côte d'Ivoire, Mozambique and Vietnam, ART-naïve PWH treated for tuberculosis were randomized to receive raltegravir or efavirenz. We assessed country differences in baseline characteristic using Wilcoxon tests and chi-square, or Fisher's exact test. We used logistic regression to analyze determinants of virologic success, defined as week-48 plasma HIV-1 RNA <50 copies/ml. RESULTS: Of 550 participants (140 from Brazil, 170 from Côte d'Ivoire, 129 from Mozambique and 111 from Vietnam) with median baseline HIV-1 RNA of 5.4 log 10 copies/ml, 362 (65.8%) achieved virologic success at week 48. Virologic success rates were: 105/140 (75.0%) in Brazil, 99/170 (58.2%) in Côte d'Ivoire, 84/129 (65.1%) in Mozambique and 74/111 (66.7%) in Vietnam ( P = 0.0233). Baseline HIV-1 RNA, but not the country, was independently associated with virologic success: baseline HIV-1 RNA ≥500 000 copies/ml (reference), HIV RNA <100 000 copies/ml odds ratio 3.12 [95% confidence interval (CI) 1.94; 5.01] and HIV-1 RNA 100 000-499 999 copies/ml odds ratio: 1.80 (95% CI 1.19; 2.73). Overall, 177/277 (63.9%) patients treated with raltegravir and 185/273 (67.9%) patients treated with efavirenz had a plasma HIV-1 RNA <50 copies/ml at week 48.CONCLUSIONS: Virologic response to antiretroviral therapy in PWH with TB varied across countries but was mainly driven by levels of pretreatment HIV-1 RNA.
51 - Equity program: strategies on clinical studies as an aggregating potential. Hematol Transfus Cell Ther. 2023 Oct-Dec;45(4):417-418. doi: 10.1016/j.htct.2023.07.001.
Crusoe EQ(1), Hallack Neto AE(2), Nantes DF(3), Ribeiro EFO(4), Pinto FMC(5), Bortolini JAP(6), Maciel JFR(7), Marques Junior JFC(8), Corrêa LC(9), Capra MEZ(10), Carvalho MDPSS(11), de Melo NS(12), Quintas RVO(13), Carneiro TX(14), Laforga VP(15), Cunha RLG(16).
Afiliação
(1) Hospital Universitário Professor Edgard Santos da Universidade Federal da Bahia (HUPES UFBA), Rede D'or Oncologia, Salvador, BA, Brasil.
(2) Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Clínica Médica. Hospital Albert Sabin de Juiz de Fora, Juiz de Fora, MG, Brasil.
(3) Hospital Santa Casa de Misericórdia de Campo Grande e Grupo GSH, Campo Grande, MS, Brasil.
(4) Serviço de Hematologia e Oncologia do Hospital Santa Lúcia, DF, Brasil.
(5) Oncologia Américas, Rio de Janeiro, RJ, Brasil.
(6) Clinica oncológica SOMA, Florianópolis, SC, Brasil.
(7) Hospital Rio Grande, Natal, RN, Brasil.
(8) Hospital Vera Cruz, Beneficência Portuguesa, Campinas, SP, Brasil.
(9) Centro Universitário Integrado Amaury de Medeiros - Universidade de Pernambuco (UPE), Hospital das Clínicas da Universidade Federal de Pernambuco, Grupo Oncoclínicas, Recife, PE, Brasil.
(10) Grupo Hospitalar Conceição, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brasil.
(11) Fundação de Hematologia e Hemoterapia do Estado do Amazonas (HEMOAM), Brasil.
(12) HEMOLABOR Laboratório e Pesquisas, Goiânia, GO, Brasil.
(13) Hospital de Clínicas Doutor Alberto Lima, Hospital São Camilo e São Luis, Macapá, AP, Brasil.
(14) Hospital Ophir Loyola, Belém, PA, Brasil.
(15) Unimed de Ponta Grossa, Ponta Grossa, PR, Brasil.
(16) Grupo Oncoclínicas, São Paulo-SP, Instituto Oncoclínicas, Rio de Janeiro, RJ, Brasil.
Resumo
The principle of health equity aims at equal access by all population diversities, mainly the most vulnerable ones. When it comes to the Brazilian public Unified Health System (SUS) and granting somehow access to different individuals, we still have many challenges. One challenge is the availability of new technologies, a major advance, but it tends to create imbalance between the public and supplementary health sectors, especially because of the cost involved in the process and delay of these technologies in getting to the public sector. Pondering over the aspect of equity and technological development, a tool that can substantially help is clinical research. The Brazilian Association of Hematology, Hemotherapy and Cellular Therapy (ABHH), through its Equity Program, recognizes that there is a possible convergence with this aspect and understands the importance of clinical trials for the principle of equity, once the most modern technology is linked to trials, not only in terms of therapy, but diagnosis as well, among other possibilities. Social disparities cause discomfort to the minds and hearts of true humans, and we from ABHH live with this concern. We live and work in the attempt to reduce imbalances and inequalities. We have effectively achieved some victories in making life more egalitarian. However, extra efforts should be devoted so we can successfully accomplish this aim. Essentiality points out the minimum and what, in fact, every individual needs, and the role of SUS is fundamental. It is internationally acknowledged by many as a model and carries out several population health actions. Concerning the hematologic specialty, challenges are plenty. We have few specialists and unfortunately, despite all the hard efforts made to reach the most distant corners, allowing the system capillarization, not every individual can have access to what they need. Hematology and Transfusion Medicine is a complex specialty for the management of cases and is also pioneer in the development of technologies. As a result, the specialty uses this to evolve in dealing with patients and their specificities. A critical point for general health equity, but mainly for the specialties demanding constant implementations, such as hematology, reflects in the added cost of such novelties. Unfortunately, the price of new technologies strongly contributes to limit and/or delay their arrival in SUS, making the public system inharmonious compared to the supplementary system. Health research is indispensable for moving towards our evolution and, undoubtedly, it aims at a more fulfilling and decent life. It is in constant evolution with even more enhanced rules after the Second World War. An important evolution in the clinical research model were the steps of technological development by study phases until culminating in the best model, namely the randomized trials. In these trials, individuals are randomly allocated to different groups with the purpose of obtaining a balanced sample, in other words, in balance; and then proving that there is an advantage in terms of evolution when comparing the new technology with the previous one. However, recently, still in this process of improving clinical trials, both American and European regulatory agencies have identified an imbalance concerning the type of participants on studies based on skin color and ethnicity, and they have started to demand greater participation of Black and non-white people in new trials.1 Therefore, clinical trials, randomized or not, contemplate the principle of equity at all times and keep improving. Other data advantageous to clinical research is the fact that these studies are sponsored by the pharmaceutical industry. Some will criticize, alleging that patients are offered like guinea pigs so companies can profit even more with their new treatments or tools. On the other hand, these research studies were responsible for extensively changing the course of modern medicine, unquestionably aggregating new technologies and improvements. Keep in mind that in our country it is required that patients have all research expenses covered by the sponsor, thus, decreasing the costs to the health system instead of increasing them. This whole combination for a country as Brazil, so diverse and with limitations of access to new technologies, mainly in SUS, favors patients towards equity in research participation. ABHH, along with its equity committee, has been playing a leading and key role to identify, understand, and correct potential limiting factors within hematology, transfusion medicine and cellular therapy in order to support and enhance the whole principle of equity. Within our specialty, there is a frenetic technological development and sensitizing our colleagues who develop clinical research to a joint growth with the population, in the most different places of Brazil, will be of paramount importance to allow us to follow the right track for equity expansion. We hope to change the premise that what is new and best comes first just for a few people. Let us foster the principle of equity with the implementation and encouragement for the development of clinical research, which undoubtedly adds value to everyone independently, but mainly to SUS.
52 - CCR5 promotes the migration of CD8(+) T cells to the leishmanial lesions. bioRxiv. 2023 Oct 13:2023.10.10.561700. doi: 10.1101/2023.10.10.561700. Preprint.
Sacramento LA(1), Amorim CF(1), Lombana CG(1), Beiting D(1), Novais F(2), Carvalho LP(3)(4)(5), Carvalho EM(3)(4)(5), Scott P(1).
Afiliação
(1) Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, PA 19104-4539, USA.
(2) Department of Microbial Infection and Immunity, College of Medicine, The Ohio State University, Columbus, OH, USA.
(3) Laboratório de Pesquisas Clínicas (LAPEC), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.
(4) Laboratório de Pesquisas Clínicas do Instituto de Pesquisas Gonçalo Muniz - Fiocruz, Salvador, Bahia, 40296-710, Brazil.
(5) Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Bahia, 40110-060, Brazil.
Resumo
Cytolytic CD8+ T cells mediate immunopathology in cutaneous leishmaniasis without controlling parasites. Here, we identify factors involved in CD8+ T cell migration to the lesion that could be targeted to ameliorate disease severity. CCR5 was the most highly expressed chemokine receptor in patient lesions, and the high expression of CCL3 and CCL4, CCR5 ligands, was associated with delayed healing of lesions. To test the requirement for CCR5, Leishmania-infected Rag1-/- mice were reconstituted with CCR5-/- CD8+ T cells. We found that these mice developed smaller lesions accompanied by a reduction in CD8+ T cell numbers compared to controls. We confirmed these findings by showing that the inhibition of CCR5 with maraviroc, a selective inhibitor of CCR5, reduced lesion development without affecting the parasite burden. Together, these results reveal that CD8+ T cells migrate to leishmanial lesions in a CCR5-dependent manner and that blocking CCR5 prevents CD8+ T cell-mediated pathology.
53 - Effects of three physical exercise modalities on respiratory function of older adults with Parkinson's disease: A randomized clinical trial. J Bodyw Mov Ther. 2023 Oct;36:425-431. doi: 10.1016/j.jbmt.2023.05.014.
Duarte GP(1), Ferraz DD(2), Trippo KV(1), Novais MCM(3), Sales M(4), Ribeiro NMDS(5), Oliveira Filho J(6).
Afiliação
(1) Department of Physical Therapy, Federal University of Bahia, Salvador, Brazil.
(2) Department of Physical Therapy, Federal University of Bahia, Salvador, Brazil.
(3) Department of Physical Therapy, Jorge Amado University Centre, Salvador, Brazil.
(4) Grupo de Pesquisa em Atenção Integral a Pessoas Com Doenças Raras e Doenças Crônicas, Complexo Hospitalar Universitário Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil.
(5) Department of Physical Therapy, Federal University of Bahia, Salvador, Brazil; Grupo de Pesquisa em Atenção Integral a Pessoas Com Doenças Raras e Doenças Crônicas, Complexo Hospitalar Universitário Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil.
(6) Department of Biomorphology, Federal University of Bahia, Salvador, Brazil.
Resumo
INTRODUCTION: Deficits in respiratory function of patients with Parkinson's disease contribute to aspiration pneumonia, one of the main causes of mortality in this population. The aim of this study was to evaluate the effects of functional training, bicycle exercise, and exergaming on respiratory function of elderly with Parkinson's disease. METHODS: A randomized clinical trial with single blinding was conducted in a public reference outpatient clinic for the elderly. The participants were randomly assigned to three groups. Group 1 was submitted to functional training (n = 18); group 2 performed bicycle exercise (n = 20), and group 3 trained with Kinect Adventures exergames (n = 20). The sessions performed lasted 8 weeks with a frequency of three 50-min sessions per week. The primary outcome was the forced expiratory volume in the first second; and the secondary outcomes were forced vital capacity, peak expiratory flow, and maximum inspiratory and expiratory pressures. RESULTS: The interventions performed did not improve the forced expiratory volume in the first second, forced vital capacity, and peak expiratory flow. However, group 2 improved (p = 0.03) maximum expiratory pressure (from 65.5cmH2O to 73.1cmH2O) (effect size 0.47), and group 3 increased (p = 0.03) maximum inspiratory pressure (from -61.3cmH2O to -71.6cmH2O) (effect size 0.53). CONCLUSIONS: No effect was found on lung volume, forced respiratory flow and capacity of the participants with Parkinson's disease submitted to three different modalities of motor training. However, bicycle exercise and exergaming have improved expiratory and inspiratory muscle strength, respectively.
54 - Does the intensity of dissociation predict antidepressant effects 24 hours after infusion of racemic ketamine and esketamine in treatment-resistant depression? A secondary analysis from a randomized controlled trial. Trends Psychiatry Psychother. 2023 Sep 17. doi: 10.47626/2237-6089-2022-0593.
Echegaray MVF(1), Mello RP(2), Magnavita GM(1), Leal GC(2), Correia-Melo FS(2), Jesus-Nunes AP(2), Vieira F(2), Bandeira ID(2), Caliman-Fontes AT(1), Telles M(2), Guerreiro-Costa LNF(2), Marback RF(2), Souza-Marques B(2), Lins-Silva DH(1), Santos-Lima C(3), Cardoso TA(4), Kapczinski F(4), Lacerda ALT(5), Quarantini LC(6).
Afiliação
(1) Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.
(2) Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil. Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil.
(3) Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil. Programa de Pós-graduação em Psicologia, Instituto de Psicologia, Universidade Federal da Bahia, Salvador, Brazil.
(4) Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Canada.
(5) Laboratório Interdisciplinar de Neurociências Clínicas, Universidade Federal de São Paulo, São Paulo, Brazil. Instituto Sinapse de Neurociências Clínicas, Campinas, Brazil.
(6) Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil. Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil. Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil.
Resumo
BACKGROUND: Ketamine and esketamine have both shown significant antidepressant effects in treatment-resistant depression (TRD), and conflicting evidence suggests that induced dissociation by these drugs can be a clinical predictor of esketamine/ketamine's efficacy. METHODS: This study is a secondary analysis from a bi-center, randomized, controlled trial. Participants were randomly assigned 1:1 to receive an IV infusion of esketamine (.25 mg/kg) or racemic ketamine (.50 mg/kg) over 40 minutes. Dissociative symptoms were assessed using the Clinician-Administered Dissociative State Scale (CADSS) 40 minutes following the beginning of the infusion. The variation in depression scores was measured with the Montgomery-Asberg Depression Rating Scale (MADRS), which was administered before the intervention as a baseline measure and 24 hrs, 72 hrs, and 7 days following infusion. RESULTS: Sixty-one patients were included in the analysis. Examining CADSS scores of 15 or below, for every 1-point increment in the CADSS score, there was a mean change of -0.5 (SD = 0.25; p-value 0.04) of predicted MADRS score from baseline to 24 hrs. The results for 72 hrs and 7 days following infusion were not significant. Limitations: This study was not designed to assess the relationship between ketamine or esketamine-induced dissociation and antidepressant effects as the main outcome, therefore confounding variables for this relationship were not controlled. CONCLUSION: We suggest a positive relationship between dissociation intensity, measured by CADSS, and antidepressant effect 24 hours after ketamine and esketamine infusion for a CADSS score of up to 15 points.
55 - Brazilian Psychiatric Association Guidelines on the Integration of Spirituality into Mental Health Clinical Practice: Part 1. Spiritual History and Differential Diagnosis. Braz J Psychiatry. 2023 Sep 17. doi: 10.47626/1516-4446-2023-3056.
Mosqueiro BP(1), Costa MA(2), Caribé AC(3), de Oliveira FO(2), Pizutti L(4), Zimpel RR(5), Baldaçara L(6), da Silva AG(7), Moreira-Almeida A(2).
Afiliação
(1) Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. Serviço de Saúde Comunitária Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil. Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental da ABP, Rio de Janeiro, Brazil.
(2) Research Center in Spirituality and Health (NUPES), School of Medicine, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil. Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental da ABP, Rio de Janeiro, Brazil.
(3) Escola Baiana de Medicina e Saúde Publica (EBMSP), Brazil. Hospital Universitário Professor Edgar Santos da Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil. Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental da ABP, Rio de Janeiro, Brazil.
(4) Departamento de Psiquiatria e Espiritualidade, Associação de Psiquiatria do Rio Grande do Sul (APRS), Porto Alegre, RS, Brazil.
(5) Associação de Psiquiatria do Rio Grande do Sul (APRS), Porto Alegre, RS, Brazil.
(6) Universidade Federal do Tocantins (UFT), Palmas, TO, Brazil. Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, Brazil.
(7) Asociación Psiquiátrica de América Latina (APAL). Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, Brazil.
Resumo
OBJECTIVE: To present an evidence-based guideline for clinical practice in Brazil with regard to religiosity and spirituality in mental healthcare. METHODS: A systematic review was conducted to identify potentially eligible articles indexed in the PubMed, PsycINFO, SciELO, LILACS and Cochrane databases. A summary of recommendations and the level of evidence was produced in accordance with the Oxford Centre for Evidence-Based Medicine. RESULTS: The systematic review identified 6,609 articles, 41 of which satisfied all the inclusion criteria. Obtaining the spiritual history (SH) was found to be an essential part of a compassionate and culturally sensitive approach. It represents a way of obtaining relevant information about patients' R/S, potential conflicts that could have an impact on adherence to treatment and to improve patient satisfaction. Consistent evidence shows that reported perceptual experiences do not represent reliable characteristics for differentiating between anomalous experiences and psychopathology. Negative symptoms, cognitive and behavioral disorganization, and functional impairment are more helpful characteristics for distinguishing these experiences from mental disorders. CONCLUSION: Considering the importance of R/S for many patients, SH should be routinely included in mental health care. Anomalous experiences are highly prevalent, requiring a sensitive and evidence-based approach to the differential diagnosis between these experiences and mental health symptoms.
56 - Latin American Trans-ancestry INitiative for OCD genomics (LATINO): Study protocol. Am J Med Genet B Neuropsychiatr Genet. 2023 Nov 9:e32962. doi: 10.1002/ajmg.b.32962.
Crowley JJ(1)(2), Cappi C(3)(4), Ochoa-Panaifo ME(5), Frederick RM(6), Kook M(6), Wiese AD(6), Rancourt D(7), Atkinson EG(8), Giusti-Rodriguez P(9), Anderberg JL(6); Latin American Trans-ancestry INitiative for OCD genomics; Brazilian Obsessive-Compulsive Spectrum Disorder Working Group; Abramowitz JS(10), Adorno VR(11), Aguirre C(12), Alves GS(13), Alves GS(14)(15), Ancalade N(1), Arellano Espinosa AA(16), et al.
Afiliação
(1) Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
(2) Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
(3) Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
(4) Departamento de Psiquiatria, Universidade de São Paulo, São Paulo, São Paulo, Brazil.
(5) Universidad Privada del Norte, Lima, Lima, Peru.
(6) Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.
(7) Department of Psychology, University of South Florida, Tampa, Florida, USA.
(8) Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.
(9) Department of Psychiatry, University of Florida College of Medicine, Gainesville, Florida, USA.
(10) Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
(11) Hospital Psiquiátrico de Asunción, Direccion General, Asuncion, Central, Paraguay.
(12) Departamento de Psiquiatría, Hospital Psiquiátrico de Asunción, Asuncion, Central, Paraguay.
(13) Hospital Nina Rodrigues/Universidade Federal do Maranhão (UFMA), Sao Luis do Maranhao, Maranhao, Brazil.
(14) Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Laboratório de Neuropsicofarmacologia-LANP, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
(15) Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Pós-Graduação em Medicina e Saúde, Salvador, Bahia, Brazil.
(16) Talk TOC, Ciudad de Mexico, Mexico.
Resumo
Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder. Worldwide, its prevalence is ~2% and its etiology is mostly unknown. Identifying biological factors contributing to OCD will elucidate underlying mechanisms and might contribute to improved treatment outcomes. Genomic studies of OCD are beginning to reveal long-sought risk loci, but >95% of the cases currently in analysis are of homogenous European ancestry. If not addressed, this Eurocentric bias will result in OCD genomic findings being more accurate for individuals of European ancestry than other ancestries, thereby contributing to health disparities in potential future applications of genomics. In this study protocol paper, we describe the Latin American Trans-ancestry INitiative for OCD genomics (LATINO, https://www.latinostudy.org). LATINO is a new network of investigators from across Latin America, the United States, and Canada who have begun to collect DNA and clinical data from 5000 richly phenotyped OCD cases of Latin American ancestry in a culturally sensitive and ethical manner. In this project, we will utilize trans-ancestry genomic analyses to accelerate the identification of OCD risk loci, fine-map putative causal variants, and improve the performance of polygenic risk scores in diverse populations. We will also capitalize on rich clinical data to examine the genetics of treatment response, biologically plausible OCD subtypes, and symptom dimensions. Additionally, LATINO will help elucidate the diversity of the clinical presentations of OCD across cultures through various trainings developed and offered in collaboration with Latin American investigators. We believe this study will advance the important goal of global mental health discovery and equity.
57 - Women living with HTLV-1 should have the opportunity to make informed decisions on prevention of mother-to-child transmission. Lancet Glob Health. 2023 Aug;11(8):e1181. doi: 10.1016/S2214-109X(23)00268-1.
Rosadas C(1), Senna K(2), da Costa M(3), Assone T(4), Casseb J(4), Nukui Y(5), Cook L(6), Mariano L(5), Galvão-Castro B(7), Rios Grassi MF(8), Penalva de Oliveira AC(9), Caterino-de-Araujo A(10), Malik B(11), Boa-Sorte N(12), Peixoto P(13), Puccioni-Sohler M(14), Santos M(2), Taylor GP(15).
Afiliação
(1) Section of Virology, Department of Infectious Disease, Imperial College London, London, UK.
(2) Núcleo de Avaliação de Tecnologias em Saúde, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil.
(3) Núcleo de Avaliação de Tecnologias em Saúde, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil; Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
(4) Departamento de Dermatologia, Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
(5) Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
(6) National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, London, UK.
(7) Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil.
(8) Instituto Gonçalo Muniz, Fundação Oswaldo Cruz, Salvador, Brazil.
(9) Instituto de Infectologia Emílio Ribas, São Paulo, Brazil.
(10) Centro de Imunologia, Instituto Adolfo Lutz, São Paulo, Brazil.
(11) Centre for Economics of Obesity, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
(12) Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil; Health Technology Assessment Unit, Hospital Universitário Professor Edgar Santos, Universidade Federal da Bahia, Salvador, Brazil.
(13) Faculdade de Medicina Veterinária, Universidade Estácio de Sá, Rio de Janeiro, Brazil.
(14) Escola de Medicina e Cirurgia, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Programa de Pós-graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
(15) Section of Virology, Department of Infectious Disease, Imperial College London, London, UK; National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, London, UK.
Resumo
No one could disagree with the title of the Comment by Jane Fisher1 in response to our health economic research2—ie, “Recommendations against breastfeeding require consultation with women for effective implementation”. Such consultations with women living with human T-cell lymphotropic virus type 1 (HTLV-1) shaped our research,2 while the absence of antenatal screening excludes women from any shared decision making. We endorse the need for antenatal screening but ensuring optimal resource allocation is key and drove our economic analysis of HTLV-1 antenatal screening. Because we used the perspective of the Ministry of Health, the costs to parents, as suggested in the Comment,1 cannot be considered. As stated in our study,2 exclusive formula feeding prevents 85% of vertical transmissions and is the most common recommendation for women living with HTLV-1.3 Literature and patients' perspectives indicate that acceptance is high3, 4 and we highlighted the importance of ensuring that such an intervention is acceptable, feasible, affordable, sustainable, and safe.2 We strongly advocate for breastfeeding and initiatives such as Baby-Friendly Health are more than welcomed. However, such advocacy should not be detrimental to women who, for whatever reason, opt not to or cannot breastfeed. Women must have autonomy to make informed decisions and receive the correct support. Regarding HTLV-1, to make an informed decision, women must know their serostatus and have access to proper care and accurate information to weigh the risk and benefits of interventions. Accurate information is key, and, in many areas, health-care professionals have scarce knowledge about HTLV-1,4, 5 resulting in an underestimation of the effect of HTLV-1, and a paternalistic approach that does not mirror the community perspective.5 Statements that breastfeeding is the major source of maternal love and imperative for a healthy life are detrimental to people living with HTLV-1 or other conditions where breastfeeding might lead to harm. In addition, the stigma that women living with HTLV-1 might endure, because of their feeding choice, should not influence the decision not to screen, it should be catalytical for change in society. We strongly agree that women must be consulted. Unfortunately, those living with HTLV-1 have been ignored for more than 40 years. Few policymakers have been listening to their demands to implement policies to avoid new infections and protect future generations. Women must have the opportunity to know if they are infected by HTLV-1. Women living with the virus must receive accurate information, have autonomy to make their decision regarding prevention of HTLV-1 mother-to-child transmission, and receive support regardless of their choice of feeding strategy. We declare no competing interests.