Papers by maria jose lemos
Journal of the International Institute, 2006
The vaccines are considered safe enough for general utilization, although some adverse events may... more The vaccines are considered safe enough for general utilization, although some adverse events may be temporally associated to vaccination. Since 1998, the Brazilian program of immunizations implemented a surveillance system with the objective of guiding the notification and investigation of the adverse events following immunization (AEFI). With the objective of assessing the performance of that system in Rio de Janeiro County, we conducted an exploratory study of adverse events associated to the administration of combined vaccines against diphtheria, pertussis and tetanus (DPT), Haemophilus influenzae type b (Hib), and DTP-Hib (" Tetra"), and notified from 1998 to 2005. The study population comprised children from two months to six years and eleven months of age that presented adverse events temporally related to some of the aforementioned vaccines. Notifications were analyzed by sex, age, place of residence of the vaccinee, type of event, time between vaccination and the event, and its notification. Incidence rates of EAPVs associated to the studied vaccines was 45.7 per 100,000 doses. Tetra had the highest rate (100.9 per 100,000 doses) among other vaccines. Children above 4 years of age had the highest rate of AEFI (165.2 per 100,000 doses), followed by children aged 1-4 years (50.4 per 100,000 doses) and by children 2-11 months (37.6 per 100,000 doses). The rates of AEFI by type were: 29.3 per 100,000 doses for local events, and 30.7 per 100,000 doses for systemic events. A total of 286 hypotonic-hyporesponsive episodes (HHE) were reported, 237 of them in children below 1 year of age (7.4 per 100,000 doses). The results revealed that the system is capable to identify the most important events, including those in the site of administration (pain, edema, blush or nodule in the application place), and systemic (fever, irritability, sleepiness, convulsions). Surveillance of adverse events following immunization presented good coverage in the different areas of the Municipality, although the rate of adverse events by dose was lower than in the studies based on active surveillance. This indicates underestimation, consistent with other studies with passive surveillance. An aspect to be improved is the appropriate follow-up of notified cases to reduce the proportion of pending cases.
Jornal de Pediatria, 2007
Objective: To evaluate the safety of a combined diphtheria-tetanus-whole cell pertussis-Haemophil... more Objective: To evaluate the safety of a combined diphtheria-tetanus-whole cell pertussis-Haemophilus influenzae type b vaccine used on the Brazilian National Immunizations Program, chiefly the incidence of hypotonichyporesponsive episodes. Method: Follow-up of a cohort of 21,064 infants (20,925 or 99.7% adhered to the study protocol), within 48 hours of vaccination with diphtheria-tetanus-whole cell pertussis-Haemophilus influenzae type b vaccine in health care units in the City of Rio de Janeiro, to ascertain and investigate spontaneous and solicited severe adverse events. Each child was followed-up for one dose only. Results: The rate of hypotonic-hyporesponsive episodes was 1/1,744 doses (confirmed cases) and 1/1,495 doses (confirmed plus suspect cases). The rate of convulsions was 1/5,231 doses. No cases of apnea were detected. These results are comparable to those found in the literature with diphtheria-tetanus-whole cell pertussis vaccine. Conclusion: The diphtheria-tetanus-whole cell pertussis-Haemophilus influenzae type b vaccine under study can be safely used in the National Immunizations Program, according to the current precautions and contraindications.
AIDS Research and Human Retroviruses, 2014
Jornal de pediatria
To evaluate the safety of a combined diphtheria-tetanus-whole cell pertussis-Haemophilus influenz... more To evaluate the safety of a combined diphtheria-tetanus-whole cell pertussis-Haemophilus influenzae type b vaccine used on the Brazilian National Immunizations Program, chiefly the incidence of hypotonic-hyporesponsive episodes. Follow-up of a cohort of 21,064 infants (20,925 or 99.7% adhered to the study protocol), within 48 hours of vaccination with diphtheria-tetanus-whole cell pertussis-Haemophilus influenzae type b vaccine in health care units in the City of Rio de Janeiro, to ascertain and investigate spontaneous and solicited severe adverse events. Each child was followed-up for one dose only. The rate of hypotonic-hyporesponsive episodes was 1/1,744 doses (confirmed cases) and 1/1,495 doses (confirmed plus suspect cases). The rate of convulsions was 1/5,231 doses. No cases of apnea were detected. These results are comparable to those found in the literature with diphtheria-tetanus-whole cell pertussis vaccine. The diphtheria-tetanus-whole cell pertussis-Haemophilus influenza...
Revista Brasileira de Reumatologia, 2006
Objetivo: correlacionar o instrumento de avaliação de qualidade de vida específico para osteoporo... more Objetivo: correlacionar o instrumento de avaliação de qualidade de vida específico para osteoporose, o Osteoporosis Assessment Questionnaire (OPAQ), com o instrumento genérico, o The Medical Outcomes Study 36-Item Short Form Health Survery (SF-36). Pacientes e Métodos: estudo observacional de corte transversal que incluiu 40 mulheres acima de 60 anos, diagnosticadas com osteoporose. Houve um momento para avaliação e um único examinador. Para a análise estatística foram utilizados coeficiente correlação de Pearson e análise fatorial do OPAQ. Resultados: houve correlação entre os domínios e componentes finais do SF-36 com os domínios do OPAQ. Evidenciou-se que os coeficientes mais altos foram entre o OPAQ Sintomas e os seguintes domínios do SF-36: dor (r=-0,6), aspectos sociais (r=-0,6%) e saúde mental (r=-0,5). Quase todos os aspectos do SF-36 se correlacionaram com o OPAQ Sintomas. E, ainda, por análise fatorial do OPAQ, observa-se que os seus 18 componentes representaram 63% de carga fatorial, ou seja, eles explicaram o valor total de impacto da osteoporose na qualidade de vida e agruparam-se em cinco fatores: fator 1 (mobilidade, cuidados próprios, independência e trabalho doméstico), fator 2 (flexibilidade, movimentação e sono), fator 3 (dor nas costas, dor relacionada à osteoporose, fadiga e humor), fator 4 (medo de cair, atividades sociais, apoio familiar e tensão) e fator 5 (andarinclinar, imagem corporal e trabalho). Conclusão: foi encontrada a correlação esperada entre SF-36 e OPAQ, que é um instrumento de avaliação específico com capacidade para avaliar aspectos específicos e gerais da qualidade de vida nesta população.
Cadernos de Saúde Pública, 1997
A Doença Meningocócica tem sido um sério problema de saúde pública no município do Rio de Janeiro... more A Doença Meningocócica tem sido um sério problema de saúde pública no município do Rio de Janeiro nos últimos 10 anos, com altas taxas de incidência em crianças de baixa idade, elevada letalidade e predomínio do sorogrupo B. Em dezembro de 1994 foi realizada a segunda campanha de vacinação anti-meningocócica contra os sorogrupos B e C, visando à imunização de crianças de 6 meses a 13 anos de idade. Foram vacinadas com duas doses cerca de 950 mil crianças. A vacina utilizada foi a produzida pelo Instituto Finlay de Cuba. Em 1995 foi observada uma modificação no comportamento da doença, quando passou a predominar o sorogrupo C e aumentou a incidência global da doença, particularmente entre os menores de 1 ano, adolescentes e adultos jovens. Nos grupos etários vacinados, a incidência foi menor que no ano de 1994, em função da diminuição do sorogrupo B. Não foram observadas modificações importantes no comportamento da letalidade.
Arquivos Brasileiros de Cardiologia, 2005
His heart rate was 150 bpm, and his blood pressure was 130/ 80 mmHg. His lungs showed respiratory... more His heart rate was 150 bpm, and his blood pressure was 130/ 80 mmHg. His lungs showed respiratory sounds in all fields and no rales. He had no signs of systemic congestion. The electrocardiogram on hospital admission showed sustained ventricular tachycardia and an approximate heart rate of 150 bpm (fig. 1). After receiving intravenous amiodarone (300 mg), he regained his VVI pacemaker rhythm. Due to the history of chest pain, serum measurement of troponin T was taken 6 hours after admission, and the result was 0.999 ng/mL (reference value: 0.010 ng/ mL). The serial measurements of CK-MB were normal, as were the hemogram, coagulogram, and urine I. On admission, creatinine was 1.5 mg/dL and potassium was 4.3 mEq/L. The hemodynamically stable patient, with a VVI pacemaker rhythm, was referred to the coronary unit, where he was maintained with intravenous nitroglycerin, heparin, amiodarone, and furosemide, in addition to oral beta-blockers, angiotensin-converting-enzyme inhibitors, acetylsalicylic acid, and clopidogrel. The echocardiogram showed a significant enlargement in the left ventricle, significant contractile dysfunction, no segmentary alterations in contractility, and moderate mitral insufficiency. On risk stratification for coronary heart disease, despite the difficulty in the electrocardiographic assessment because of the pacemaker rhythm, the patient was considered at high risk due to his history of chest pain associated with severe arrhythmia and ventricular dysfunction and positive troponin T measurement. The coronary angiography then performed showed no obstructive lesions (figures 2 and 3). No myocardial perfusion scintigraphy was performed. While the patient waited for discharge from the coronary unit, he experienced sustained ventricular tachycardia with no pulse. He underwent electrical defibrillation, which was successful after the forth shock with a return of the pulse and hemodynamic instability. The patient continued to have episodes of nonsustained ventricular tachycardia with a pulse, which was reverted to the pacemaker rhythm by use of intravenous amiodarone. The patient was then referred for implantation of a cardioverter/defibrillator, which was successful. After this episode, the patient evolved with cardiogenic shock, acute renal dysfunction (peak creatinine-6.4 mg/dL), and liver dysfunction with maximum values of ALT and AST of 5,011 UI/L and 12,560 UI/L, respectively. The serological research for hepatitis A, B, and C, cytomegalovirus, toxoplasmosis, and HIV was negative. The patient underwent hemodynamic monitoring with the Swan-Ganz catheter, which showed, in the initial hemodynamic measurements (with 10 µg/kg/min of
Revista de Saúde Pública, 2012
OBJETIVO: Avaliar a efetividade de um programa de controle de qualidade de imagem nos serviços de... more OBJETIVO: Avaliar a efetividade de um programa de controle de qualidade de imagem nos serviços de mamografia da rede do Sistema Único de Saúde. MÉTODOS: Estudo prospectivo com análise temporal do tipo "antes e depois" de uma ação de vigilância em saúde. Participaram do estudo 35 serviços que tinham mamógrafos em operação e realizavam exames regularmente em Goiás entre 2007 e 2009. Foram avaliados os serviços, por testes de desempenho de mamógrafos, processadoras e demais materiais em três visitas técnicas, a qualidade da imagem e a dose de entrada no simulador radiográfico de mama. Cada serviço recebeu uma pontuação correspondente ao percentual dos testes em conformidade com os padrões. RESULTADOS: Os percentuais médios de conformidade dos serviços foram de 64,1% (± 13,3%) na primeira visita, 68,4% (± 15,9%) na segunda e 77,1% (± 13,3%) na terceira (p < 0,001). As principais melhorias foram decorrentes dos ajustes da força de compressão da mama, do controle automático d...
Weather, Climate, and Society, 2013
As the climate in the midwestern United States becomes increasingly variable because of global cl... more As the climate in the midwestern United States becomes increasingly variable because of global climate change, it is critical to provide tools to the agricultural community to ensure adaptability and profitability of agricultural cropping systems. When used by farmers and their advisors, agricultural decision support tools can reduce uncertainty and risks in the planning, operation, and management decisions of the farm enterprise. Agricultural advisors have historically played a key role in providing information and guidance in these decisions. However, little is known about what these advisors know or think about weather and climate information and their willingness to incorporate this type of information into their advice to farmers. In this exploratory study, a diverse set of professionals who advise corn growers, including government, nonprofit, for-profit, and agricultural extension personnel, were surveyed in four states in the midwestern Corn Belt. Results from the survey ind...
Memórias do Instituto Oswaldo Cruz, 2008
A randomized, double-blinded study evaluating the immunogenicity, safety and consistency of produ... more A randomized, double-blinded study evaluating the immunogenicity, safety and consistency of production of a combined diphtheria-tetanus-pertussis-Haemophilus influenzae type b vaccine entirely produced in Brazil by Bio-Manguinhos and Instituto Butantan (DTP/Hib-BM) was undertaken. The reference vaccine had the same DTP vaccine but the Hib component was produced using purified materials supplied by GlaxoSmithKline (DTP/Hib-GSK), which is registered and has supplied the Brazilian National Immunization Program for over more than five years. One thousand infants were recruited for the study and received vaccinations at two, four and six months of age. With respect to immunogenicity, the vaccination protocol was followed in 95.6% and 98.4% of infants in the DTP/Hib-BM and DTP/Hib-GSK groups, respectively. For the Hib component of the study, there was 100% seroprotection (≥ 0.15 μg/mL) with all three lots of DTP/Hib-BM and DTP/Hib-GSK. The geometric mean titer (GMT) was 9.3 μg/ mL, 10.3 μg/mL and 10.3 μg/mL for lots 1, 2 and 3 of DTP/Hib-BM, respectively, and the GMT was 11.3 μg/mL for DTP/Hib-GSK. For diphtheria, tetanus and pertussis, seroprotection was 99.7%, 100% and 99.9%, respectively, for DTP/Hib-BM, three lots altogether and 99.2%, 100% and 100% for DTP/Hib-GSK. GMTs were similar across all lots and vaccines. Adverse events rates were comparable among the vaccine groups. The Brazilian DTP/Hib vaccine demonstrated an immunogenicity and reactogenicity profile similar to that of the reference vaccine.
LWT - Food Science and Technology, 2000
The thermal inactivation of horseradish peroxidase in aqueous solution was studied in the pH rang... more The thermal inactivation of horseradish peroxidase in aqueous solution was studied in the pH range of 3.0 to 12.5, at temperatures ranging from 40 3C to 95 3C. The data were well xtted by a double exponential model. The enzyme showed highest stability around neutral pH and the stability was particularly decreased above pH 11. The z value of the less labile fraction at pH 11.5 to 12.5 (temperatures from 40 to 65 3C) and of the more labile fraction at pH 3}4 (temperatures from 65 to 85 3C) were close to 10 3C, making these systems suitable as time-temperature integrators for assessing microbial lethality in thermal processing of low-acid foods, particularly if they can be stabilized further without awecting their low z-value.
The Journal of Immunology, 2004
Tumors evade immune surveillance despite the frequent expression of tumor-associated Ags (TAA). T... more Tumors evade immune surveillance despite the frequent expression of tumor-associated Ags (TAA). Tumor cells escape recognition by CD8+ T cells through several mechanisms, including down-regulation of MHC class I molecules and associated Ag-processing machinery. However, although it is well accepted that optimal anti-tumor immune responses require tumor-reactive CD4+ T cells, few studies have addressed how tumor cells evade CD4+ T cell recognition. In this study, we show that a common TAA, GA733-2, and its murine orthologue, mouse epithelial glycoprotein (mEGP), function in blocking MHC class II-restricted Ag presentation by dendritic cells. GA733-2 is a common TAA that is expressed normally at low levels by some epithelial tissues and a subset of dendritic cells, but at high levels on colon, breast, lung, and some nonepithelial tumors. We show that ectopic expression of mEGP or GA733-2, respectively, in dendritic cells derived from murine bone marrow or human monocytes results in a ...
The Journal of Immunology, 2003
The activation, proliferation, differentiation, and trafficking of CD4 T cells is central to the ... more The activation, proliferation, differentiation, and trafficking of CD4 T cells is central to the development of type I immune responses. MHC class II (MHCII)-bearing dendritic cells (DCs) initiate CD4+ T cell priming, but the relative contributions of other MHCII+ APCs to the complete Th1 immune response is less clear. To address this question, we examined Th1 immunity in a mouse model in which I-Aβb expression was targeted specifically to the DCs of I-Aβb−/− mice. MHCII expression is reconstituted in CD11b+ and CD8α+ DCs, but other DC subtypes, macrophages, B cells, and parenchymal cells lack of expression of the I-Aβb chain. Presentation of both peptide and protein Ags by these DC subsets is sufficient for Th1 differentiation of Ag-specific CD4+ T cells in vivo. Thus, Ag-specific CD4+ T cells are primed to produce Th1 cytokines IL-2 and IFN-γ. Additionally, proliferation, migration out of lymphoid organs, and the number of effector CD4+ T cells are appropriately regulated. However...
Journal of Experimental Medicine, 2004
Control of the intracellular protozoan, Leishmania major, requires major histocompatibility compl... more Control of the intracellular protozoan, Leishmania major, requires major histocompatibility complex class II (MHC II)–dependent antigen presentation and CD4+ T cell T helper cell 1 (Th1) differentiation. MHC II–positive macrophages are a primary target of infection and a crucial effector cell controlling parasite growth, yet their function as antigen-presenting cells remains controversial. Similarly, infected Langerhans cells (LCs) can prime interferon (IFN)γ–producing Th1 CD4+ T cells, but whether they are required for Th1 responses is unknown. We explored the antigen-presenting cell requirement during primary L. major infection using a mouse model in which MHC II, I-Aβb, expression is restricted to CD11b+ and CD8α+ dendritic cells (DCs). Importantly, B cells, macrophages, and LCs are all MHC II–negative in these mice. We demonstrate that antigen presentation by these DC subsets is sufficient to control a subcutaneous L. major infection. CD4+ T cells undergo complete Th1 differenti...
Journal of Endocrinology, 2009
Germline mutations of the multiple endocrine neoplasia type 1 (MEN1) gene cause parathyroid, panc... more Germline mutations of the multiple endocrine neoplasia type 1 (MEN1) gene cause parathyroid, pancreatic and pituitary tumours in man. MEN1 mutations also cause familial isolated primary hyperparathyroidism (FIHP) and the same MEN1 mutations, in different families, can cause either FIHP or MEN1. This suggests a role for genetic background and modifier genes in altering the expression of a mutation. We investigated the effects of genetic background on the phenotype of embryonic lethality that occurs in a mouse model for MEN1. Men1+/− mice were backcrossed to generate C57BL/6 and 129S6/SvEv incipient congenic strains, and used to obtain homozygous Men1−/− mice. No viable Men1−/− mice were obtained. The analysis of 411 live embryos obtained at 9.5–16.5 days post-coitum (dpc) revealed that significant deviations from the expected Mendelian 1:2:1 genotype ratio were first observed at 12.5 and 14.5 dpc in the 129S6/SvEv and C57BL/6 strains respectively (P<0.05). Moreover, live Men1−/− e...
The Journal of Clinical Endocrinology & Metabolism, 2005
Context: Hereditary multiple exostosis (HME) is an autosomal dominant disorder characterized by t... more Context: Hereditary multiple exostosis (HME) is an autosomal dominant disorder characterized by the development of benign cartilagecapped tumors at the juxta-epiphyseal regions of long bones. HME is usually caused by mutations of EXT1 or EXT2. Objective: The objective of this study was to investigate a threegeneration Austrian kindred with HME for EXT1 and EXT2 mutations and for abnormalities of bone mineral density (BMD). Methods: DNA sequence and mRNA analyses were used to identify the mutation and its associated consequences. Serum biochemical and radiological investigations assessed bone metabolism and BMD. Results: HME-affected members had a lower femoral neck BMD compared with nonaffected members (z-scores, Ϫ2.98 vs. Ϫ1.30; P ϭ 0.011), and in those less than 30 yr of age, the lumbar spine BMD was also low (z-scores, Ϫ2.68 vs. Ϫ1.42; P ϭ 0.005). However, they had normal mobility and normal serum concentrations of calcium, phosphate, alkaline phosphatase activity, creatinine, PTH, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, osteocalcin, and -crosslaps. DNA sequence analysis of EXT1 revealed a heterozygous g3c transversion that altered the invariant ag dinucleotide of the intron 8 acceptor splice site. RT-PCR analysis using lymphoblastoid RNA showed that the mutation resulted in skipping of exon 9 with a premature termination at codon 599. DNA sequence abnormalities of the osteoprotegerin gene, which is in close proximity to the EXT1 gene, were not detected. Conclusions: A novel heterozygous acceptor splice site mutation of EXT1 results in HME that is associated with a low peak bone mass, indicating a possible additional role for EXT1 in bone biology and in regulating BMD.
Uploads
Papers by maria jose lemos