Introduction: Anticoagulation clinics (AC) have better impact on anticoagulation control than usu... more Introduction: Anticoagulation clinics (AC) have better impact on anticoagulation control than usual medical care (UMC). However, there is no randomized trial testing the results of AC in low-income realities. We sought to examine the performance of an AC in a group of patients treated at a Brazilian public hospital. Hypothesis: The assistance provided by AC presents difference in TTR when compared to the UMC. Methods: This was a randomized clinical trial to test the efficacy and safety of a recently-implemented AC over UMC in a group of outpatients with heart disease. The primary and secondary endpoints were time in the therapeutic range (TTR) and warfarin-associated complications, respectively. Overall, 280 patients were enrolled and randomly assigned to one of the two arms: group A: one year at AC (A1: first semester; A2: second semester); and group B: one semester receiving UMC (B1) and other at AC (B2). Results: The mean age was 56.8±13.1 years and patients were mostly female (5...
Poster: "ECR 2019 / C-2486 / Pancreatic Pseudotumors: Lesions that can mimic primary pancrea... more Poster: "ECR 2019 / C-2486 / Pancreatic Pseudotumors: Lesions that can mimic primary pancreatic neoplasms." by: "D. Strabelli, L. Coura, G. A. B. G. Bandeira, M. H. Verussa, I. S. Oliveira, M. D. S. Rocha; Sao Paulo/BR"
Introduction: Hyperferritinemia (HF) may reflect the inflammatory status of patients with NAFLD a... more Introduction: Hyperferritinemia (HF) may reflect the inflammatory status of patients with NAFLD and obesity, but about 33% reflects a real hepatic iron overload. The dysmetabolic iron overload syndrome (DIOS) definition is HF, normal transferrin saturation, and mild hepatic iron overload in a patient with metabolic disorders. The gold standard for diagnosis of iron overload is the liver biopsy. As it is an invasive method, new methods are necessary. Among them, magnetic resonance imaging (MRI) is the most available one. Methods: This study evaluated patients with HF, overweight and NAFLD. All patients were submitted to liver biopsy. MRI relaxometry (Fat/Iron analysis - 3T machine), measurement of inflammatory markers (TNF α and IL-6), analysis of the expression of ferritin light and heavy chain subunits (FTL and FTH) and serum hepcidin were held. Data were correlated with liver biopsy. Results: 152 biopsy-proven NAFLD patients were screened but only 67 were included in this study. D...
The laboratorial diagnosis of leishmaniasis is based on parasitological methods, which are invasi... more The laboratorial diagnosis of leishmaniasis is based on parasitological methods, which are invasive, present high cost, require laboratorial infrastructure and/or trained professionals; as well as by immunological methods, which usually present variable sensitivity and/or specificity, such as when they are applied to identify asymptomatic cases and/or mammalian hosts presenting low levels of antileishmanial antibodies. As consequence, new studies aiming to identify more refined antigens to diagnose visceral (VL) and tegumentary (TL) leishmaniasis are urgently necessary. In the present work, the Leishmania eukaryotic elongation factor-1 beta (EF1b) protein, which was identified in L. infantum protein extracts by antibodies in VL patients' sera, was cloned and its recombinant version (rEF1b) was expressed, purified and tested as a diagnostic marker for VL and TL. The post-therapeutic serological follow-up was also evaluated in treated and untreated VL and TL patients, when anti-rEF1b antibody levels were measured before and after treatment. Results showed that rEF1b was highly sensitive and specific to diagnose symptomatic and asymptomatic canine VL, as well as human TL and VL. In addition, low cross-reactivity was observed when sera from healthy subjects or leishmaniasis-related diseases patients were tested. The serological follow-up showed also that rEF1b-specific antibodies declined significantly after treatment, suggesting that this protein could be also evaluated as a prognostic marker for human leishmaniasis.
AJR. American journal of roentgenology, Jan 24, 2018
Currently, there is no consensus in the literature regarding the screening of hepatic nodules in ... more Currently, there is no consensus in the literature regarding the screening of hepatic nodules in patients who have undergone the Fontan procedure. The objectives of this study are to evaluate in this population the frequency of hepatic nodules at ultrasound (US), CT, and MRI; to measure liver stiffness using acoustic radiation force impulse (ARFI) elastography; and to investigate predictive factors for hepatic nodules. In this cross-sectional study, 49 patients who underwent the Fontan procedure were prospectively recruited from August 2014 through June 2016. These patients underwent clinical evaluation for hepatic disorders, ARFI elastography, US, CT, and MRI. Most of the patients had no symptoms, and hepatic nodules were detected in three of 49 (6.1%) patients at US, 14 of 44 (31.8%) patients at CT, and 19 of 48 (39.6%) patients at MRI. Liver stiffness at ARFI elastography was significantly higher in patients with hepatic nodules than in patients without such nodules (2.64 ± 0.81 ...
Regulatory T cells (Tregs) are known to control immune responses by suppressing the antigen-prese... more Regulatory T cells (Tregs) are known to control immune responses by suppressing the antigen-presenting and effector T cells. Some mechanisms adopted by Tregs in combating Mycobacterium infections have been proposed. Nevertheless, in M. leprae infection, also known as leprosy or Hansen's disease, the role of Tregs has not been completely elucidated. Using multicolor flow cytometry, we evaluated the expression of different cell surface and intracellular molecules present in Tregs from peripheral blood samples of leprosy patients. Before initiating treatment, thirteen new cases of leprosy were grouped according to the Ridley-Jopling classification in to the paucibacilary (PB) or multibacilary (MB) group. Fifteen non-infected individuals (NI) were included as control subjects. Tregs were higher in the MB group than in the NI group. Tregs also co-expressed high amounts of PD1 and PDL-1, indicating that these cells could induce apoptosis of effector cells and simultaneously prevent th...
Introduction Anatomical and functional influences on gastric bypass (GBP) results are often poorl... more Introduction Anatomical and functional influences on gastric bypass (GBP) results are often poorly evaluated and not yet fully understood. Purpose The purpose of this study is to evaluate the influence of the gastric pouch volume and its emptying rate on longterm weight loss and food tolerance after GBP. Materials and Methods Weight loss, food tolerance, pouch volumetry (V) by three-dimensional reconstruction, and pouch emptying rate by 4 h scintigraphy were evaluated in 67 patients. Cutoffs were identified for V and retention percentage (%Ret) at 1 h (%Ret1). From these parameters, the sample was categorized, looking for associations between V, %Ret, weight loss, and food tolerance, assessed by a questionnaire for quick assessment of food tolerance (SS). Results PO median follow-up time was 47 months; median V was 28 mL; %Ret at 1, 2, and 4 h were 8, 2, and 1%, respectively. There were associations between V ≤ 40 mL and higher emptying rates up to 2 h (V ≤ 40 mL: %Ret1 = 6, %Ret2 = 2, p = 0.009; V > 40 mL: %Ret1 = 44, %Ret2 = 13.5, p = 0.045). An association was found between higher emptying speed in 1 h and higher late weight loss (WL), represented by lower percentage of excess weight loss (%EWL) regain (p = 0.036) and higher %EWL (p = 0.033) in the group with %Ret1 ≤ 12%, compared to the group %Ret1 ≥ 25%. Better food tolerance (SS > 24), was associated with lower %Ret1 (p = 0.003). Conclusion Smaller pouch size is associated with a faster gastric emptying, greater WL maintenance, and better food tolerance. These data suggest that a small pouch with rapid emptying rate is an important technical parameter for good outcomes in GBP.
Leprosy or Hansen's disease is a chronic infectious disease of the skin and nerves, caused by... more Leprosy or Hansen's disease is a chronic infectious disease of the skin and nerves, caused by the intracellular bacilli Mycobacterium leprae. It is characterized by a spectrum of clinical forms depending on the host's immune response to M. leprae. Patients with tuberculoid (TT) leprosy have strong cell-mediated immunity (CMI) with elimination of the bacilli, whereas patients with lepromatous (LL) leprosy exhibit defective CMI to M. leprae. Despite advances in the understanding of the pathogenesis of leprosy and the development of new therapeutic strategies, there is a need for the identification of biomarkers which be used for early diagnosis and to discrimination between different forms of the disease, as prognostic markers. Here, we analyzed the serum levels of IL-1β, IL-6, IL-8, IL-10, IL-12p70, IL-13, IL-17A, IFN-γ and TNF in order to address the contribution of these cytokines in late phase of M. leprae infection, and the impact of multidrug therapy (MDT). Our results d...
Background: Abernethy malformation is a rare congenital vascular abnormality in which the portal ... more Background: Abernethy malformation is a rare congenital vascular abnormality in which the portal vein bypasses the liver and drains directly into the inferior vena cava. Diagnosis is complex and requires good quality imaging methods to identify details in systemic and portal circulation in order to establish diagnostic confirmation and treatment strategy. In this study we highlight the significance of the use of CT scans and Color Doppler Duplex Ultrasound for the diagnosis, treatment and evolution assessment in two adults with Abernethy malformation. Case presentation: The diagnosis and the treatment of two patients with Abernethy malformation by CT scan and Color Doppler Duplex Ultrasound is described. One patient was submitted to liver transplantation due to chronic liver disease and multiple nodules diagnosed as adenoma. The other patient had normal liver function and a mild neurological and psychomotor dysfunction, therefore we adopted clinical treatment and close liver parenchyma evaluation and nodule surveillance, using an imaging approach involving intercalating CT scan and Color Doppler Duplex Ultrasound every 6 months. We highlight some important direct and indirect findings of non-invasive imaging methods. Conclusion: Abernethy malformation requires meticulous image diagnosis to improve treatment and avoid iatrogenic procedures. CT scans and Color Doppler Duplex Ultrasound are both efficient methods for diagnosis, treatment planning and evolution assessment of patients with Abernethy malformation.
The serodiagnosis of human tegumentary leishmaniasis (TL) presents some problems, such as the low... more The serodiagnosis of human tegumentary leishmaniasis (TL) presents some problems, such as the low level of antileishmanial antibodies found in most of the patients, as well as the cross-reactivity in subjects infected by other trypanosomatids. In the present study, an immunoproteomic approach was performed aimed at identification of antigens in total extracts of stationary-phase promastigote and amastigote-like forms of Leishmania ( Viannia ) braziliensis using sera from TL patients. With the purpose of reducing the cross-reactivity of the identified proteins, spots recognized by sera from TL patients, as well as those recognized by antibodies present in sera from noninfected patients living in areas where TL is endemic and sera from Chagas disease patients, were discarded. Two Leishmania hypothetical proteins and 18 proteins with known functions were identified as antigenic. The study was extended with some of them to validate the results of the immunoscreening. The coding regions ...
Chagas disease (ChD) is a main cause of cardiopathy in Latin America, causing thousands of deaths... more Chagas disease (ChD) is a main cause of cardiopathy in Latin America, causing thousands of deaths each year.(1) Amiodarone has been widely used as antiarrhythmic drug to prevent recurrences of malignant ventricular arrhythmias in patients with ChD. Although the antiarrhythmic effects of amiodarone are well known, there are some evidences that it also has anti-Trypanosoma cruzi activity,(2) disrupting Ca 2+ homeostasis and blocking oxidosqualenecyclase enzyme in T. cruzi, causing ultrastructural damage.(3) Nevertheless, data showing antiparasitic effects of amiodarone in human are lacking, with only one case report demonstrating decrease in parasite load after amiodarone use.(4) We evaluated whether patients in use of amiodarone have lower parasite load than matched infected subjects, employing a recently developed target-capture real-time PCR assay that can detect as few as one parasite per 20mL of processed blood(5), in a previously described cohort of Chagas disease subjects studied by the National Heart, Lung and Blood Institute (NHLBI) Retrovirus Epidemiological Donor Study-II (REDS-II).
Pereira Nunes MC et al. Factores predictivos de la mortalidad en pacientes con miocardiopatía: im... more Pereira Nunes MC et al. Factores predictivos de la mortalidad en pacientes con miocardiopatía: importancia de la enfermedad de Chagas
Methods and Materials: We studied 57 patients with previous US diagnosis of ICA total occlusion, ... more Methods and Materials: We studied 57 patients with previous US diagnosis of ICA total occlusion, who were followed by the vascular surgery ambulatory of our institution. These patients were evaluated by the US and by CEUS in order to survey the possibility of a residual patent lumen of such. The CTA was then performed in these patients as the gold-standard method. Results: The US demonstrated the sensitivity of 86% compared with CTA. The CEUS has shown a high sensitivity (100%) as well as a high specificity (100%) for distinguishing between the complete occlusion and pseudo-occlusion of ICA, supplying further information over US, and having excellent correlation with the CTA. In addition to being a safe procedure our study proved that CEUS is an effective method, prone to be good alternative to more expensive and invasive imaging exams. Conclusion: CEUS is comparably as sensible and specific as CTA in the distinction between occlusion and pseudo-occlusion of ICA which is major information to the management of these patients.
Note: This copy is for your personal non-commercial use only. To order presentation-ready copies ... more Note: This copy is for your personal non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights.
LUEDEMANN, M., ET AL.: Implantable Cardioverter Defibrillator in a Child Using a Single Subcutane... more LUEDEMANN, M., ET AL.: Implantable Cardioverter Defibrillator in a Child Using a Single Subcutaneous Array Lead and an Abdominal Active Can. This report describes the case of an 8-year-old boy with hypertrophic cardiomyopathy (HCM) who underwent ICD implantation for recurrent syncope. To avoid vascular complications and to minimize the surgical approach in this small child, a nonthoracotomy ICD system was chosen using a single subcutaneous array lead with only one finger, an abdominally placed active can, and epicardial dual chamber pacing and sensing electrodes. During an 8-month follow-up, DFT was confirmed and there were no ventricular tachycardia or complications. It appears to be a safe device for the prevention of sudden cardiac death in infants and small children.
Chronic chagasic cardiomyopathy (CCC) is characterized mainly by a dilated cardiomyopathy complic... more Chronic chagasic cardiomyopathy (CCC) is characterized mainly by a dilated cardiomyopathy complicated by frequent and complex ventricular arrhythmias and/or conduction defects. The aim of the present study was to evaluate functional implications of neurotransmitter receptor autoantibodies in vivo. Sera from chagasic patients were used to measure the level of autoantibodies to peptide fragments from the M2 cholinergic and beta1 adrenergic receptors. Optical density values and the frequency of anti-M2 and anti-beta1 antibodies were significantly higher in the indeterminate form and in CCC patients than in normal individuals. There was no correlation between levels of autoantibodies and clinical parameters of ventricular dysfunction, as assessed by echocardiography. Patients presenting with chronotropic insufficiency in exercise test had higher levels of anti-M2 but not anti-beta1 autoantibodies. Although anti-M2 and anti-beta1 antibodies do not appear to play a role in the pathophysiology of the heart failure that accompanies severe CCC, anti-M2 cholinergic autoantibodies may contribute to the pathogenesis of Chagas' disease dysautonomia.
Chagas disease cardiomyopathy is a common form of dilated cardiomyopathy worldwide, and an import... more Chagas disease cardiomyopathy is a common form of dilated cardiomyopathy worldwide, and an important cause of stroke in Latin America. The long-term cumulative risk of ischemic cerebrovascular event (ICE) and its relation to left ventricular (LV) dysfunction have not been determined. The aims of this study were to describe the incidence and to evaluate the effect of LV ejection fraction on the risk for ICE in patients with Chagas cardiomyopathy. A total of 213 consecutive patients with Chagas disease and LV systolic dysfunction, 131 males, mean age 48+/-12 years, were prospectively enrolled. The use of anticoagulation was based on clinical indications. The end point was ICE, which included fatal or nonfatal stroke and transient ischemic attack. Risk factors for events were assessed by Cox proportional-hazards analysis. Mean follow-up was 36 months; 69 patients died and seven underwent cardiac transplantation. The overall incidence of ICE was 2.67 events per 100 patient/years. Independent risk factors for ICE included LV ejection fraction (HR 0.95, 95% CI 0.91 to 0.99, p=0.009) and left atrial volume corrected for body surface area (HR 1.04, 95% CI 1.01 to 1.07, p=0.007), which persisted after adjustment for anticoagulation use. Patients with ejection fractions<or=35% had a relative risk of events of 3.41, as compared with the other patients. The presence of apical aneurysm or thrombus, age, and history of previous stroke were not an independent long-term risk for ICE. In patients with Chagas cardiomyopathy, the annual incidence of ICE is low. Left ventricular ejection fraction and indexed left atrial volume appear to be independently associated with these events.
To assess contrast-enhanced (C+), fat-saturated (FatSat), T1-weighted (T1W) imaging in the charac... more To assess contrast-enhanced (C+), fat-saturated (FatSat), T1-weighted (T1W) imaging in the characterization of the soft tissue mass associated with primary bone tumors, we compared it with T2-weighted (T2W) imaging in patients with osteosarcoma (n = 36) and Ewing sarcoma family of tumors (Ewing sarcoma; n = 11). Periosseous tumor compared with normal muscle had greater contrast-to-noise ratio (CNR) on the FatSat T1W C+ image than on T2W for 81% (38/47; P < .0001) of patients. The CNR of periosseous tumor compared with subcutaneous fat was greater on FatSat T1W C+ for 98% (46/47; P < .0001). Radiologists found it easier to evaluate neurovascular bundle proximity to tumor with FatSat T1W C+ images than with T2W for 64% of patients (30/47; P < .0001). They judged FatSat T1W C+ superior to T2W for periosseous tumor conspicuity and visualization of soft tissue necrosis in 62% (29/47; P < .0001). In patients with osteosarcoma or Ewing sarcoma, FatSat T1W C+ imaging may replace T2W imaging for soft tissue mass evaluation, especially if contrast is being used for dynamic enhancement.
We applied the respiratory sinus arrhythmia (RSA) quantification algorithm to 24-hour ECG recordi... more We applied the respiratory sinus arrhythmia (RSA) quantification algorithm to 24-hour ECG recordings of Chagas disease (ChD) patients with (G1, n = 148) and without left ventricular dysfunction (LVD) (G2, n = 33), and in control subjects (G0, n = 28). Both ChD groups displayed a reduced RSA index; G1 = 299 (144-812); G2 = 335 (162-667), p = 0.011, which was correlated with vagal indexes of heart rate variability analysis. RSA index is a marker of vagal modulation in ChD patients.
Introduction: Anticoagulation clinics (AC) have better impact on anticoagulation control than usu... more Introduction: Anticoagulation clinics (AC) have better impact on anticoagulation control than usual medical care (UMC). However, there is no randomized trial testing the results of AC in low-income realities. We sought to examine the performance of an AC in a group of patients treated at a Brazilian public hospital. Hypothesis: The assistance provided by AC presents difference in TTR when compared to the UMC. Methods: This was a randomized clinical trial to test the efficacy and safety of a recently-implemented AC over UMC in a group of outpatients with heart disease. The primary and secondary endpoints were time in the therapeutic range (TTR) and warfarin-associated complications, respectively. Overall, 280 patients were enrolled and randomly assigned to one of the two arms: group A: one year at AC (A1: first semester; A2: second semester); and group B: one semester receiving UMC (B1) and other at AC (B2). Results: The mean age was 56.8±13.1 years and patients were mostly female (5...
Poster: "ECR 2019 / C-2486 / Pancreatic Pseudotumors: Lesions that can mimic primary pancrea... more Poster: "ECR 2019 / C-2486 / Pancreatic Pseudotumors: Lesions that can mimic primary pancreatic neoplasms." by: "D. Strabelli, L. Coura, G. A. B. G. Bandeira, M. H. Verussa, I. S. Oliveira, M. D. S. Rocha; Sao Paulo/BR"
Introduction: Hyperferritinemia (HF) may reflect the inflammatory status of patients with NAFLD a... more Introduction: Hyperferritinemia (HF) may reflect the inflammatory status of patients with NAFLD and obesity, but about 33% reflects a real hepatic iron overload. The dysmetabolic iron overload syndrome (DIOS) definition is HF, normal transferrin saturation, and mild hepatic iron overload in a patient with metabolic disorders. The gold standard for diagnosis of iron overload is the liver biopsy. As it is an invasive method, new methods are necessary. Among them, magnetic resonance imaging (MRI) is the most available one. Methods: This study evaluated patients with HF, overweight and NAFLD. All patients were submitted to liver biopsy. MRI relaxometry (Fat/Iron analysis - 3T machine), measurement of inflammatory markers (TNF α and IL-6), analysis of the expression of ferritin light and heavy chain subunits (FTL and FTH) and serum hepcidin were held. Data were correlated with liver biopsy. Results: 152 biopsy-proven NAFLD patients were screened but only 67 were included in this study. D...
The laboratorial diagnosis of leishmaniasis is based on parasitological methods, which are invasi... more The laboratorial diagnosis of leishmaniasis is based on parasitological methods, which are invasive, present high cost, require laboratorial infrastructure and/or trained professionals; as well as by immunological methods, which usually present variable sensitivity and/or specificity, such as when they are applied to identify asymptomatic cases and/or mammalian hosts presenting low levels of antileishmanial antibodies. As consequence, new studies aiming to identify more refined antigens to diagnose visceral (VL) and tegumentary (TL) leishmaniasis are urgently necessary. In the present work, the Leishmania eukaryotic elongation factor-1 beta (EF1b) protein, which was identified in L. infantum protein extracts by antibodies in VL patients' sera, was cloned and its recombinant version (rEF1b) was expressed, purified and tested as a diagnostic marker for VL and TL. The post-therapeutic serological follow-up was also evaluated in treated and untreated VL and TL patients, when anti-rEF1b antibody levels were measured before and after treatment. Results showed that rEF1b was highly sensitive and specific to diagnose symptomatic and asymptomatic canine VL, as well as human TL and VL. In addition, low cross-reactivity was observed when sera from healthy subjects or leishmaniasis-related diseases patients were tested. The serological follow-up showed also that rEF1b-specific antibodies declined significantly after treatment, suggesting that this protein could be also evaluated as a prognostic marker for human leishmaniasis.
AJR. American journal of roentgenology, Jan 24, 2018
Currently, there is no consensus in the literature regarding the screening of hepatic nodules in ... more Currently, there is no consensus in the literature regarding the screening of hepatic nodules in patients who have undergone the Fontan procedure. The objectives of this study are to evaluate in this population the frequency of hepatic nodules at ultrasound (US), CT, and MRI; to measure liver stiffness using acoustic radiation force impulse (ARFI) elastography; and to investigate predictive factors for hepatic nodules. In this cross-sectional study, 49 patients who underwent the Fontan procedure were prospectively recruited from August 2014 through June 2016. These patients underwent clinical evaluation for hepatic disorders, ARFI elastography, US, CT, and MRI. Most of the patients had no symptoms, and hepatic nodules were detected in three of 49 (6.1%) patients at US, 14 of 44 (31.8%) patients at CT, and 19 of 48 (39.6%) patients at MRI. Liver stiffness at ARFI elastography was significantly higher in patients with hepatic nodules than in patients without such nodules (2.64 ± 0.81 ...
Regulatory T cells (Tregs) are known to control immune responses by suppressing the antigen-prese... more Regulatory T cells (Tregs) are known to control immune responses by suppressing the antigen-presenting and effector T cells. Some mechanisms adopted by Tregs in combating Mycobacterium infections have been proposed. Nevertheless, in M. leprae infection, also known as leprosy or Hansen's disease, the role of Tregs has not been completely elucidated. Using multicolor flow cytometry, we evaluated the expression of different cell surface and intracellular molecules present in Tregs from peripheral blood samples of leprosy patients. Before initiating treatment, thirteen new cases of leprosy were grouped according to the Ridley-Jopling classification in to the paucibacilary (PB) or multibacilary (MB) group. Fifteen non-infected individuals (NI) were included as control subjects. Tregs were higher in the MB group than in the NI group. Tregs also co-expressed high amounts of PD1 and PDL-1, indicating that these cells could induce apoptosis of effector cells and simultaneously prevent th...
Introduction Anatomical and functional influences on gastric bypass (GBP) results are often poorl... more Introduction Anatomical and functional influences on gastric bypass (GBP) results are often poorly evaluated and not yet fully understood. Purpose The purpose of this study is to evaluate the influence of the gastric pouch volume and its emptying rate on longterm weight loss and food tolerance after GBP. Materials and Methods Weight loss, food tolerance, pouch volumetry (V) by three-dimensional reconstruction, and pouch emptying rate by 4 h scintigraphy were evaluated in 67 patients. Cutoffs were identified for V and retention percentage (%Ret) at 1 h (%Ret1). From these parameters, the sample was categorized, looking for associations between V, %Ret, weight loss, and food tolerance, assessed by a questionnaire for quick assessment of food tolerance (SS). Results PO median follow-up time was 47 months; median V was 28 mL; %Ret at 1, 2, and 4 h were 8, 2, and 1%, respectively. There were associations between V ≤ 40 mL and higher emptying rates up to 2 h (V ≤ 40 mL: %Ret1 = 6, %Ret2 = 2, p = 0.009; V > 40 mL: %Ret1 = 44, %Ret2 = 13.5, p = 0.045). An association was found between higher emptying speed in 1 h and higher late weight loss (WL), represented by lower percentage of excess weight loss (%EWL) regain (p = 0.036) and higher %EWL (p = 0.033) in the group with %Ret1 ≤ 12%, compared to the group %Ret1 ≥ 25%. Better food tolerance (SS > 24), was associated with lower %Ret1 (p = 0.003). Conclusion Smaller pouch size is associated with a faster gastric emptying, greater WL maintenance, and better food tolerance. These data suggest that a small pouch with rapid emptying rate is an important technical parameter for good outcomes in GBP.
Leprosy or Hansen's disease is a chronic infectious disease of the skin and nerves, caused by... more Leprosy or Hansen's disease is a chronic infectious disease of the skin and nerves, caused by the intracellular bacilli Mycobacterium leprae. It is characterized by a spectrum of clinical forms depending on the host's immune response to M. leprae. Patients with tuberculoid (TT) leprosy have strong cell-mediated immunity (CMI) with elimination of the bacilli, whereas patients with lepromatous (LL) leprosy exhibit defective CMI to M. leprae. Despite advances in the understanding of the pathogenesis of leprosy and the development of new therapeutic strategies, there is a need for the identification of biomarkers which be used for early diagnosis and to discrimination between different forms of the disease, as prognostic markers. Here, we analyzed the serum levels of IL-1β, IL-6, IL-8, IL-10, IL-12p70, IL-13, IL-17A, IFN-γ and TNF in order to address the contribution of these cytokines in late phase of M. leprae infection, and the impact of multidrug therapy (MDT). Our results d...
Background: Abernethy malformation is a rare congenital vascular abnormality in which the portal ... more Background: Abernethy malformation is a rare congenital vascular abnormality in which the portal vein bypasses the liver and drains directly into the inferior vena cava. Diagnosis is complex and requires good quality imaging methods to identify details in systemic and portal circulation in order to establish diagnostic confirmation and treatment strategy. In this study we highlight the significance of the use of CT scans and Color Doppler Duplex Ultrasound for the diagnosis, treatment and evolution assessment in two adults with Abernethy malformation. Case presentation: The diagnosis and the treatment of two patients with Abernethy malformation by CT scan and Color Doppler Duplex Ultrasound is described. One patient was submitted to liver transplantation due to chronic liver disease and multiple nodules diagnosed as adenoma. The other patient had normal liver function and a mild neurological and psychomotor dysfunction, therefore we adopted clinical treatment and close liver parenchyma evaluation and nodule surveillance, using an imaging approach involving intercalating CT scan and Color Doppler Duplex Ultrasound every 6 months. We highlight some important direct and indirect findings of non-invasive imaging methods. Conclusion: Abernethy malformation requires meticulous image diagnosis to improve treatment and avoid iatrogenic procedures. CT scans and Color Doppler Duplex Ultrasound are both efficient methods for diagnosis, treatment planning and evolution assessment of patients with Abernethy malformation.
The serodiagnosis of human tegumentary leishmaniasis (TL) presents some problems, such as the low... more The serodiagnosis of human tegumentary leishmaniasis (TL) presents some problems, such as the low level of antileishmanial antibodies found in most of the patients, as well as the cross-reactivity in subjects infected by other trypanosomatids. In the present study, an immunoproteomic approach was performed aimed at identification of antigens in total extracts of stationary-phase promastigote and amastigote-like forms of Leishmania ( Viannia ) braziliensis using sera from TL patients. With the purpose of reducing the cross-reactivity of the identified proteins, spots recognized by sera from TL patients, as well as those recognized by antibodies present in sera from noninfected patients living in areas where TL is endemic and sera from Chagas disease patients, were discarded. Two Leishmania hypothetical proteins and 18 proteins with known functions were identified as antigenic. The study was extended with some of them to validate the results of the immunoscreening. The coding regions ...
Chagas disease (ChD) is a main cause of cardiopathy in Latin America, causing thousands of deaths... more Chagas disease (ChD) is a main cause of cardiopathy in Latin America, causing thousands of deaths each year.(1) Amiodarone has been widely used as antiarrhythmic drug to prevent recurrences of malignant ventricular arrhythmias in patients with ChD. Although the antiarrhythmic effects of amiodarone are well known, there are some evidences that it also has anti-Trypanosoma cruzi activity,(2) disrupting Ca 2+ homeostasis and blocking oxidosqualenecyclase enzyme in T. cruzi, causing ultrastructural damage.(3) Nevertheless, data showing antiparasitic effects of amiodarone in human are lacking, with only one case report demonstrating decrease in parasite load after amiodarone use.(4) We evaluated whether patients in use of amiodarone have lower parasite load than matched infected subjects, employing a recently developed target-capture real-time PCR assay that can detect as few as one parasite per 20mL of processed blood(5), in a previously described cohort of Chagas disease subjects studied by the National Heart, Lung and Blood Institute (NHLBI) Retrovirus Epidemiological Donor Study-II (REDS-II).
Pereira Nunes MC et al. Factores predictivos de la mortalidad en pacientes con miocardiopatía: im... more Pereira Nunes MC et al. Factores predictivos de la mortalidad en pacientes con miocardiopatía: importancia de la enfermedad de Chagas
Methods and Materials: We studied 57 patients with previous US diagnosis of ICA total occlusion, ... more Methods and Materials: We studied 57 patients with previous US diagnosis of ICA total occlusion, who were followed by the vascular surgery ambulatory of our institution. These patients were evaluated by the US and by CEUS in order to survey the possibility of a residual patent lumen of such. The CTA was then performed in these patients as the gold-standard method. Results: The US demonstrated the sensitivity of 86% compared with CTA. The CEUS has shown a high sensitivity (100%) as well as a high specificity (100%) for distinguishing between the complete occlusion and pseudo-occlusion of ICA, supplying further information over US, and having excellent correlation with the CTA. In addition to being a safe procedure our study proved that CEUS is an effective method, prone to be good alternative to more expensive and invasive imaging exams. Conclusion: CEUS is comparably as sensible and specific as CTA in the distinction between occlusion and pseudo-occlusion of ICA which is major information to the management of these patients.
Note: This copy is for your personal non-commercial use only. To order presentation-ready copies ... more Note: This copy is for your personal non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights.
LUEDEMANN, M., ET AL.: Implantable Cardioverter Defibrillator in a Child Using a Single Subcutane... more LUEDEMANN, M., ET AL.: Implantable Cardioverter Defibrillator in a Child Using a Single Subcutaneous Array Lead and an Abdominal Active Can. This report describes the case of an 8-year-old boy with hypertrophic cardiomyopathy (HCM) who underwent ICD implantation for recurrent syncope. To avoid vascular complications and to minimize the surgical approach in this small child, a nonthoracotomy ICD system was chosen using a single subcutaneous array lead with only one finger, an abdominally placed active can, and epicardial dual chamber pacing and sensing electrodes. During an 8-month follow-up, DFT was confirmed and there were no ventricular tachycardia or complications. It appears to be a safe device for the prevention of sudden cardiac death in infants and small children.
Chronic chagasic cardiomyopathy (CCC) is characterized mainly by a dilated cardiomyopathy complic... more Chronic chagasic cardiomyopathy (CCC) is characterized mainly by a dilated cardiomyopathy complicated by frequent and complex ventricular arrhythmias and/or conduction defects. The aim of the present study was to evaluate functional implications of neurotransmitter receptor autoantibodies in vivo. Sera from chagasic patients were used to measure the level of autoantibodies to peptide fragments from the M2 cholinergic and beta1 adrenergic receptors. Optical density values and the frequency of anti-M2 and anti-beta1 antibodies were significantly higher in the indeterminate form and in CCC patients than in normal individuals. There was no correlation between levels of autoantibodies and clinical parameters of ventricular dysfunction, as assessed by echocardiography. Patients presenting with chronotropic insufficiency in exercise test had higher levels of anti-M2 but not anti-beta1 autoantibodies. Although anti-M2 and anti-beta1 antibodies do not appear to play a role in the pathophysiology of the heart failure that accompanies severe CCC, anti-M2 cholinergic autoantibodies may contribute to the pathogenesis of Chagas' disease dysautonomia.
Chagas disease cardiomyopathy is a common form of dilated cardiomyopathy worldwide, and an import... more Chagas disease cardiomyopathy is a common form of dilated cardiomyopathy worldwide, and an important cause of stroke in Latin America. The long-term cumulative risk of ischemic cerebrovascular event (ICE) and its relation to left ventricular (LV) dysfunction have not been determined. The aims of this study were to describe the incidence and to evaluate the effect of LV ejection fraction on the risk for ICE in patients with Chagas cardiomyopathy. A total of 213 consecutive patients with Chagas disease and LV systolic dysfunction, 131 males, mean age 48+/-12 years, were prospectively enrolled. The use of anticoagulation was based on clinical indications. The end point was ICE, which included fatal or nonfatal stroke and transient ischemic attack. Risk factors for events were assessed by Cox proportional-hazards analysis. Mean follow-up was 36 months; 69 patients died and seven underwent cardiac transplantation. The overall incidence of ICE was 2.67 events per 100 patient/years. Independent risk factors for ICE included LV ejection fraction (HR 0.95, 95% CI 0.91 to 0.99, p=0.009) and left atrial volume corrected for body surface area (HR 1.04, 95% CI 1.01 to 1.07, p=0.007), which persisted after adjustment for anticoagulation use. Patients with ejection fractions<or=35% had a relative risk of events of 3.41, as compared with the other patients. The presence of apical aneurysm or thrombus, age, and history of previous stroke were not an independent long-term risk for ICE. In patients with Chagas cardiomyopathy, the annual incidence of ICE is low. Left ventricular ejection fraction and indexed left atrial volume appear to be independently associated with these events.
To assess contrast-enhanced (C+), fat-saturated (FatSat), T1-weighted (T1W) imaging in the charac... more To assess contrast-enhanced (C+), fat-saturated (FatSat), T1-weighted (T1W) imaging in the characterization of the soft tissue mass associated with primary bone tumors, we compared it with T2-weighted (T2W) imaging in patients with osteosarcoma (n = 36) and Ewing sarcoma family of tumors (Ewing sarcoma; n = 11). Periosseous tumor compared with normal muscle had greater contrast-to-noise ratio (CNR) on the FatSat T1W C+ image than on T2W for 81% (38/47; P < .0001) of patients. The CNR of periosseous tumor compared with subcutaneous fat was greater on FatSat T1W C+ for 98% (46/47; P < .0001). Radiologists found it easier to evaluate neurovascular bundle proximity to tumor with FatSat T1W C+ images than with T2W for 64% of patients (30/47; P < .0001). They judged FatSat T1W C+ superior to T2W for periosseous tumor conspicuity and visualization of soft tissue necrosis in 62% (29/47; P < .0001). In patients with osteosarcoma or Ewing sarcoma, FatSat T1W C+ imaging may replace T2W imaging for soft tissue mass evaluation, especially if contrast is being used for dynamic enhancement.
We applied the respiratory sinus arrhythmia (RSA) quantification algorithm to 24-hour ECG recordi... more We applied the respiratory sinus arrhythmia (RSA) quantification algorithm to 24-hour ECG recordings of Chagas disease (ChD) patients with (G1, n = 148) and without left ventricular dysfunction (LVD) (G2, n = 33), and in control subjects (G0, n = 28). Both ChD groups displayed a reduced RSA index; G1 = 299 (144-812); G2 = 335 (162-667), p = 0.011, which was correlated with vagal indexes of heart rate variability analysis. RSA index is a marker of vagal modulation in ChD patients.
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