European Journal of Heart Failure Supplements, 2005
... Basic Science 686 Alterations in troponin I phosphorylation could account for the contractile... more ... Basic Science 686 Alterations in troponin I phosphorylation could account for the contractile defect in failing heart AM Jacques, S. Marston, A. Messer National Heart and Lung Institute, Cardiac Medicine, London, United Kingdom ... Pinho-Filho 4, A. Mota:, A.AG. ...
The origin of metastatic adenocarcinoma lesions can sometimes be difficult to diagnose. The objec... more The origin of metastatic adenocarcinoma lesions can sometimes be difficult to diagnose. The objectives of our study were to establish the cytokeratin staining pattern of primary and metastatic lung and colorectal adenocarcinomas, and to determine if this helps to identify the site of origin of metastatic lesions. We reviewed a total of 102 tissue samples from patients in our tumour registry, with either primary or metastatic lung or colorectal adenocarcinoma. Tissue sections were stained for cytokeratin 7 and 20 and read as positive or negative for staining. Clinical and radiologic information was reviewed from computerised charts. The cytokeratin 7+/cytokeratin 207 pattern characterised 96% (29 out of 30) of primary and 95% (21 out of 22) of metastatic lung adenocarcinomas. All the primary (26), and 88% (21 out of 24) of metastatic colorectal adenocarcinomas stained cytokeratin 77/cytokeratin 20+. Samples from a variety of metastatic sites were evaluated for cytokeratin 7 and 20 staining. Out of the 102 samples, in 95% (97 out of 102) of the cases, the cytokeratin 7 and cytokeratin 20 staining pattern characterised and differentiated between lung and colorectal adenocarcinoma. Primary and metastatic lung adenocarcinomas show a cytokeratin 7+/cytokeratin 207 staining pattern, while colorectal adenocarcinomas stain cytokeratin 77/cytokeratin 20+. Cytokeratin staining is helpful in the diagnostic differentiation of metastatic lesions from these two common primaries, and assists in determining the site of origin of metastatic lesions.
A imuno-oncologia contemporânea é separada atualmente em quatro grandes categorias: estimulação i... more A imuno-oncologia contemporânea é separada atualmente em quatro grandes categorias: estimulação imune não específica, terapia imune celular, imunização ativa e tratamento com anticorpos monoclonais. Esta revisão tem como escopo principal trazer o estado da arte no uso de anticorpos monoclonais que atuam como inibidores dos pontos de checagem imunológica (IPCI). São sete os IPCIs atualmente em uso clínico: um inibidor do CTLA-4 (ipilimumabe), três inibidores do PD-1 (pembrolizumabe, nivolumabe e cemiplimabe) e três inibidores do PD-L1 (atezolizumabe, avelumabe, durvalumabe). Os dados compilados sugerem que a imunoterapia é efetiva em inúmeros tumores, em diferentes cenários (primeira, segunda ou terceira linhas de tratamento), bem como quando comparado a diferentes regimes terapêuticos (quimioterapia com droga única, quimioterapia com mais de uma droga, inibidores de tirosina cinase e placebo). Em relação aos efeitos adversos associados ao uso dos inibidores dos pontos de checagem im...
Abstract Objectives To date, it is unknown whether systematic biopsies can be safely omitted in p... more Abstract Objectives To date, it is unknown whether systematic biopsies can be safely omitted in patients with unsuspicious MRI findings or if systematic biopsies should be required when targeting focal lesions (PI-RADS 3–5). Methods A series of 366 patients (249 without a previous biopsy) were examined in a 1.5 Tesla MRI scanner. All patients were submitted to systematic biopsies (12–14 regions) with additional targeted biopsies (by cognitive fusion) of focal PI-RADS lesions (PI-RADS 3–5). Results In our series, patients with PI-RADS 1/2 findings had rates of adenocarcinoma of any grade, >GG1 and GG4/5 of 34%, 14% and 3%, respectively. The use of MRI prior to biopsy in our series increased the detection of clinically significant prostate cancer (CSPCa) in 28% of patients with focal lesions, and focal lesions were present in 293/366 (80%) of all patients. For CSPCa (>GG1), targeted biopsies improved the diagnosis in 28% of patients, while systematic biopsies resulted in an additional 19% of cancer cases in the series. Conclusion Systematic biopsies should still be considered in patients with PI-RADS 1/2 findings. Our findings also suggest a stronger benefit of the combined strategy of targeted and systematic biopsies than the findings of previous studies concerning the detection of CSPCa in biopsy-naïve patients.
Once there is evidence of systemic involvement in malignant melanoma, treatment options become se... more Once there is evidence of systemic involvement in malignant melanoma, treatment options become severely limited and the disease is virtually incurable. There are, however, options available to treat patients, including single-agent chemotherapy, single-agent biologic response modifier (BRM), combination chemotherapy, and the combination of chemotherapeutic agents and BRMs. These treatment modalities and their indications for use are discussed.
Burnout syndrome is a common occurrence among oncologists. Doctors enrolled in residency programs... more Burnout syndrome is a common occurrence among oncologists. Doctors enrolled in residency programs in clinical oncology are exposed to similar risk factors; however, few data are available in this population. This study assessed the occurrence of burnout and associated factors among first-year residents at Brazilian institutions. The present prospective, multicenter, cohort study was conducted with doctors enrolled in residency programs in clinical oncology at Brazilian institutions affiliated with the public health system. The participants answered a sociodemographic questionnaire, the Maslach Burnout Inventory (MBI), Lipp's Stress Inventory, and the Beck Depression Inventory (BDI), upon admission to the program and 6 and 12 months later. Of 37 eligible residency programs in 2009, 11 (30.6 %) agreed to participate in the study. Fifty-four residents, representing 100 % of new admissions to the participating institutions, were included. Most of the participants met the criteria for severe burnout upon admission to the residency programs (emotional exhaustion in 49.0 % and depersonalization in 64.7 %). The scores on MBI domains emotional exhaustion and depersonalization increased significantly (p < 0.01) during the first year of residency, and the prevalence of burnout increased to 88 % at the end of that first year. The present study found a high prevalence of burnout among doctors enrolled in residency programs in clinical oncology at Brazilian institutions. A large fraction of the participants met the criteria for burnout syndrome upon admission to the program, which suggests that the problem began during the course of the previous residency program in internal medicine.
Revista Brasileira de Hematologia e Hemoterapia, 2005
Uso de terapia regenerativa com células-tronco da medula óssea em doenças cardiovasculares-perspe... more Uso de terapia regenerativa com células-tronco da medula óssea em doenças cardiovasculares-perspectiva do hematologista Regenerative therapy using bone marrow stem cells in cardiovascular diseases-The perspective of the hematologist
mild pain at the bone marrow needle puncture site. No other complications or specific side effect... more mild pain at the bone marrow needle puncture site. No other complications or specific side effects related to the procedure were observed. Bilirubin levels were lower at 1 (2.19 ± 0.9) and 4 mo (2.10 ± 1.0) after cell transplantation that baseline levels (2.78 ± 1.2). Albumin levels 4 mo after BMC infusion (3.73 ± 0.5) were higher than baseline levels (3.47 ± 0.5). International normalized ratio (INR) decreased from 1.48 (SD = 0.23) to 1.43 (SD = 0.23) one month after cell transplantation. CONCLUSION: BMC infusion into hepatic artery of patients with advanced chronic liver disease is safe and feasible. In addition, a decrease in mean serum bilirubin and INR levels and an increase in albumin levels are observed. Our data warrant further studies in order to evaluate the effect of BMC transplantation in patients with advanced chronic liver disease.
Revista Brasileira de Hematologia e Hemoterapia, 2006
Previous data suggest that Salvador, the capital of the State of Bahia, a northeastern state of B... more Previous data suggest that Salvador, the capital of the State of Bahia, a northeastern state of Brazil, has the highest prevalence of HTLV infection in blood donors among Brazilian cities. The aim of this case-control study was to identify the determinants of risk for HTLV infection among blood donors in the city of Salvador. Between January 2000 and December 2003, 504 blood donors with positive screening tests for HTLV infection (unconfirmed prevalence of 0.48%) were invited to participate in our study. A total of 154 had performed a Western Blot (WB) test, 139 were of which found to be positive (false positive screening rate 9.9%). Using a standardized questionnaire, a single interviewer obtained information on demographic, socioeconomical and educational characteristics, as well as sexual behavior from 91 out of the 139 positive by WB and from 194 HTLV-negative blood donors. Prevalence of HTLV infection was 0.48%. Multivariate analysis revealed women (OR 3.79 [1.61-8.88], p=0.002), low family income* (OR 3.37 [1.17-9.66], p=0.02), self-reported history of sexual transmitted diseases (OR 6.15 [2.04-18.51], p=0.001), 2 or more sexual partners during life (OR 9.29 [2.16-39.94], p=0.0020) and inconsistent use of condoms (OR 4.73 [1.98-11.26], p=0.0004) as risk factors for HTLV infection. In accordance with previous published data, our results point to an association between low socio-economical level, poor education and unsafe sexual behavior with HTLV infection. We observed a lower prevalence of HLTV infection when compared to previous data.
Revista da Sociedade Brasileira de Medicina Tropical, 2007
O objetivo foi descrever as características sociodemográficas, epidemiológicas e comportamentais ... more O objetivo foi descrever as características sociodemográficas, epidemiológicas e comportamentais de mulheres infectadas (64) e não infectadas (66) pelo HTLV-1 em Salvador, Bahia. O diagnóstico sorológico foi obtido por ELISA, WB e Imunofluorescência. Dados epidemiológicos e sociodemográficos foram coletados utilizando questionário padronizado. O Qui-quadrado ou teste de Fisher foi usado para dados categóricos e ANOVA ou Kruskall Wallis (3 grupos) e teste T ou Mann Whitney (2 grupos) para os dados contínuos. As variáveis associadas foram ajustadas por regressão logística. Mais da metade (57,8%) das mulheres soropositivas eram assintomáticas. As sintomáticas (com PET/MAH) tinham menor escolaridade. A comparação entre mulheres soropositivas e soronegativas mostrou que a hemotransfusão, a prática de sexo anal, coitarca antes dos 18 anos e ter mais de 3 parceiros sexuais na vida foram fatores de risco para infecção pelo HTLV-1. A prevenção da transmissão sexual e vertical (aleitamento ma...
Extrathyroidal features of Graves disease include ophthalmopathy, dermopathy, and acropachy. The ... more Extrathyroidal features of Graves disease include ophthalmopathy, dermopathy, and acropachy. The latter manifestation presents with clubbing-like digital deformities with or without periosteal reaction and bone pain. A 52-year-old woman was diagnosed with Graves disease (exophthalmos, thyrotoxicosis, and pretibial myxedema) in 1999. Initially she was unsuccessfully treated with radioactive iodine and later submitted to a total thyroidectomy. Since that time she has been on thyroid hormone replacement. In the past few years she had noticed a worsening of the myxedema and pain in both feet. A subcutaneous biopsy confirmed the presence of myxedematous tissue. On examination, beyond the presence of myxedema and exophthalmos, there was periarticular swelling (Fig. 1) and generalized digital appearance of clubbing (Fig. 2) typical of thyroid acropachy. The rest of physical examination was unremarkable. TSH was 0.15 U/mL (reference range 0.5–5.5 U/ mL), and free T4 was within normal range, TSH receptor antibodies positive. Foot radiograph was normal without periosteal reaction and MRI demonstrated the presence of abnormal soft tissue in forefeet. The ophthalmopathy and the myxedema were unresponsive to corticosteroid therapy.
Background: Heart failure due to Chagas' disease (HFCD) is a progressive inflammatory cardiomyopa... more Background: Heart failure due to Chagas' disease (HFCD) is a progressive inflammatory cardiomyopathy that affects millions of individuals in Latin America. Studies using mice models of HFCD indicate that bone marrow mononuclear cell transplantation (BMCT) may reduce inflammation, fibrosis, and improve myocardial function. Objective: The purpose of this study was to evaluate, for the first time in humans, the safety and efficacy of BMCT to the myocardium of patients with HFCD. Methods: A total of 28 HFCD patients (mean age 52.2 ± 9.9 years) with NYHA class III and IV were submitted to BMCT through intracoronary injection. Effects on the left ventricle ejection fraction (LVEF), functional capacity, quality-of-life, arrhythmias, biochemical, immunological, and neuro-humoral parameters, were evaluated. Results: There were no complications directly related to the procedure. LVEF was 20.1 ± 6.8% and 28.3 ± 7.9%, p < 0.03 at baseline and 180 days after the procedure, respectively. In the same period, significant improvements were observed in the NYHA class (3.1 ± 0.3 to 1.8 ± 0.5; p < 0.001), quality-of-life (50.9 ± 11.7 to 25.1 ± 15.9; p < 0.001), and in the six-minute walking test (355 ± 136 m to 437 ± 94 m; p < 0,01). There were no changes in markers of immune or neurohormonal activation. No complications were registered. Conclusion: Our data suggest that the intracoronary injection of BMCT is safe and potentially effective in patients with HFCD. The extent of the benefit, however, appears to be small and needs to be confirmed in a larger randomized, double blind, placebo controlled clinical trial. (Arq Bras Cardiol 2011;96(4):325-331
Avaliar efeitos precoces do transplante de células de medula óssea para o miocárdio de pacientes ... more Avaliar efeitos precoces do transplante de células de medula óssea para o miocárdio de pacientes com insufi ciência cardíaca (IC) de etiologia chagásica. MÉTODOS A amostra consistiu de 28 pacientes, idade média 52,2±9,9 anos, 24 masculinos, 25 em classe NYHA III e 3 em NYHA IV, apesar de tratamento otimizado. O procedimento consistiu na aspiração de 50ml de medula óssea, separação da fração mononuclear e injeção intracoronariana. Foram avaliados os efeitos sobre a fração de ejeção ventricular esquerda (FEVE), distância no teste de 6 minutos, qualidade de vida, classe NYHA, efeitos arritmogênicos e bioquímicos.
It has been difficult to explain why all HTLV-1 sequences in Salvador, a city in the northeast of... more It has been difficult to explain why all HTLV-1 sequences in Salvador, a city in the northeast of Brazil, belong to the Transcontinental (A) subgroup of the Cosmopolitan (a) subtype, since according to historical data the vast majority of slaves brought to Brazil (through Salvador) came from west Africa, where only the western African subgroup (C) has been found. To shed more light on this subject we conducted a phylogenetic analysis of 23 isolates from blood donors of Salvador. DNA was extracted and submitted to a nested PCR for amplification of the entire LTR region. The PCR products were purified and sequenced on an automated sequencer. Neighbor-joining and maximum likelihood phylogenetic analyses were performed. None of the new sequences from Salvador clustered within the West-African subgroup C. Confirming previous results, all sequences belonged to the Transcontinental subgroup (A) of the Cosmopolitan subtype, and clustered in two Latin American clusters. In addition we showed sequences from southern Africa clustering in both Latin American clusters. One of the new sequences is ancestral to the larger Latin American cluster beta due to a duplication of a 12-bp long fragment, a finding that has not been previously described. These findings support the hypothesis that HTLV-1 isolates circulating in Latin America have a closer relationship to South African compared to West-African HTLV-1 strains. The 12-bp-long duplications in one of the sequences has no obvious clinical or biological implications yet.
... 1997;12:56-8. 8. Robinson E. Undergraduate cancer education around the world. In: Robinson E,... more ... 1997;12:56-8. 8. Robinson E. Undergraduate cancer education around the world. In: Robinson E, Sherman CD, Love RR (eds). ... 16. Rushood AA, Nassim HM, Azeemuddin T. Patient satisfaction after photorefractive keratectomy for low myopia using the visual ana-logue scale. ...
Patients with relapsed lymphoma are usually incurable with conventional salvage chemotherapy [1].... more Patients with relapsed lymphoma are usually incurable with conventional salvage chemotherapy [1]. High-dose chemotherapy (HDC) followed by autologous bone marrow or peripheral stem cell (PBSC) reinfusion can reproducibly cure a fraction of these patients [2, 3, 4]. In fact, it was recently demonstrated that for patients who achieve a response to salvage chemotherapy, HDC is superior to maintenance salvage chemotherapy
European Journal of Heart Failure Supplements, 2005
... Basic Science 686 Alterations in troponin I phosphorylation could account for the contractile... more ... Basic Science 686 Alterations in troponin I phosphorylation could account for the contractile defect in failing heart AM Jacques, S. Marston, A. Messer National Heart and Lung Institute, Cardiac Medicine, London, United Kingdom ... Pinho-Filho 4, A. Mota:, A.AG. ...
The origin of metastatic adenocarcinoma lesions can sometimes be difficult to diagnose. The objec... more The origin of metastatic adenocarcinoma lesions can sometimes be difficult to diagnose. The objectives of our study were to establish the cytokeratin staining pattern of primary and metastatic lung and colorectal adenocarcinomas, and to determine if this helps to identify the site of origin of metastatic lesions. We reviewed a total of 102 tissue samples from patients in our tumour registry, with either primary or metastatic lung or colorectal adenocarcinoma. Tissue sections were stained for cytokeratin 7 and 20 and read as positive or negative for staining. Clinical and radiologic information was reviewed from computerised charts. The cytokeratin 7+/cytokeratin 207 pattern characterised 96% (29 out of 30) of primary and 95% (21 out of 22) of metastatic lung adenocarcinomas. All the primary (26), and 88% (21 out of 24) of metastatic colorectal adenocarcinomas stained cytokeratin 77/cytokeratin 20+. Samples from a variety of metastatic sites were evaluated for cytokeratin 7 and 20 staining. Out of the 102 samples, in 95% (97 out of 102) of the cases, the cytokeratin 7 and cytokeratin 20 staining pattern characterised and differentiated between lung and colorectal adenocarcinoma. Primary and metastatic lung adenocarcinomas show a cytokeratin 7+/cytokeratin 207 staining pattern, while colorectal adenocarcinomas stain cytokeratin 77/cytokeratin 20+. Cytokeratin staining is helpful in the diagnostic differentiation of metastatic lesions from these two common primaries, and assists in determining the site of origin of metastatic lesions.
A imuno-oncologia contemporânea é separada atualmente em quatro grandes categorias: estimulação i... more A imuno-oncologia contemporânea é separada atualmente em quatro grandes categorias: estimulação imune não específica, terapia imune celular, imunização ativa e tratamento com anticorpos monoclonais. Esta revisão tem como escopo principal trazer o estado da arte no uso de anticorpos monoclonais que atuam como inibidores dos pontos de checagem imunológica (IPCI). São sete os IPCIs atualmente em uso clínico: um inibidor do CTLA-4 (ipilimumabe), três inibidores do PD-1 (pembrolizumabe, nivolumabe e cemiplimabe) e três inibidores do PD-L1 (atezolizumabe, avelumabe, durvalumabe). Os dados compilados sugerem que a imunoterapia é efetiva em inúmeros tumores, em diferentes cenários (primeira, segunda ou terceira linhas de tratamento), bem como quando comparado a diferentes regimes terapêuticos (quimioterapia com droga única, quimioterapia com mais de uma droga, inibidores de tirosina cinase e placebo). Em relação aos efeitos adversos associados ao uso dos inibidores dos pontos de checagem im...
Abstract Objectives To date, it is unknown whether systematic biopsies can be safely omitted in p... more Abstract Objectives To date, it is unknown whether systematic biopsies can be safely omitted in patients with unsuspicious MRI findings or if systematic biopsies should be required when targeting focal lesions (PI-RADS 3–5). Methods A series of 366 patients (249 without a previous biopsy) were examined in a 1.5 Tesla MRI scanner. All patients were submitted to systematic biopsies (12–14 regions) with additional targeted biopsies (by cognitive fusion) of focal PI-RADS lesions (PI-RADS 3–5). Results In our series, patients with PI-RADS 1/2 findings had rates of adenocarcinoma of any grade, >GG1 and GG4/5 of 34%, 14% and 3%, respectively. The use of MRI prior to biopsy in our series increased the detection of clinically significant prostate cancer (CSPCa) in 28% of patients with focal lesions, and focal lesions were present in 293/366 (80%) of all patients. For CSPCa (>GG1), targeted biopsies improved the diagnosis in 28% of patients, while systematic biopsies resulted in an additional 19% of cancer cases in the series. Conclusion Systematic biopsies should still be considered in patients with PI-RADS 1/2 findings. Our findings also suggest a stronger benefit of the combined strategy of targeted and systematic biopsies than the findings of previous studies concerning the detection of CSPCa in biopsy-naïve patients.
Once there is evidence of systemic involvement in malignant melanoma, treatment options become se... more Once there is evidence of systemic involvement in malignant melanoma, treatment options become severely limited and the disease is virtually incurable. There are, however, options available to treat patients, including single-agent chemotherapy, single-agent biologic response modifier (BRM), combination chemotherapy, and the combination of chemotherapeutic agents and BRMs. These treatment modalities and their indications for use are discussed.
Burnout syndrome is a common occurrence among oncologists. Doctors enrolled in residency programs... more Burnout syndrome is a common occurrence among oncologists. Doctors enrolled in residency programs in clinical oncology are exposed to similar risk factors; however, few data are available in this population. This study assessed the occurrence of burnout and associated factors among first-year residents at Brazilian institutions. The present prospective, multicenter, cohort study was conducted with doctors enrolled in residency programs in clinical oncology at Brazilian institutions affiliated with the public health system. The participants answered a sociodemographic questionnaire, the Maslach Burnout Inventory (MBI), Lipp&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Stress Inventory, and the Beck Depression Inventory (BDI), upon admission to the program and 6 and 12 months later. Of 37 eligible residency programs in 2009, 11 (30.6 %) agreed to participate in the study. Fifty-four residents, representing 100 % of new admissions to the participating institutions, were included. Most of the participants met the criteria for severe burnout upon admission to the residency programs (emotional exhaustion in 49.0 % and depersonalization in 64.7 %). The scores on MBI domains emotional exhaustion and depersonalization increased significantly (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) during the first year of residency, and the prevalence of burnout increased to 88 % at the end of that first year. The present study found a high prevalence of burnout among doctors enrolled in residency programs in clinical oncology at Brazilian institutions. A large fraction of the participants met the criteria for burnout syndrome upon admission to the program, which suggests that the problem began during the course of the previous residency program in internal medicine.
Revista Brasileira de Hematologia e Hemoterapia, 2005
Uso de terapia regenerativa com células-tronco da medula óssea em doenças cardiovasculares-perspe... more Uso de terapia regenerativa com células-tronco da medula óssea em doenças cardiovasculares-perspectiva do hematologista Regenerative therapy using bone marrow stem cells in cardiovascular diseases-The perspective of the hematologist
mild pain at the bone marrow needle puncture site. No other complications or specific side effect... more mild pain at the bone marrow needle puncture site. No other complications or specific side effects related to the procedure were observed. Bilirubin levels were lower at 1 (2.19 ± 0.9) and 4 mo (2.10 ± 1.0) after cell transplantation that baseline levels (2.78 ± 1.2). Albumin levels 4 mo after BMC infusion (3.73 ± 0.5) were higher than baseline levels (3.47 ± 0.5). International normalized ratio (INR) decreased from 1.48 (SD = 0.23) to 1.43 (SD = 0.23) one month after cell transplantation. CONCLUSION: BMC infusion into hepatic artery of patients with advanced chronic liver disease is safe and feasible. In addition, a decrease in mean serum bilirubin and INR levels and an increase in albumin levels are observed. Our data warrant further studies in order to evaluate the effect of BMC transplantation in patients with advanced chronic liver disease.
Revista Brasileira de Hematologia e Hemoterapia, 2006
Previous data suggest that Salvador, the capital of the State of Bahia, a northeastern state of B... more Previous data suggest that Salvador, the capital of the State of Bahia, a northeastern state of Brazil, has the highest prevalence of HTLV infection in blood donors among Brazilian cities. The aim of this case-control study was to identify the determinants of risk for HTLV infection among blood donors in the city of Salvador. Between January 2000 and December 2003, 504 blood donors with positive screening tests for HTLV infection (unconfirmed prevalence of 0.48%) were invited to participate in our study. A total of 154 had performed a Western Blot (WB) test, 139 were of which found to be positive (false positive screening rate 9.9%). Using a standardized questionnaire, a single interviewer obtained information on demographic, socioeconomical and educational characteristics, as well as sexual behavior from 91 out of the 139 positive by WB and from 194 HTLV-negative blood donors. Prevalence of HTLV infection was 0.48%. Multivariate analysis revealed women (OR 3.79 [1.61-8.88], p=0.002), low family income* (OR 3.37 [1.17-9.66], p=0.02), self-reported history of sexual transmitted diseases (OR 6.15 [2.04-18.51], p=0.001), 2 or more sexual partners during life (OR 9.29 [2.16-39.94], p=0.0020) and inconsistent use of condoms (OR 4.73 [1.98-11.26], p=0.0004) as risk factors for HTLV infection. In accordance with previous published data, our results point to an association between low socio-economical level, poor education and unsafe sexual behavior with HTLV infection. We observed a lower prevalence of HLTV infection when compared to previous data.
Revista da Sociedade Brasileira de Medicina Tropical, 2007
O objetivo foi descrever as características sociodemográficas, epidemiológicas e comportamentais ... more O objetivo foi descrever as características sociodemográficas, epidemiológicas e comportamentais de mulheres infectadas (64) e não infectadas (66) pelo HTLV-1 em Salvador, Bahia. O diagnóstico sorológico foi obtido por ELISA, WB e Imunofluorescência. Dados epidemiológicos e sociodemográficos foram coletados utilizando questionário padronizado. O Qui-quadrado ou teste de Fisher foi usado para dados categóricos e ANOVA ou Kruskall Wallis (3 grupos) e teste T ou Mann Whitney (2 grupos) para os dados contínuos. As variáveis associadas foram ajustadas por regressão logística. Mais da metade (57,8%) das mulheres soropositivas eram assintomáticas. As sintomáticas (com PET/MAH) tinham menor escolaridade. A comparação entre mulheres soropositivas e soronegativas mostrou que a hemotransfusão, a prática de sexo anal, coitarca antes dos 18 anos e ter mais de 3 parceiros sexuais na vida foram fatores de risco para infecção pelo HTLV-1. A prevenção da transmissão sexual e vertical (aleitamento ma...
Extrathyroidal features of Graves disease include ophthalmopathy, dermopathy, and acropachy. The ... more Extrathyroidal features of Graves disease include ophthalmopathy, dermopathy, and acropachy. The latter manifestation presents with clubbing-like digital deformities with or without periosteal reaction and bone pain. A 52-year-old woman was diagnosed with Graves disease (exophthalmos, thyrotoxicosis, and pretibial myxedema) in 1999. Initially she was unsuccessfully treated with radioactive iodine and later submitted to a total thyroidectomy. Since that time she has been on thyroid hormone replacement. In the past few years she had noticed a worsening of the myxedema and pain in both feet. A subcutaneous biopsy confirmed the presence of myxedematous tissue. On examination, beyond the presence of myxedema and exophthalmos, there was periarticular swelling (Fig. 1) and generalized digital appearance of clubbing (Fig. 2) typical of thyroid acropachy. The rest of physical examination was unremarkable. TSH was 0.15 U/mL (reference range 0.5–5.5 U/ mL), and free T4 was within normal range, TSH receptor antibodies positive. Foot radiograph was normal without periosteal reaction and MRI demonstrated the presence of abnormal soft tissue in forefeet. The ophthalmopathy and the myxedema were unresponsive to corticosteroid therapy.
Background: Heart failure due to Chagas' disease (HFCD) is a progressive inflammatory cardiomyopa... more Background: Heart failure due to Chagas' disease (HFCD) is a progressive inflammatory cardiomyopathy that affects millions of individuals in Latin America. Studies using mice models of HFCD indicate that bone marrow mononuclear cell transplantation (BMCT) may reduce inflammation, fibrosis, and improve myocardial function. Objective: The purpose of this study was to evaluate, for the first time in humans, the safety and efficacy of BMCT to the myocardium of patients with HFCD. Methods: A total of 28 HFCD patients (mean age 52.2 ± 9.9 years) with NYHA class III and IV were submitted to BMCT through intracoronary injection. Effects on the left ventricle ejection fraction (LVEF), functional capacity, quality-of-life, arrhythmias, biochemical, immunological, and neuro-humoral parameters, were evaluated. Results: There were no complications directly related to the procedure. LVEF was 20.1 ± 6.8% and 28.3 ± 7.9%, p < 0.03 at baseline and 180 days after the procedure, respectively. In the same period, significant improvements were observed in the NYHA class (3.1 ± 0.3 to 1.8 ± 0.5; p < 0.001), quality-of-life (50.9 ± 11.7 to 25.1 ± 15.9; p < 0.001), and in the six-minute walking test (355 ± 136 m to 437 ± 94 m; p < 0,01). There were no changes in markers of immune or neurohormonal activation. No complications were registered. Conclusion: Our data suggest that the intracoronary injection of BMCT is safe and potentially effective in patients with HFCD. The extent of the benefit, however, appears to be small and needs to be confirmed in a larger randomized, double blind, placebo controlled clinical trial. (Arq Bras Cardiol 2011;96(4):325-331
Avaliar efeitos precoces do transplante de células de medula óssea para o miocárdio de pacientes ... more Avaliar efeitos precoces do transplante de células de medula óssea para o miocárdio de pacientes com insufi ciência cardíaca (IC) de etiologia chagásica. MÉTODOS A amostra consistiu de 28 pacientes, idade média 52,2±9,9 anos, 24 masculinos, 25 em classe NYHA III e 3 em NYHA IV, apesar de tratamento otimizado. O procedimento consistiu na aspiração de 50ml de medula óssea, separação da fração mononuclear e injeção intracoronariana. Foram avaliados os efeitos sobre a fração de ejeção ventricular esquerda (FEVE), distância no teste de 6 minutos, qualidade de vida, classe NYHA, efeitos arritmogênicos e bioquímicos.
It has been difficult to explain why all HTLV-1 sequences in Salvador, a city in the northeast of... more It has been difficult to explain why all HTLV-1 sequences in Salvador, a city in the northeast of Brazil, belong to the Transcontinental (A) subgroup of the Cosmopolitan (a) subtype, since according to historical data the vast majority of slaves brought to Brazil (through Salvador) came from west Africa, where only the western African subgroup (C) has been found. To shed more light on this subject we conducted a phylogenetic analysis of 23 isolates from blood donors of Salvador. DNA was extracted and submitted to a nested PCR for amplification of the entire LTR region. The PCR products were purified and sequenced on an automated sequencer. Neighbor-joining and maximum likelihood phylogenetic analyses were performed. None of the new sequences from Salvador clustered within the West-African subgroup C. Confirming previous results, all sequences belonged to the Transcontinental subgroup (A) of the Cosmopolitan subtype, and clustered in two Latin American clusters. In addition we showed sequences from southern Africa clustering in both Latin American clusters. One of the new sequences is ancestral to the larger Latin American cluster beta due to a duplication of a 12-bp long fragment, a finding that has not been previously described. These findings support the hypothesis that HTLV-1 isolates circulating in Latin America have a closer relationship to South African compared to West-African HTLV-1 strains. The 12-bp-long duplications in one of the sequences has no obvious clinical or biological implications yet.
... 1997;12:56-8. 8. Robinson E. Undergraduate cancer education around the world. In: Robinson E,... more ... 1997;12:56-8. 8. Robinson E. Undergraduate cancer education around the world. In: Robinson E, Sherman CD, Love RR (eds). ... 16. Rushood AA, Nassim HM, Azeemuddin T. Patient satisfaction after photorefractive keratectomy for low myopia using the visual ana-logue scale. ...
Patients with relapsed lymphoma are usually incurable with conventional salvage chemotherapy [1].... more Patients with relapsed lymphoma are usually incurable with conventional salvage chemotherapy [1]. High-dose chemotherapy (HDC) followed by autologous bone marrow or peripheral stem cell (PBSC) reinfusion can reproducibly cure a fraction of these patients [2, 3, 4]. In fact, it was recently demonstrated that for patients who achieve a response to salvage chemotherapy, HDC is superior to maintenance salvage chemotherapy
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