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Sakamoto AP, Silva CA, Pita AC, Trindade VC, Islabao AG, Fiorot FJ, Lopes SR, Pereira RM, Saad-Magalhaes C, Russo GC, Len CA, Prado RD, Campos LM, Aikawa NE, Appenzeller S, Ferriani VP, Silva MF, Felix M, Fonseca AR, Assad AP, Sztajnbok FR, Santos MC, Bica BE, Sena EG, Moraes AJ, Fraga MM, Robazzi TC, Spelling PF, Scheibel IM, Cavalcanti AS, Matos EN, Guimaraes LJ, Santos FP, Mota LM, Bonfa E, Terreri MT. Risk factors for mortality in 1528 Brazilian childhood-onset systemic lupus erythematosus patients. Lupus 2023; 32:781-790. [PMID: 37070932 DOI: 10.1177/09612033231170515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVES To identify associations between mortality in cSLE patients and their characteristics: clinical and laboratory features, disease activity and damage scores, and treatment; to evaluate risk factors associated with mortality in cSLE; and to determine the most frequent causes of death in this group of patients. METHODS We performed a multicenter retrospective cohort using data from 1,528 cSLE patients followed in 27 pediatric rheumatology tertiary centers in Brazil. Patients' medical records were reviewed according to a standardized protocol, in which information regarding demographic and clinical features, disease activity and damage scores, and treatment were collected and compared between deceased cSLE patients and survivors. Univariate and multivariate analyses by Cox regression model were used to calculate risk factors for mortality, whereas survival rates were analyzed by Kaplan-Meier plots. RESULTS A total of 63/1,528 (4.1%) patients deceased, 53/63 were female (84.1%), median age at death was 11.9 (9.4-13.1) years and median time interval between cSLE diagnosis and death was 3.2 (0.5-5.3) years. Sepsis was the main cause of death in 27/63 (42.8%) patients, followed by opportunistic infections in 7/63 (11.1%), and alveolar hemorrhage in 6/63 (9.5%) patients. The regression models resulted in neuropsychiatric lupus (NP-SLE) (HR = 2.56, 95% CI = 1.48-4.42) and chronic kidney disease (CKD) (HR = 4.33, 95% CI = 2.33-4.72), as risk factors significantly associated with mortality. Overall patient survival after cSLE diagnosis at 5, 10, and 15 years were 97%, 95.4%, and 93.8%, respectively. CONCLUSIONS This study confirmed that the recent mortality rate in cSLE in Brazil is low, but still of concern. NP-SLE and CKD were the main risk factors for mortality, indicating that the magnitude of these manifestations was significantly high.
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Affiliation(s)
- Ana P Sakamoto
- Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ana C Pita
- Pediatric Rheumatology Unit, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Vitor C Trindade
- Pediatric Rheumatology Unit, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Aline G Islabao
- Pediatric Rheumatology Unit, Hospital da Crianca de Brasilia Jose Alencar, Brasilia, DF, Brazil
| | - Fernanda J Fiorot
- Pediatric Rheumatology Unit, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sandra Rm Lopes
- Pediatric Rheumatology Unit, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rosa Mr Pereira
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Claudia Saad-Magalhaes
- Pediatric Rheumatology Division, Sao Paulo State University (UNESP) - Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
| | - Gleice Cs Russo
- Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Claudio A Len
- Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Rogerio do Prado
- Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Lucia Ma Campos
- Pediatric Rheumatology Unit, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nadia E Aikawa
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology - School of Medical Science - University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Virginia Pl Ferriani
- Pediatric Rheumatology Unit, Ribeirao Preto Medical School - University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Marco F Silva
- Pediatric Rheumatology Unit, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - Marta Felix
- Pediatric Rheumatology Unit, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Adriana R Fonseca
- Pediatric Rheumatology Unit, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Ana Pl Assad
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Flavio R Sztajnbok
- Pediatric Rheumatology Unit, Pedro Ernesto University Hospital, Rio de Janeiro, RJ, Brazil
| | - Maria C Santos
- Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericordia de Sao Paulo, Sao Paulo, SP, Brazil
| | - Blanca E Bica
- Rheumatology Division - Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Evaldo G Sena
- Pediatric Rheumatology Unit, Lauro Vanderley University Hospital, Joao Pessoa, PB, Brazil
| | - Ana J Moraes
- Pediatric Rheumatology Unit, Federal University of Para, Belem, PA, Brazil
| | - Melissa M Fraga
- Pediatric Rheumatology Unit, Hospital Darcy Vargas, Sao Paulo, SP, Brazil
| | - Teresa C Robazzi
- Pediatric Rheumatology Unit, Federal University of Bahia, Salvador, BA, Brazil
| | - Paulo F Spelling
- Pediatric Rheumatology Unit, Hospital Evangelico de Curitiba, Curitiba, PR, Brazil
| | - Iloite M Scheibel
- Pediatric Rheumatology Unit, Hospital Criança Conceicao, Porto Alegre, RS, Brazil
| | - Andre S Cavalcanti
- Pediatric Rheumatology Unit, Federal University of Pernambuco, Recife, PE, Brazil
| | - Erica N Matos
- Pediatric Rheumatology Unit, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | - Flavia P Santos
- Pediatric Rheumatology Unit, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Licia Mh Mota
- Rheumatology Unit, University of Brasilia, Brasilia, DF, Brazil
| | - Eloisa Bonfa
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Maria T Terreri
- Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
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Silva MF, Ferreira AA, Grunewald STF, Cunha CF. DESAFIOS NO MANEJO DA GESTAÇÃO EM UMA PACIENTE COM HEMOGLOBINÚRIA PAROXÍSTICA NOTURNA: RELATO DE CASO. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Silva ANDS, Teixeira EB, Oliveira MB, Rotella LB, Viana VBJ, Silva MF, Gomes JAB, Wanderley AV, Oliveira EHC, Khayat AS. ANÁLISE DE ALTERAÇÕES GENÔMICAS QUANTITATIVAS EM GENES APAGADORES (KDM1B E KDM7) EM LEUCEMIA LINFOBLÁSTICA AGUDA PEDIÁTRICA. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Santos MF, Honório LM, Moreira APGM, Garcia PAN, Silva MF, Vidal VF. Analysis of a Fast Control Allocation approach for nonlinear over-actuated systems. ISA Trans 2022; 126:545-561. [PMID: 34462136 DOI: 10.1016/j.isatra.2021.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 07/26/2021] [Accepted: 08/05/2021] [Indexed: 06/13/2023]
Abstract
Autonomous Robots with multiple directional thrusters are normally over-actuated systems that require nonlinear control allocation methods to map the forces that drive the robot's dynamics and act as virtual control variables to the actuators. This process demands computational efforts that, sometimes, are not available in small robotic platforms. The present paper introduces a new control allocation approach with fast convergence, high accuracy, and dealing with complex nonlinear problems, especially in embedded systems. The adopted approach divides the desired nonlinear system into coupled linear problems. For that purpose, the Real Actions (RAs) and Virtual Control Variables (VCVs) are broke in two or more sets each. While the RA subsets are designed to linearize the system according to different input subspaces, the VCV is designed to be partially coupled to overlap the output subspaces. This approach generates smaller linear systems with fast and robust convergence used sequentially to solve nonlinear allocation problems. This methodology is assessed in mathematical tutorial cases and over-actuated UAV simulations.
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Affiliation(s)
- M F Santos
- Department of Electroelectronics, CEFET-MG, José Peres Street, 558, Leopoldina, Brazil
| | - L M Honório
- Department of Energy Systems, UFJF, José Lourenço Kelmer Street, Juiz de Fora, Brazil.
| | - A P G M Moreira
- Department of Electrical and Computer Engineering, FEUP, UPorto, Dr. Roberto Frias Street, Porto, Portugal
| | - P A N Garcia
- Department of Energy Systems, UFJF, José Lourenço Kelmer Street, Juiz de Fora, Brazil
| | - M F Silva
- Department of Energy Systems, UFJF, José Lourenço Kelmer Street, Juiz de Fora, Brazil
| | - V F Vidal
- Department of Energy Systems, UFJF, José Lourenço Kelmer Street, Juiz de Fora, Brazil
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5
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Islabão AG, Mota LMH, Ribeiro MCM, Arabi TM, Cividatti GN, Queiroz LB, Andrade DC, Sakamoto AP, Trindade VC, Novak GV, Molinari BC, Campos LM, Aikawa NE, Pereira RMR, Terreri MT, Magalhães CS, Marini R, Gomes HR, Silva MF, Oliveira SK, Sztajnbok FR, Sacchetti SB, Bica BE, Sena EG, Moraes AP, Santos MC, Robazzi TC, Spelling PF, Scheibel IM, Cavalcanti AS, Naka EN, Guimarães LJ, Santos FP, Sampaio MC, Bonfá E, Silva CA. Childhood-onset systemic lupus erythematosus-related antiphospholipid syndrome: A multicenter study with 1519 patients. Autoimmun Rev 2020; 19:102693. [PMID: 33164791 DOI: 10.1016/j.autrev.2020.102693] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/08/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess childhood-onset systemic lupus erythematosus-related antiphospholipid syndrome(cSLE-APS) in a large Brazilian population. METHODS A retrospective observational cohort study was carried-out in 27 Pediatric Rheumatology university centers, including 1519 cSLE patients. RESULTS cSLE-APS was observed in 67/1519 (4%) and was diagnosed at disease onset in 39/67 (58%). The median disease duration was 4.9 (0-17) years. Thrombosis recurrences were evidenced in 18/67 (27%) cSLE-APS patients. The most frequent thrombosis sites in cSLE-APS patients were: venous thrombosis in 40/67 (60%), especially deep vein thrombosis in 29/40 (72%); arterial thrombosis in 35/67 (52%), particularly stroke; small vessels thrombosis in 9/67 (13%) and mixed thrombosis in 3/67 (4%). Pregnancy morbidity was observed in 1/67 (1%). Non-thrombotic manifestation associated to cSLE-APS occurred in 21/67 (31%), mainly livedo reticularis in 14/67 (21%), valvar thickening in 4/67 (6%) and valvar vegetations not related to infections in 2/67 (3%). None of them had catastrophic APS. Further analysis demonstrated that the median of SLICC/ACR-DI [1(0-5) vs. 0(0-7),p < 0.0001] was significantly higher in cSLE-APS patients compared to cSLE without APS. The frequencies of cerebrovascular disease (40% vs. 1%,p < 0.0001), polyneuropathy (9% vs. 1%,p < 0.0001), SLICC/ACR-DI ≥1 (57% vs. 27%, p < 0.0001) and intravenous cyclophosphamide use (59% vs. 37%, p < 0.0001) were significantly higher in the former group. CONCLUSIONS Our large multicenter study demonstrated that cSLE-APS was a rare condition, occurring during disease course with a high accrual damage. Central and peripheral neuropsychiatric involvements were distinctive features of this autoimmune thrombosis.
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Affiliation(s)
- Aline G Islabão
- Pediatric Rheumatology Unit, Hospital da Criança de Brasília Jose Alencar, Brasília, BR, Brazil; Post-graduation Program in Medical Science, University of Brasilia, Brasília, BR, Brazil.
| | - Licia M H Mota
- Post-graduation Program in Medical Science, University of Brasilia, Brasília, BR, Brazil; Rheumatology Unit, University of Brasilia, Brasília, BR, Brazil
| | | | - Tamima M Arabi
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR, Brazil
| | - Georgiana N Cividatti
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR, Brazil
| | - Ligia B Queiroz
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR, Brazil
| | - Danieli C Andrade
- Division of Rheumatology Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR, Brazil
| | - Ana P Sakamoto
- Pediatric Rheumatology Unit, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vitor C Trindade
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR, Brazil
| | - Glaucia V Novak
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR, Brazil
| | - Beatriz C Molinari
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR, Brazil
| | - Lucia M Campos
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR, Brazil
| | - Nádia E Aikawa
- Division of Rheumatology Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR, Brazil
| | - Rosa M R Pereira
- Division of Rheumatology Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR, Brazil
| | - Maria T Terreri
- Pediatric Rheumatology Unit, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Claudia S Magalhães
- Pediatric Rheumatology Division, Sao Paulo State University (UNESP), Botucatu, BR, Brazil
| | - Roberto Marini
- Pediatric Rheumatology Unit, University of Campinas (UNICAMP), Campinas, BR, Brazil
| | - Hugo R Gomes
- Pediatric Rheumatology Unit, Ribeirão Preto Medical School - University of São Paulo, Ribeirão Preto, BR, Brazil
| | - Marco F Silva
- Pediatric Rheumatology Unit, Hospital Geral de Fortaleza, Fortaleza, BR, Brazil
| | - Sheila K Oliveira
- Pediatric Rheumatology Unit, Rio de Janeiro Federal University (IPPMG-UFRJ), Rio de Janeiro, BR, Brazil
| | - Flavio R Sztajnbok
- Pediatric Rheumatology Unit, Pedro Ernesto University Hospital, Rio de Janeiro, BR, Brazil
| | - Silvana B Sacchetti
- Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, BR, Brazil
| | - Blanca E Bica
- Rheumatology Division - Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, BR, Brazil
| | - Evaldo G Sena
- Pediatric Rheumatology Unit, Lauro Vanderley University Hospital, João Pessoa, BR, Brazil
| | - Ana P Moraes
- Pediatric Rheumatology Unit, Federal University of Pará, Belém, BR, Brazil
| | - Maria C Santos
- Pediatric Rheumatology Unit, Hospital Darcy Vargas, São Paulo, BR, Brazil
| | - Teresa C Robazzi
- Pediatric Rheumatology Unit, Federal University of Bahia, Salvador, BR, Brazil
| | - Paulo F Spelling
- Pediatric Rheumatology Unit, Hospital Evangélico de Curitiba, Curitiba, BR, Brazil
| | - Iloite M Scheibel
- Pediatric Rheumatology Unit, Hospital Criança Conceição, Porto Alegre, BR, Brazil
| | - Andre S Cavalcanti
- Pediatric Rheumatology Unit, Federal University of Pernambuco, Recife, BR, Brazil
| | - Erica N Naka
- Pediatric Rheumatology Unit, Federal University of Mato Grosso do Sul, Campo Grande, BR, Brazil
| | | | - Flavia P Santos
- Pediatric Rheumatology Unit, Federal University of Minas Gerais, Belo Horizonte, BR, Brazil
| | - Magda C Sampaio
- Pediatric Immunology Unit, Children's Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR, Brazil
| | - Eloisa Bonfá
- Division of Rheumatology Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR, Brazil
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR, Brazil
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Vieira EMF, Pires AL, Silva JPB, Magalhães VH, Grilo J, Brito FP, Silva MF, Pereira AM, Goncalves LM. High-Performance μ-Thermoelectric Device Based on Bi 2Te 3/Sb 2Te 3 p-n Junctions. ACS Appl Mater Interfaces 2019; 11:38946-38954. [PMID: 31560510 DOI: 10.1021/acsami.9b13254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A flexible and ultralight planar thermoelectric generator based on 15 thermocouples composed of n-type bismuth telluride (Bi2Te3) and p-type antimony telluride (Sb2Te3) legs (each with 400 nm thick) connected in series, on 25 μm thick Kapton substrate, was fabricated with impressive power factor values of 2.7 and 0.8 mW K-2 m-1 (at 298 K) for Bi2Te3 and Sb2Te3 films, respectively. The p-n junction thermoelectric device can generate a maximum open-circuit voltage and output power of 210 mV and 0.7 μW (3.3 mW cm-2), respectively, for a temperature difference of 35 K, which is higher than the one observed for a conventional thermoelectric device with metallic contacts for p-n junctions. The results were combined with numerical simulations, showing a good match between the experimental and the numerical results. The current density versus voltage (J-V) characteristics of the fabricated p-n junctions revealed a diode behavior with a turn-on voltage of ≈0.3 V and an impressive rectifying ratio (I+1V/I-1V) of ≈2 × 104.
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Affiliation(s)
- E M F Vieira
- Universidade do Minho, CMEMS-UMINHO , Campus Azurem , 4804-533 Guimaraes , Portugal
| | - A L Pires
- IFIMUP and IN-Institute of Nanoscience and Nanotechnology, Departamento de Física e Astronomia, Faculdade de Ciências da Universidade do Porto , Universidade do Porto , Rua do Campo Alegre 687 , 4169-007 Porto , Portugal
| | - J P B Silva
- Centro de Física das Universidades do Minho e do Porto (CF-UM-UP) , Campus de Gualtar , 4710-057 Braga , Portugal
| | - V H Magalhães
- Universidade do Minho, CMEMS-UMINHO , Campus Azurem , 4804-533 Guimaraes , Portugal
| | - J Grilo
- Universidade do Minho, CMEMS-UMINHO , Campus Azurem , 4804-533 Guimaraes , Portugal
| | - F P Brito
- Mechanical Engineering Department , MEtRICs, University of Minho , Campus de Azurem , 4800 Guimaraes , Portugal
| | - M F Silva
- Universidade do Minho, CMEMS-UMINHO , Campus Azurem , 4804-533 Guimaraes , Portugal
| | - A M Pereira
- IFIMUP and IN-Institute of Nanoscience and Nanotechnology, Departamento de Física e Astronomia, Faculdade de Ciências da Universidade do Porto , Universidade do Porto , Rua do Campo Alegre 687 , 4169-007 Porto , Portugal
| | - L M Goncalves
- Universidade do Minho, CMEMS-UMINHO , Campus Azurem , 4804-533 Guimaraes , Portugal
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Fiorot FJ, Islabão AG, Pereira RM, Terreri MT, Saad-Magalhães C, Novak GV, Molinari BC, Sakamoto AP, Aikawa NE, Campos LM, Peracchi OA, Appenzeller S, Ferriani VP, Silva MF, Fonseca AR, Sztajnbok FR, Paim LB, Fraga MM, Okuda EM, Bica BE, Sena EG, Moraes AJ, Rolim AM, Spelling PF, Scheibel IM, Cavalcanti AS, Matos EN, Robazzi TC, Guimarães LJ, Santos FP, Ramos VC, Carneiro-Sampaio M, Bonfá E, Silva CA. Disease presentation of 1312 childhood-onset systemic lupus erythematosus: influence of ethnicity. Clin Rheumatol 2019; 38:2857-2863. [PMID: 31209708 DOI: 10.1007/s10067-019-04631-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/24/2019] [Accepted: 05/31/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the influence of ethnicity in presentation of childhood-onset systemic lupus erythematosus (cSLE) patients. METHODS This multicenter study included cSLE patients (American College of Rheumatology criteria) followed in 27 Pediatric Rheumatology services of Brazil. Ethnicities were classified in four groups according to the parents' and all four grandparents' self-reported ethnicity. The statistical analysis was performed using the Bonferroni's correction (p < 0.0027). RESULTS According to ethnic groups, 1537 cSLE patients were classified in Caucasian (n = 786), African-Latin American (n = 526), Asian (n = 8), and others/unknown (n = 217). Comparisons between 1312 African-Latin American and Caucasian revealed similar median age at cSLE diagnosis [12.2(2.6-18) vs. 12.1(0.3-18) years, p = 0.234], time interval to diagnosis [0.25(0-12) vs. 0.3(0-10) years, p = 0.034], and SLEDAI-2K score [14(0-55) vs. 14(0-63), p = 0.781] in both groups. The mean number of diagnostic criteria according to SLICC (6.47 ± 1.911 vs. 5.81 ± 1.631, p < 0.0001) and frequencies of maculopapular lupus rash (8% vs. 3%, p < 0.0001), palate oral ulcers (17% vs. 11%, p = 0.001), tongue oral ulcers (4% vs. 1%, p = 0.001), and nonscarring alopecia (29% vs. 16%, p < 0.0001) were significantly higher in African-Latin American, whereas malar rash (45% vs. 58%, p < 0.0001) was more frequent in Caucasian. The presence of anti-phospholipid antibody (23% vs. 12%, p < 0.0001), low complement levels (58% vs. 41%, p < 0.0001), and isolated direct Coombs test (10% vs. 5%, p = 0.001) was also significantly higher in the former group. CONCLUSIONS Our study demonstrated that disease presentation severity of African-Latin American cSLE patients is comparable with Caucasian. Mucocutaneous manifestations and autoantibodies profile were the only distinctive features of the former group. The unique mixed background of Brazilian patients probably minimized race diversity spectrum of these patients. Key Points • Our study demonstrated that disease presentation severity of African-Latin American cSLE patients is comparable with Caucasian. • Mucocutaneous manifestations and autoantibodies profile were the only distinctive features of African-Latin American cSLE patients. • African-Latin American cSLE patients had more often anti-phospholipid antibodies and hypocomplementemia. • The unique mixed background of Brazilian patients probably minimized race diversity spectrum of these patients.
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Affiliation(s)
- Fernanda J Fiorot
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Aline G Islabão
- Pediatric Rheumatology Unit, Hospital Jose Alencar, Brasilia, Brazil
| | - Rosa M Pereira
- Division of Rheumatology Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maria T Terreri
- Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Glaucia V Novak
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Beatriz C Molinari
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Ana P Sakamoto
- Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Nadia E Aikawa
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil.,Division of Rheumatology Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lucia M Campos
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Octavio A Peracchi
- Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Simone Appenzeller
- Pediatric Rheumatology Unit, University of Campinas (UNICAMP), Campinas, Brazil
| | - Virgínia P Ferriani
- Pediatric Rheumatology Unit, Ribeirao Preto Medical School - University of Sao Paulo, Ribeirão Preto, Brazil
| | - Marco F Silva
- Pediatric Rheumatology Unit, Hospital Geral de Fortaleza, Fortaleza, Brazil
| | - Adriana R Fonseca
- Pediatric Rheumatology Unit, Rio de Janeiro Federal University (IPPMG-UFRJ), Rio de Janeiro, Brazil
| | - Flávio R Sztajnbok
- Pediatric Rheumatology Unit, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
| | - Luciana B Paim
- Pediatric Rheumatology Unit, Albert Sabin Children's Hospital, Fortaleza, Brazil
| | - Melissa M Fraga
- Pediatric Rheumatology Unit, Hospital Darcy Vargas, Sao Paulo, Brazil
| | - Eunice M Okuda
- Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericórdia de Sao Paulo, Sao Paulo, Brazil
| | - Blanca E Bica
- Rheumatology Division - Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Evaldo G Sena
- Pediatric Rheumatology Unit, Lauro Vanderley University Hospital, João Pessoa, Brazil
| | - Ana J Moraes
- Pediatric Rheumatology Unit, Federal University of Pará, Belém, Brazil
| | - Ana M Rolim
- Pediatric Rheumatology Unit, Obras Sociais Irmã Dulce, Salvador, Brazil
| | - Paulo F Spelling
- Pediatric Rheumatology Unit, Hospital Evangélico de Curitiba, Curitiba, Brazil
| | - Iloite M Scheibel
- Pediatric Rheumatology Unit, Hospital Criança Conceição, Porto Alegre, Brazil
| | - André S Cavalcanti
- Pediatric Rheumatology Unit, Federal University of Pernambuco, Recife, Brazil
| | - Erica N Matos
- Pediatric Rheumatology Unit, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Teresa C Robazzi
- Pediatric Rheumatology Unit, Federal University of Bahia, Salvador, Brazil
| | | | - Flávia P Santos
- Pediatric Rheumatology Unit, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Valeria C Ramos
- Pediatric Rheumatology Unit, Pontifícia Catholic University of Sorocaba, São Paulo, Brazil
| | - Magda Carneiro-Sampaio
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Eloisa Bonfá
- Division of Rheumatology Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil. .,Division of Rheumatology Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
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Novak GV, Molinari BC, Ferreira JC, Sakamoto AP, Terreri MT, Pereira RMR, Saad-Magalhães C, Aikawa NE, Campos LM, Len CA, Appenzeller S, Ferriani VP, Silva MF, Oliveira SK, Islabão AG, Sztajnbok FR, Paim LB, Barbosa CM, Santos MC, Bica BE, Sena EG, Moraes AJ, Rolim AM, Spelling PF, Scheibel IM, Cavalcanti AS, Matos EN, Robazzi TC, Guimarães LJ, Santos FP, Silva CT, Bonfá E, Silva CA. Characteristics of 1555 childhood-onset lupus in three groups based on distinct time intervals to disease diagnosis: a Brazilian multicenter study. Lupus 2018; 27:1712-1717. [PMID: 30020023 DOI: 10.1177/0961203318787037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective The objective of this study was to compare demographic data, clinical/laboratorial features and disease activity at diagnosis in three different groups with distinct time intervals between onset of signs/symptoms and disease diagnosis. Methods A multicenter study was performed in 1555 childhood-onset systemic lupus erythematosus (American College of Rheumatology criteria) patients from 27 pediatric rheumatology services. Patients were divided into three childhood-onset systemic lupus erythematosus groups: A: short time interval to diagnosis (<1 month); B: intermediate time interval (≥1 and <3 months); and C: long time interval (≥3 months). An investigator meeting was held to define the protocol. Demographic data, SLICC classification criteria and SLEDAI-2 K were evaluated. Results The number of patients in each group was: A = 60 (4%); B = 522 (33.5%); and C = 973 (62.5%). The median age at diagnosis (11.1 (4.2-17) vs. 12 (1.9-17.7) vs. 12.5 (3-18) years, P = 0.025) was significantly lower in group A compared with groups B and C. The median number of diagnostic criteria according to SLICC (7 (4-12) vs. 6 (4-13) vs. 6 (4-12), P < 0.0001) and SLEDAI-2 K (18 (6-57) vs. 16 (2-63) vs. 13 (1-49), P < 0.0001) were significantly higher in group A than the other two groups. The frequency of oral ulcers in the palate (25% vs. 15% vs. 11%, P = 0.003), pleuritis (25% vs. 24% vs. 14%, P < 0.0001), nephritis (52% vs. 47% vs. 40%, P = 0.009), neuropsychiatric manifestations (22% vs. 13% vs. 10%, P = 0.008), thrombocytopenia (32% vs. 18% vs. 19%, P = 0.037), leucopenia/lymphopenia (65% vs. 46% vs. 40%, P < 0.0001) and anti-dsDNA antibodies (79% vs. 66% vs. 61%, P = 0.01) were significantly higher in group A compared with the other groups. In contrast, group C had a less severe disease characterized by higher frequencies of synovitis (61% vs. 66% vs. 71%, P = 0.032) and lower frequencies of serositis (37% vs. 33% vs. 25%, P = 0.002), proteinuria >500 mg/day (48% vs. 45% vs. 36%, P = 0.002) and low complement levels (81% vs. 81% vs. 71%, P < 0.0001) compared with groups A or B. Conclusions Our large Brazilian multicenter study demonstrated that for most childhood-onset systemic lupus erythematosus patients, diagnosis is delayed probably due to mild disease onset. Conversely, the minority has a very short time interval to diagnosis and a presentation with a more severe and active multisystemic condition.
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Affiliation(s)
- G V Novak
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - B C Molinari
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - J C Ferreira
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - A P Sakamoto
- 2 Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - M T Terreri
- 2 Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - R M R Pereira
- 3 Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C Saad-Magalhães
- 4 Pediatric Rheumatology Division, Sao Paulo State University (UNESP), Botucatu, Brazil
| | - N E Aikawa
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- 3 Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - L M Campos
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C A Len
- 2 Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - S Appenzeller
- 5 Pediatric Rheumatology Unit, University of Campinas (UNICAMP), Campinas, Brazil
| | - V P Ferriani
- 6 Pediatric Rheumatology Unit, University of Sao Paulo, Ribeirão Preto, Brazil
| | - M F Silva
- 7 Pediatric Rheumatology Unit, Hospital Geral de Fortaleza, Fortaleza, Brazil
| | - S K Oliveira
- 8 Pediatric Rheumatology Unit, Rio de Janeiro Federal University (IPPMG-UFRJ), Rio de Janeiro, Brazil
| | - A G Islabão
- 9 Pediatric Rheumatology Unit, Hospital Jose Alencar, Brasília, Brazil
| | - F R Sztajnbok
- 10 Pediatric Rheumatology Unit, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
| | - L B Paim
- 11 Pediatric Rheumatology Unit, Albert Sabin Children's Hospital, Fortaleza, Brazil
| | - C M Barbosa
- 12 Pediatric Rheumatology Unit, Hospital Darcy Vargas, Sao Paulo, Brazil
| | - M C Santos
- 13 Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericórdia de Sao Paulo, Sao Paulo, Brazil
| | - B E Bica
- 14 Rheumatology Division, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - E G Sena
- 15 Pediatric Rheumatology Unit, Lauro Vanderley University Hospital, João Pessoa, Brazil
| | - A J Moraes
- 16 Pediatric Rheumatology Unit, Federal University of Pará, Belém, Brazil
| | - A M Rolim
- 17 Pediatric Rheumatology Unit, Obras Sociais Irmã Dulce, Salvador, Brazil
| | - P F Spelling
- 18 Pediatric Rheumatology Unit, Hospital Evangélico de Curitiba, Curitiba, Brazil
| | - I M Scheibel
- 19 Pediatric Rheumatology Unit, Hospital Criança Conceição, Porto Alegre, Brazil
| | - A S Cavalcanti
- 20 Pediatric Rheumatology Unit, Federal University of Pernambuco, Recife, Brazil
| | - E N Matos
- 21 Pediatric Rheumatology Unit, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - T C Robazzi
- 22 Pediatric Rheumatology Unit, Federal University of Bahia, Salvador, Brazil
| | - L J Guimarães
- 23 Pediatric Rheumatology Unit, University of Brasilia, Brasília, Brazil
| | - F P Santos
- 24 Pediatric Rheumatology Unit, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - C T Silva
- 25 Pediatric Rheumatology Unit, Hospital Municipal Piedade, Rio de Janeiro, Brazil
| | - E Bonfá
- 3 Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C A Silva
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- 3 Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Sansawat T, Singh P, Lee HC, Silva MF, Ha SD, Kang I. Antilisterial effects of hop alpha and beta acids in turkey slurry at 7 and 37°C. Poult Sci 2018; 97:2207-2210. [PMID: 29762788 DOI: 10.3382/ps/pex422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Indexed: 11/20/2022] Open
Abstract
Chemical components of hop resins effectively inhibit the growth of L. monocytogenes in microbiological culture media. This study was conducted to investigate antilisterial activities of hop α- and β-acid in turkey slurry. Turkey slurries were inoculated with L. monocytogenes, formulated with hop α- or β-acid from 0 to 1,000 ppm, and incubated at 37°C for 24 h or at 7°C for 12 days. During storage at 37°C for 24 h, L. monocytogenes populations were reduced from 2.40 log CFU/g to non-detectable (<1 log CFU/g) in α-acid at ≥750 ppm and β-acid at 1,000 ppm, whereas the control (0 ppm) allowed the pathogen to grow to 8.0 log CFU/g. During storage at 7°C for 12 d, the slurry treated with α-acid at ≥100 ppm and β-acid at ≥500 ppm showed listeristatic effects, while listericidal effects were observed in the slurries at 1,000 ppm, regardless of hop acid type. Hop α-acid ≤ 50 ppm and β-acid ≤ 100 ppm failed to inhibit L. monocytogenes, and the pattern of bacterial growth was similar to that of control with no significant difference (P > 0.05). Based on these results, the concentration of α-acid > 100 ppm or β-acid > 500 ppm is minimally required to inhibit L. monocytogenes when turkey batters are formulated with hop acids as a single antilisterial agent prior to cooking and storage at 7°C.
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Affiliation(s)
- T Sansawat
- Department of Agriculture and Natural Resources, University of Phayao, Muang Phayao, 56000, Thailand
| | - P Singh
- Department of Food Science & Human Nutrition, Michigan State University, East Lansing, 48824
| | - H C Lee
- Department of Animal Science, California Polytechnic State University, San Luis Obispo, 93407
| | - M F Silva
- Department of Food Science & Human Nutrition, Michigan State University, East Lansing, 48824
| | - S D Ha
- School of Food Science and Technology, Advanced Food Safety Research group, BrainKorea21 Plus, Chung-Ang Univ., 72-1 Nae-Ri, Daeduck-Myun, Ansung, Kyunggido 456-756, Republic of Korea
| | - I Kang
- Department of Animal Science, California Polytechnic State University, San Luis Obispo, 93407
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Urashima AS, Silva MF, Correa JJ, Moraes MC, Singh AV, Smith EC, Sainz MB. Prevalence and Severity of Ratoon Stunt in Commercial Brazilian Sugarcane Fields. Plant Dis 2017; 101:815-821. [PMID: 30678559 DOI: 10.1094/pdis-07-16-1030-re] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Brazil has 9 million ha of sugarcane, 85% of which are located in the Center-South area of the country. Field trials and surveys around the globe have shown that ratoon stunt disease (RSD), caused by Leifsonia xyli subsp. xyli, can severely reduce tonnage yield. Previous small-scale studies in Brazil have demonstrated RSD infection in all varieties, with values varying from 25 to 68%. Nevertheless, the prevalence and severity of RSD in commercial fields had not previously been assessed. To address this issue, we surveyed 13,173 ha in 1,154 fields of the eight main sugarcane varieties of the Center-South area, taking 92,114 samples from 50 mills in five different states. Our data showed that 10% of fields were infected, and that 58% of mills had at least one RSD-infected field. The variety RB92579 had the highest proportion of infected fields (17%) and, on average, the prevalence and severity in these fields was high compared with other varieties. RB867515, the most cultivated in Brazil, showed infection in 6.2% of sampled fields (5.5% of sampled area) causing an estimated annual economic loss of over US$1 million. This was the first time the economic importance of RSD on Brazilian commercial sugarcane production was estimated. The Cerrado region had the highest prevalence of RSD: 16% of fields, 17% of the cultivated area, and 82% of mills. The use of diseased planting material was identified in 9% of plant cane fields, representing 10% of the cultivated area. Copyright © 2017 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
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Affiliation(s)
- A S Urashima
- Centro de Ciências Agrárias, Universidade Federal de São Carlos, Araras, Sāo Paulo, Brazil 13600-000
| | - M F Silva
- Centro de Ciências Agrárias, Universidade Federal de São Carlos, Araras, Sāo Paulo, Brazil 13600-000
| | - J J Correa
- Syngenta Proteção de Cultivos Ltda, Sāo Paulo, Sāo Paulo, Brazil 04795-900
| | - M C Moraes
- Syngenta Proteção de Cultivos Ltda, Sāo Paulo, Sāo Paulo, Brazil 04795-900
| | - A V Singh
- Syngenta Crop Protection LLC, Research Triangle Park, NC 27709
| | - E C Smith
- Syngenta, Jealott's Hill International Research Center, Bracknell, Berkshire, RG42 6EY, United Kingdom
| | - M B Sainz
- Syngenta Proteção de Cultivos, São Paulo
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MV H, Boiteux JJ, Fern醤dez MA, Lucero G, Silva MF, Pizzuolo PH. Effect of phenolic compounds present in Argentinian plant extracts on mycelial growth of the plant pathogen Botrytis cinerea Pers. ACTA ACUST UNITED AC 2017. [DOI: 10.32604/phyton.2017.86.270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lourenço B, Kozu KT, Leal GN, Silva MF, Fernandes EG, França CM, Souza FH, Silva CA. Contracepção para adolescentes com doenças reumáticas crônicas. Revista Brasileira de Reumatologia 2017. [DOI: 10.1016/j.rbr.2016.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Gomes RC, Silva MF, Kozu K, Bonfá E, Pereira RM, Terreri MT, Magalhães CS, Sacchetti SB, Marini R, Fraga M, Carvalho LM, Barbosa CM, Carneiro-Sampaio M, Silva CA. Features of 847 Childhood-Onset Systemic Lupus Erythematosus Patients in Three Age Groups at Diagnosis: A Brazilian Multicenter Study. Arthritis Care Res (Hoboken) 2016; 68:1736-1741. [PMID: 27014968 DOI: 10.1002/acr.22881] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 01/14/2016] [Accepted: 03/01/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate demographic data and clinical and laboratory features at disease diagnosis in 3 different age groups of childhood-onset systemic lupus erythematosus (SLE): group A, early-onset (<6 years); group B, school age (≥6 to <12 years); and group C, adolescent (≥12 to <18 years). METHODS This was a Brazilian multicenter cohort retrospective study in 10 pediatric rheumatology centers, including 847 childhood-onset SLE patients. RESULTS Patients were divided into 3 groups: group A with 39 patients (4%), group B with 395 patients (47%), and group C with 413 patients (49%). Of 39 childhood-onset SLE patients in group A, 3 (8%) were ages <2 years, 4 (10%) were ≥2 to <3 years, and 32 (82%) were ≥3 and <6 years. A total of 74 childhood-onset SLE patients were analyzed for C1q levels, and complete C1q deficiency was observed in 3 of 74 patients (4%), all in group A. Groups were similar regarding high frequencies of female sex, nephritis, neuropsychiatric involvement, Systemic Lupus Erythematosus Disease Activity Index 2000 score ≥8, autoantibody profile, elevated acute phase proteins, and low complement levels (P > 0.05). However, the frequency of fever (78% versus 61% versus 47%; P < 0.0001), hepatomegaly (42% versus 29% versus 14%; P < 0.0001), splenomegaly (28% versus 12% versus 4%; P < 0.0001), and discoid lupus (13% versus 4% versus 4%; P = 0.020) was significantly higher in group A compared to groups B and C. The frequency of weight loss >2 kg (19% versus 28% versus 36%; P = 0.017), photosensitivity (34% versus 41% versus 51%; P = 0.006), leukopenia <4,000/mm3 (14% versus 25% versus 30%; P = 0.048), and lymphopenia <1,500/mm3 (22% versus 41% versus 47%; P = 0.011) was significantly lower in group A. CONCLUSION Our large multicenter study identified the finding that the initial appearance of childhood-onset SLE is characterized by comparable high frequency of internal organ involvement and some distinct clinical and laboratory features in early-onset and adolescent groups.
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Affiliation(s)
- Roberta C Gomes
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marco F Silva
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Katia Kozu
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eloisa Bonfá
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rosa M Pereira
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | - Roberto Marini
- State University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Melissa Fraga
- Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | - Clovis A Silva
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
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Silva MF, Ferriani MP, Terreri MT, Pereira RM, Magalhães CS, Bonfá E, Campos LM, Okuda EM, Appenzeller S, Ferriani VP, Barbosa CM, Ramos VC, Lotufo S, Silva CA. A Multicenter Study of Invasive Fungal Infections in Patients with Childhood-onset Systemic Lupus Erythematosus. J Rheumatol 2016; 42:2296-303. [PMID: 26568586 DOI: 10.3899/jrheum.150142] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To study the prevalence, risk factors, and mortality of invasive fungal infections (IFI) in patients with childhood-onset systemic lupus erythematosus (cSLE). METHODS A retrospective multicenter cohort study was performed in 852 patients with cSLE from 10 pediatric rheumatology services. An investigator meeting was held and all participants received database training. IFI were diagnosed according to the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group Consensus Group criteria (proven, probable, and possible). Also evaluated were demographic, clinical, and laboratory data, and disease activity [SLE Disease Activity Index 2000 (SLEDAI-2K)], cumulative damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), treatment, and outcomes. RESULTS IFI were observed in 33/852 patients (3.9%) with cSLE. Proven IFI was diagnosed in 22 patients with cSLE, probable IFI in 5, and possible IFI in 6. Types of IFI were candidiasis (20), aspergillosis (9), cryptococcosis (2), and 1 each disseminated histoplasmosis and paracoccidioidomycosis. The median of disease duration was lower (1.0 vs 4.7 yrs, p < 0.0001) with a higher current SLEDAI-2K [19.5 (0-44) vs 2 (0-45), p < 0.0001] and current prednisone (PRED) dose [50 (10-60) vs 10 (2-90) mg/day, p < 0.0001] in patients with IFI compared with those without IFI. The frequency of death was higher in the former group (51% vs 6%, p < 0.0001). Logistic regression analysis revealed that SLEDAI-2K (OR 1.108, 95% CI 1.057-1.163, p < 0.0001), current PRED dose (OR 1.046, 95% CI 1.021-1.071, p < 0.0001), and disease duration (OR 0.984, 95% CI 0.969-0.998, p = 0.030) were independent risk factors for IFI (R(2) Nagelkerke 0.425). CONCLUSION To our knowledge, this is the first study to characterize IFI in patients with cSLE. We identified that disease activity and current glucocorticoid use were the main risk factors for these life-threatening infections, mainly in the first years of disease course, with a high rate of fatal outcome.
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Affiliation(s)
- Marco F Silva
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Mariana P Ferriani
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Maria T Terreri
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Rosa M Pereira
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Claudia S Magalhães
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Eloisa Bonfá
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Lucia M Campos
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Eunice M Okuda
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Simone Appenzeller
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Virgínia P Ferriani
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Cássia M Barbosa
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Valéria C Ramos
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Simone Lotufo
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Clovis A Silva
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo.
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15
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Lourenço B, Kozu KT, Leal GN, Silva MF, Fernandes EGC, França CMP, Souza FHC, Silva CA. Contraception for adolescents with chronic rheumatic diseases. Rev Bras Reumatol Engl Ed 2016; 57:73-81. [PMID: 28137405 DOI: 10.1016/j.rbre.2016.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 06/12/2016] [Indexed: 10/21/2022] Open
Abstract
Contraception is an important issue and should be a matter of concern in every medical visit of adolescent and young patients with chronic rheumatic diseases. This narrative review discusses contraception methods in adolescents with juvenile systemic lupus erythematosus (JSLE), antiphospholipid syndrome (APS), juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis (JDM). Barrier methods are safe and their use should be encouraged for all adolescents with chronic rheumatic diseases. Combined oral contraceptives (COC) are strictly prohibited for JSLE and APS patients with positive antiphospholipid antibodies. Reversible long-acting contraception can be encouraged and offered routinely to the JSLE adolescent patient and other rheumatic diseases. Progestin-only pills are safe in the majority of rheumatic diseases, although the main concern related to its use by adolescents is poor adherence due to menstrual irregularity. Depot medroxyprogesterone acetate injections every three months is a highly effective contraception strategy, although its long-term use is associated with decreased bone mineral density. COC or other combined hormonal contraceptive may be options for JIA and JDM patients. Oral levonorgestrel should be considered as an emergency contraception method for all adolescents with chronic rheumatic diseases, including patients with contraindication to COC.
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Affiliation(s)
- Benito Lourenço
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade do Adolescente, São Paulo, SP, Brazil.
| | - Katia T Kozu
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Gabriela N Leal
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Radiologia, São Paulo, SP, Brazil
| | - Marco F Silva
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Elisabeth G C Fernandes
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Camila M P França
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Fernando H C Souza
- Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Reumatologia, São Paulo, SP, Brazil
| | - Clovis A Silva
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade do Adolescente, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Reumatologia, São Paulo, SP, Brazil
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16
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Mina R, Harris JG, Klein-Gitelman MS, Appenzeller S, Centeville M, Eskra D, Huggins JL, Johnson AL, Khubchandani R, Khandekar P, Lee J, Liu HM, Pendl JD, Silva CA, Silva MF, Zaal AI, DeWitt EM, Ardoin SP, Brunner HI. Initial Benchmarking of the Quality of Medical Care in Childhood-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2016. [PMID: 26219749 DOI: 10.1002/acr.22666] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the quality of medical care in childhood-onset systemic lupus erythematosus (SLE) at tertiary pediatric rheumatology centers as measured by observance of SLE quality indicators (SLE-QIs). METHODS International consensus has been achieved for childhood-onset SLE-QIs capturing medical care provision in 9 domains: diagnostic testing, education of cardiovascular (CV) risk and lifestyles, lupus nephritis (LN), medication management, bone health, ophthalmologic surveillance, transition, pregnancy, and vaccination. Using medical record information, the level of performance of these childhood-onset SLE-QIs was assessed in childhood-onset SLE populations treated at 4 tertiary pediatric rheumatology centers in the US, 2 in Brazil, and 1 center in India. RESULTS A total of 483 childhood-onset SLE patients were assessed. Care for the 310 US patients differed markedly for childhood-onset SLE-QIs addressing LN, bone health, vaccinations, education on CV risk, and transition planning. Performance of safety blood testing for medications was high at all centers. Despite often similar performance on the childhood-onset SLE-QI, access to kidney biopsies was lower in Brazil than in the US. Irrespective of the country of practice, larger centers tended to meet the childhood-onset SLE-QIs more often than smaller centers. CONCLUSION The childhood-onset SLE-QIs, evidence-based minimum standards of medical care, are not consistently met in the US or some other countries outside the US. This has the potential to contribute to suboptimal childhood-onset SLE outcomes.
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Affiliation(s)
- Rina Mina
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Julia G Harris
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | | | | | | | - Diane Eskra
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Anne L Johnson
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Jiha Lee
- University of Cincinnati, Cincinnati, Ohio
| | - Hai Mei Liu
- Children's Hospital of Fudan University, Shanghai, China
| | - Joshua D Pendl
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Ahmad I Zaal
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Stacy P Ardoin
- Nationwide Children's Hospital and Ohio State University, Columbus, Ohio
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Henriques S, Silva E, Cruz S, Silva MF, Ferreira-Dias G, Lopes-da-Costa L, Mateus L. Oestrous cycle-dependent expression of Fas and Bcl2 family gene products in normal canine endometrium. Reprod Fertil Dev 2015; 28:RD14245. [PMID: 25707315 DOI: 10.1071/rd14245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 01/10/2015] [Indexed: 02/28/2024] Open
Abstract
During the oestrous cycle canine endometrium undergoes cyclical cellular proliferation, apoptosis and differentiation. To study the regulation of endometrial apoptosis and proliferation events the expression of apoptosis-related genes was analysed by real-time polymerase chain reaction and cellular expression of their proteins was identified through immunohistochemistry. Cellular apoptosis and proliferation events were detected by TdT-mediated dUTP-biotin nick end labeling (TUNEL) and proliferation marker Ki67 immunostaining, respectively. The highest proliferative index was observed in the follicular phase (all endometrial cellular components) and at early dioestrus (basal glands). This was associated with a low apoptotic index and a strong expression of anti- (Bcl2) and pro-apoptotic proteins (Fas, FasL, Bax). Subsequently (Days 11-45 of dioestrus), basal glandular epithelium experienced the highest apoptotic index, coincidental with a decrease of Bcl2 expression and a low ratio of Bcl2/Bax transcription. An increase in the apoptotic index of crypts, stromal and endothelial cells was observed at late dioestrus and the beginning of anoestrus. These results indicate that pro- and anti-apoptotic proteins regulate the balance between cell proliferation and death in the canine endometrium during the oestrous cycle. High Bcl2 expression in both the follicular and early dioestrous phases stimulate glandular proliferation and prevent apoptosis but, in the non-pregnant uterus, a decrease in Bcl2 expression together with an increase in pro-apoptotic proteins induces apoptosis of basal glandular epithelium cells.
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Guariento A, Silva MF, Tassetano PSF, Rocha SM, Campos LM, Valente M, Silva CA. Liver and spleen biometrics in childhood-onset systemic lupus erythematosus patients. Pediatr Rheumatol Online J 2014. [PMCID: PMC4191654 DOI: 10.1186/1546-0096-12-s1-p327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Zaal AI, Appenzeller S, Harris JG, Silva MF, Lee J, Centeville M, Liu H, Pendl JD, Huggins JL, Johnson A, Silva CA, Hermine B. A133: Initial Benchmarking of the Quality of Medical Care of Children and Adolescents with Lupus. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ahmad I. Zaal
- Children's Hospital of Damascus University; Damascus Syria
| | - Simone Appenzeller
- Faculty of Medical Science, State University of Campinas Unicamp; São Paulo Brazil
| | | | - Marco F. Silva
- Faculdade de Medicina da Universidade de São Paulo; São Paulo Brazil
| | - Jiha Lee
- University of Cincinnati; Cincinnati OH
| | - Maraisa Centeville
- Faculty of Medical Science, State University of Campinas Unicamp; São Paulo Brazil
| | - HaiMei Liu
- Children's Hospital of Fundan University; Shanghai China
| | - Joshua D. Pendl
- Cincinnati Children's Hospital Medical Center; Cincinnati OH
| | | | - Anne Johnson
- Cincinnati Children's Hospital Medical Center; Cincinnati OH
| | - Clovis A. Silva
- Faculdade de Medicina da Universidade de São Paulo; São Paulo Brazil
| | - Brunner Hermine
- Cincinnati Children's Hospital Medical Center; Cincinnati OH
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Cabral CAC, Natali AJ, Natali AY, Novaes RD, Lavorato VN, Drumond LR, Carneiro Júnior MA, Silva MF, Quintão-Junior JF, Gontijo LN, Silva CHO, Felix LB, Silva ME. Protein restriction does not impair adaptations induced in cardiomyocytes by exercise in rats. Int J Sports Med 2013; 34:1015-9. [PMID: 23670356 DOI: 10.1055/s-0033-1343403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The effect of a treadmill running program on physical performance and morphofunctional adaptations was investigated in control and malnourished rats. Male 4-week old Wistar rats were randomized in groups of 12 animals: control trained (CT), control sedentary (CS), malnourished trained (MT) and malnourished sedentary (MS). Control and malnourished animals received chow with 12% protein or 6% protein, respectively. Trained groups were subjected to a treadmill running program for 8 weeks. Physical performance, biochemical parameters, cardiomyocytes morphology and biomechanics were determined. Malnourished animals presented reduction in body mass, serum levels of total protein, albumin and hemoglobin compared to the control groups. At 1 and 3 Hz cardiomyocytes from CT and MT showed higher cell shortening, speed of contraction and relaxation compared to the other groups. At 3 Hz cardiomyocytes from MS showed reduction in cell shortening and speed of contraction compared to CS. Protein restriction does not prevent the improvement in physical performance or cardiomyocytes biomechanical efficiency and growth in response to exercise. These findings could represent a modulatory effect of exercise to maintain cardiomyocyte growth at the expense of reducing the rate of body growth in order to ensure proper cellular function in conditions of cardiovascular overload imposed by exercise.
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Affiliation(s)
- C A C Cabral
- Núcleo de Pesquisas em Ciências Biológicas - NUPEB, Federal University of Ouro Preto, Ouro Preto, Brazil
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Silva MF, Sapisochin G, Strasser SI, Hewa-Geeganage S, Chen J, Wigg AJ, Jones R, Saraiva R, Kikuchi L, Carrilho F, Fontes PRO, Charco R. Liver resection and transplantation offer similar 5-year survival for Child-Pugh-Turcotte A HCC-patients with a single nodule up to 5 cm: a multicenter, exploratory analysis. Eur J Surg Oncol 2013; 39:386-95. [PMID: 23375469 DOI: 10.1016/j.ejso.2012.12.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 11/15/2012] [Accepted: 12/07/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIM The current guideline of the American Association for the Study of Liver Diseases recommends liver resection for Child-Pugh-Turcotte A patients with a single hepatocellular carcinoma, total serum bilirubin ≤ 1 mg/dL and absence of significant portal hypertension. This subset of patients would have a long-term survival comparable to transplantation. The main aim of this study is to evaluate the survival rates in patients with a single nodule ≤ 5 cm following resection. METHODS Medical records of 105 Child-Pugh-Turcotte A patients who underwent liver resection between 1997 and 2009 were analyzed in 3 countries. RESULTS One, 3-, and 5-year survival rate was 97%, 83%, and 66%, respectively, and no variable that can be assessed prior to liver resection predicted survival probabilities. CONCLUSIONS Liver resection offers 5-year survival similar to transplantation for Child-Pugh-Turcotte A patients with hepatocellular carcinoma and a single nodule up to 5 cm, independently of any patient baseline characteristics.
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Affiliation(s)
- M F Silva
- Department of Gastroenterology, Flinders University, Adelaide, Australia.
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Silva MF, Ribeiro AS, Fiorot FJ, Aikawa NE, Lotito AP, Campos LM, Mauad T, Silva CA. Invasive aspergillosis: a severe infection in juvenile systemic lupus erythematosus patients. Lupus 2012; 21:1011-6. [PMID: 22451602 DOI: 10.1177/0961203312442752] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Infections are an important cause of morbidity and mortality in juvenile systemic lupus erythematosus (JSLE). Among them, invasive aspergillosis (IA), which is usually related to immunosuppressed patients, has been rarely reported in JSLE. From 1983 to 2011, 5604 patients were followed at our institution and 283 (5%) met the American College of Rheumatology (ACR) classification criteria for SLE. Six (2.1%) of our JSLE patients had IA. One of them was previously reported and five will be described herein. Four of them were female. The median age at JSLE diagnosis was 12 years (8–16) and the median interval between diagnosis of JSLE and IA was 6 months (1–38). All had pulmonary involvement and three of them had systemic involvement. The median Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) was 19 (7–22). Diagnosis of IA was performed by isolation of Aspergillus spp., two in bronchoalveolar lavage culture and by way of autopsy in the others. All of them were treated with corticosteroids and/or immunosuppressive drugs at IA diagnosis (azathioprine and/or intravenous cyclophosphamide). They all required treatment in the pediatric intensive care unit with mechanical ventilation and antifungal therapy (fluconazole, amphotericin B, itraconazole and/or voriconazole); nonetheless, none of them survived. In conclusion, this was the first report that evaluated the prevalence of IA in a large population of JSLE patients from a tertiary pediatric hospital, and clearly showed the severity of the outcome, especially in patients with active disease and treated with immunosuppressive agents. This study reinforces the importance of early diagnosis and treatment with certain antifungals, especially in critically ill patients.
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Affiliation(s)
- MF Silva
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo, Brazil
| | - AS Ribeiro
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo, Brazil
| | - FJ Fiorot
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo, Brazil
| | - NE Aikawa
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo, Brazil
- Division of Rheumatology, Faculdade de Medicina da Universidade São Paulo, Brazil
| | - AP Lotito
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo, Brazil
| | - LM Campos
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo, Brazil
| | - T Mauad
- Department of Pathology, Faculdade de Medicina da Universidade São Paulo, Brazil
| | - CA Silva
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo, Brazil
- Division of Rheumatology, Faculdade de Medicina da Universidade São Paulo, Brazil
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Silva MF, Faria P, Regateiro FS, Forjaz V, Januário C, Freire A, Castelo-Branco M. Independent patterns of damage within magno-, parvo- and koniocellular pathways in Parkinson's disease. Brain 2005; 128:2260-71. [PMID: 16000338 DOI: 10.1093/brain/awh581] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Sensory deficits have been documented in Parkinson's disease, in particular within the visual domain. However, ageing factors related to the brain and to neural and non-neural ocular structures could explain some of the previously reported results, in particular the claimed impairment within the koniocellular pathway. This study addressed visual impairment attributable to the magno- (luminance), parvo- (red-green) and koniocellular (blue-yellow) pathways in a population of Parkinson's disease patients. To avoid potentially confounding factors, all subjects underwent a full neurophthalmological assessment which led to exclusion of subjects with increased intraocular pressure, diabetes even in the absence of retinopathy, and ocular abnormalities (from a total of 72 patients' eyes, 12 were excluded). Both parvo- and koniocellular pathways were studied by means of contrast sensitivity (CS) measurements along protan, tritan and deutan axes and also by fitting chromatic discrimination ellipses using eight measured contrast axes. Magnocellular function was assessed, using stimuli that induce a frequency doubling illusion, in 17 locations in the fovea and periphery. Achromatic (luminance modulation) thresholds were significantly higher in Parkinson's disease both in foveal and peripheral locations. A significant impairment was observed along protan and deutan axes, but only marginally along the tritan axis. These results were corroborated by a significant elongation of chromatic discrimination ellipses in our Parkinson's disease group. Correlation analysis showed that achromatic and chromatic CS measures were independent, which implies that multiple visual pathways are affected independently in Parkinson's disease. Magnocellular impairment was significantly correlated with age and disease stage, in contrast to the measured chromatic deficits. We conclude that in Parkinson's disease, independent damage occurs in the early magno- and parvocellular pathways. Furthermore, traditional koniocellular probing strategies in Parkinson's disease may be confounded by ageing factors, which may reconcile the previously reported controversial findings concerning chromatic impairment in Parkinson's disease.
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Affiliation(s)
- M F Silva
- Department of Biophysics and Center for Ophthalmology, IBILI-Faculty of Medicine, Coimbra University Hospital, Coimbra, Portugal
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Lima NA, Silva MF, Oliveira LN, Capelle K. Density functionals not based on the electron gas: local-density approximation for a Luttinger liquid. Phys Rev Lett 2003; 90:146402. [PMID: 12731934 DOI: 10.1103/physrevlett.90.146402] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2001] [Indexed: 05/24/2023]
Abstract
By shifting the reference system for the local-density approximation (LDA) from the electron gas to other model systems, one obtains a new class of density functionals, which by design account for the correlations present in the chosen reference system. This strategy is illustrated by constructing an explicit LDA for the one-dimensional Hubbard model. While the traditional ab initio LDA is based on a Fermi liquid (the three-dimensional interacting electron gas), this one is based on a Luttinger liquid. First applications to inhomogeneous Hubbard models, including one containing a localized impurity, are reported.
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Affiliation(s)
- N A Lima
- Departamento de Física e Informática, Instituto de Física de São Carlos, Universidade de São Paulo, Caixa Postal 369, São Carlos, 13560-970 São Paulo, Brazil
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Silva MF, Selhorst J, Overmars H, van Gennip AH, Maya M, Wanders RJ, de Almeida IT, Duran M. Characterization of plasma acylcarnitines in patients under valproate monotherapy using ESI-MS/MS. Clin Biochem 2001; 34:635-8. [PMID: 11849623 DOI: 10.1016/s0009-9120(01)00272-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The effect of administration of the antiepileptic drug valproate (VPA), on the composition of the plasma acylcarnitine profile (including free carnitine) was investigated. DESIGN AND METHODS Plasma samples were obtained from 18 individuals (13 males:5 females; 15-65 y) on long-term treatment with VPA (resulting in plasma levels of 14.6-135.0 mg/L; therapeutic conc.: 40-100 mg/L). Acylcarnitines (AC) in plasma were quantified by electrospray tandem mass spectrometry (ESI-MS/MS). RESULTS VPA was found to increase the levels (mean +/- SD, microM) of 3-hydroxy-isovalerylcarnitine (0.10 +/- 0.04; controls: 0.02-0.06), C14:2 acylcarnitine (0.11 +/- 0.05; controls: 0.02-0.08), propylglutarylcarnitine (0.06 +/- 0.05; controls: 0.00-0.04), and C18-0H-acylcarnitine (0.09 +/- 0.05; controls: 0.00-0.04). The free carnitine (C) (42.2 +/- 9.0; controls: 22.3-54.9) and the total carnitine (52.3 +/- 10.1; controls: 26.5-73.6) were not significantly altered by VPA. Other AC (C2-C18, monounsaturated and hydroxylated) were all within the control range and especially no increase of C8 (valproyl) carnitine was observed. A positive correlation was found between the ratios [AC] / [C] (p < 0.05) or [long-chain AC (C10-C18)] / [C] (p < 0.09) with the plasma VPA concentration. CONCLUSIONS The unequivocal increase in 3-hydroxy-isovalerylcarnitine is consistent with the increase of 3-hydroxy-isovaleric acid observed in urine of VPA treated patients. This finding suggests an interaction mechanism of VPA with specific enzymes, namely involved in leucine metabolism. Adult patients under VPA monotherapy do not suffer from carnitine deficiency; the effect of the accumulating acylcarnitines is ill-defined.
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Affiliation(s)
- M F Silva
- Department of Clinical Chemistry and Paediatrics, University of Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands
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Silva MF, Ruiter JP, IJlst L, Jakobs C, Duran M, de Almeida IT, Wanders RJ. Differential effect of valproate and its Delta2- and Delta4-unsaturated metabolites, on the beta-oxidation rate of long-chain and medium-chain fatty acids. Chem Biol Interact 2001; 137:203-12. [PMID: 11566289 DOI: 10.1016/s0009-2797(01)00234-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Overall fatty acid oxidation rates were investigated in rat hepatocytes using [9,10-3H]-palmitic, [9,10-3H]-oleic, [9,10-3H]-myristic and [2,3-3H]-phenylpropionic acids. The effect of both valproate (VPA) (0-10 mM) and two of its unsaturated metabolites, Delta2(E)-VPA and Delta4-VPA (0-10 mM), on the overall 3H2O production rate was studied. The results give evidence of a general inhibitory effect of VPA on the beta-oxidation rate of all the tested substrates. Similar effects were observed with both VPA metabolites but these effects appeared to be dependent on the chain length of the substrate. When the effect on the oxidation of the medium-chain fatty acid 3-phenylpropionate (PPA) was studied, Delta2(E)-VPA at 0.5 mM caused a 94% inhibition of the overall beta-oxidation rate. However, with long-chain substrates, 0.5 mM Delta(4)-VPA was a more potent inhibitor (20-30% of control activity) than 0.5 mM Delta(2E)-VPA (60-80% of control activity). Our results suggest that VPA and/or its metabolites inhibit fatty acyl-CoA metabolism within the mitochondrion by two different mechanisms. The first mechanism involves CoASH sequestration, which affects the oxidation rate of all fatty acids with different chain length. The second mechanism is more specific in nature and involves selective inhibition of particular enzymes implicated in fatty acid beta-oxidation.
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Affiliation(s)
- M F Silva
- Department of Clinical Chemistry and Paediatrics, University of Amsterdam, Academic Medical Centre, 1105 AZ, Amsterdam, Netherlands
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Abstract
To elucidate the interference mechanisms of valproate (VPA) with mitochondrial fatty acid beta-oxidation (FAO), the profile of acylcarnitine formation was studied in vitro. Human fibroblasts were incubated with 0.2 mmol/L [U-(13)C]palmitate, 0.4 mmol/L l-carnitine, +/- VPA (2 mmol/L) (96 h at 37 degrees C). Acylcarnitines (AC) were analyzed by GC-CI-MS. VPA induced an impaired production of acetylcarnitine (C2) and an increase on long-chain AC (C10 to C16) both in control and in FAO-deficient cell lines (VLCAD, LCHAD, MTP).
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Affiliation(s)
- M F Silva
- Department of Clinical Chemistry and Paediatrics, University of Amsterdam, Academic Medical Centre, 1105 AZ Amsterdam, The Netherlands
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Sombra L, Luconi M, Silva MF, Olsina RA, Fernandez L. Spectrophotometric determination of trace aluminium content in parenteral solutions by combined cloud point preconcentration-flow injection analysis. Analyst 2001; 126:1172-6. [PMID: 11478656 DOI: 10.1039/b009251g] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A cloud point preconcentration and flow injection (FI) analysis methodology for aluminium(III) determination has been developed. The analyte in the initial aqueous solution was complexed with Chrome Azurol S (CAS) in the presence of the cationic surfactant benzyldimethyltetradecylammonium chloride (BDTAC). The absorption spectroscopic characteristics of the ternary complex [Al(III)-CAS-BDTAC] were examined in detail. The preconcentration step was carried out by means of the non-ionic surfactant polyethylene glycol p-nonylphenyl ether (PONPE 7.5). The enriched analyte solution was injected into an FI system using an HPLC pump. The chemical variables affecting the analytical performance of the combined methodology were studied and optimised. The developed approach was successfully applied to the determination of trace amounts of aluminium in parenteral solutions without previous treatment. Under the optimum experimental conditions, 99.9% extraction was achieved for a preconcentration factor of 50. The limit of detection was 1.12 x 10(-7) mol(-1). The calibration plot was linear over at least two orders of magnitude of aluminium concentration. The developed coupled methodology, which thoroughly satisfies the typical requirements for pharmaceutical control processes, is appropriate for monitoring the aluminium concentration in parenteral nutrition.
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Affiliation(s)
- L Sombra
- Area of Analytical Chemistry, National University of San Luis, Chacabuco y Pedernera, Argentina
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Silva MF, Melo EV, Stewart B, De Vizio W, Sintes JL, Petrone ME, Volpe AR, Zhang Y, McCool JJ, Proskin HM. The enhanced anticaries efficacy of a sodium fluoride and dicalcium phosphate dihydrate dentifrice in a dual-chambered tube. A 2-year caries clinical study on children in Brazil. Am J Dent 2001; 14 Spec No:19A-23A. [PMID: 11481927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
PURPOSE To clinically evaluate and compare a dentifrice system in a dual-chambered tube, wherein one chamber contained sodium fluoride in a silica base and the other chamber contained dicalcium phosphate dihydrate (Test Dentifrice delivering 0.243% sodium fluoride), to a dentifrice containing 0.243% sodium fluoride in a silica base (Positive Control Dentifrice). MATERIALS AND METHODS This study was conducted in harmony with the published 1988 American Dental Association guidelines for studies geared toward the comparison of fluoride dentifrices. This 2-yr caries clinical study employed a double-blind, parallel-group design, and involved 6-10 yr-old children from the metropolitan area of Maceio, Alagoas, Brazil. Qualifying subjects were stratified according to age and sex, and were randomly assigned to the two treatment groups, with multiple subjects in the same household all assigned to the dentifrice randomly allocated to the first among them. Caries examinations were conducted in accordance with U.S. Food and Drug Administration guidelines for the clinical evaluation of drugs to prevent dental caries. One calibrated examiner performed all the measurements. After treatment assignment, study participants were instructed to brush their teeth at home with their assigned dentifrice at least twice daily. Brushing instructions were reinforced by indoctrination in proper oral hygiene techniques by dental professionals, supplemented by pamphlets supplied by the sponsor and yearly mailings to participants, emphasizing good oral hygiene and the need to enforce compliance with the study. Post-baseline examinations were performed after 1 yr of product use, and again after 2 yrs of product use. RESULTS Two thousand four hundred thirty-two (2,432) subjects completed this 2-yr study. For these subjects, the mean caries scores (DMFS, decayed, missing and filled tooth surfaces) at baseline were 3.84 for the Test Dentifrice group, and 4.06 for the Positive Control Dentifrice group. For caries increments after 1 yr, the respective means were 2.02 for the Test Dentifrice group and 2.12 for the Positive Control Dentifrice group. Finally, after 2 yrs, the mean caries increments were 4.30 for the Test Dentifrice group, and 4.83 for the Positive Control Dentifrice group. No statistically significant difference was indicated between the treatment groups at baseline or between the 1-yr caries increment scores. However, there was a statistically significant difference in the 2-yr caries increment scores between the treatment groups. Relative to the Positive Control Dentifrice group, the Test Dentifrice group presented a 10.97% reduction in caries increment scores at 2 yrs. In accordance with the procedures and standards provided by the published guidelines of the American Dental Association for the comparison of the anticaries efficacy of fluoride dentifrices, the results of this study support the conclusion that the dentifrice system in a dual-chambered tube, wherein one chamber contained sodium fluoride in a silica base and the other chamber contained dicalcium phosphate dihydrate, delivering 0.243% sodium fluoride, provided a superior level of anticaries efficacy than did the dentifrice containing 0.243% sodium fluoride in a silica base.
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Affiliation(s)
- M F Silva
- Department of Dentistry, Federal University of Alagoas, Maceio, Brazil.
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Silva MF, Ruiter JP, IJlst L, Allers P, ten Brink HJ, Jakobs C, Duran M, Tavares de Almeida I, Wanders RJ. Synthesis and intramitochondrial levels of valproyl-coenzyme A metabolites. Anal Biochem 2001; 290:60-7. [PMID: 11180937 DOI: 10.1006/abio.2000.4947] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A number of valproate adverse reactions are due to its interference with several metabolic pathways, including that of fatty acid oxidation. In order to resolve which mitochondrial enzymes of fatty acid oxidation are inhibited by which VPA intermediates we have developed methods to synthesize their CoA ester forms. This paper describes the synthesis of VPA acyl-CoA ester metabolites as well as data on the fate of VPA in rat liver mitochondria. Valproyl-CoA, Delta2-valproyl-CoA, and 3-OH-valproyl-CoA were obtained through chemical synthesis. 3-Keto-valproyl-CoA was prepared by a novel enzymatic procedure followed by a combination of solid-phase extraction and preparative HPLC purification. This approach proved to be efficient in obtaining all the beta-oxidation intermediates of valproyl-CoA. The synthetic standards were used for the determination of intramitochondrial concentrations of valproyl-CoA, Delta2-valproyl-CoA, 3-OH-valproyl-CoA, and 3-keto-valproyl-CoA by HPLC. These levels were determined after incubation of intact rat liver mitochondria with VPA under conditions of state 3 and state 4 respiration. The results show that valproyl-CoA and to a much lesser extent 3-keto-valproyl-CoA are the main metabolites of VPA in mitochondria. This information will be of great use in resolving the mechanisms involved in the inhibition of mitochondrial processes like fatty acid oxidation by VPA.
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Affiliation(s)
- M F Silva
- Department of Clinical Chemistry and Paediatrics, University of Amsterdam, The Netherlands
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Bocca AL, Silva MF, Silva CL, Cunha FQ, Figueiredo F. Macrophage expression of class II major histocompatibility complex gene products in Paracoccidioides brasiliensis-infected mice. Am J Trop Med Hyg 1999; 61:280-7. [PMID: 10463680 DOI: 10.4269/ajtmh.1999.61.280] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
C57B1/6 isogenic mice infected with Paracoccidioides brasiliensis strains showed a disruption in the expression of Ia antigen. Expression slowly decreased during the course of the infection with a slight variation dependent on the route of inoculation and the fungal strain used, but production of interferon-gamma and tumor necrosis factor-alpha were observed. Suppression of Ia antigen expression and depression of the immunoproliferative responses of spleen cells were strongly correlated with nitric oxide levels. These parameters were inhibited when the animals were treated with nitro-L-arginine, which resulted in inhibition the activation of nitric oxide (NO) production. Analysis of the data showed that changes in the expression of the Ia antigen occur in P. brasiliensis infection and are strongly correlated with NO levels. These phenomena may be interrelated and reflect macrophage activation that contributes to the control of the disease and to the immunosuppression observed during the course of the infection.
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Affiliation(s)
- A L Bocca
- Department of Cell Biology, Biology Institute, Faculty of Health Sciences, University of Brasília, Brasília DF, Brazil
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Silva MF, Zin WA, Saldiva PH. Airspace configuration at different transpulmonary pressures in normal and paraquat-induced lung injury in rats. Am J Respir Crit Care Med 1998; 158:1230-4. [PMID: 9769286 DOI: 10.1164/ajrccm.158.4.9710067] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this study is to evaluate histoarchitecture of airspaces at different positive transpulmonary pressures, both during inflation and deflation of excised normal and paraquat-damaged rat lungs. Freshly excised lungs were placed in a plethysmograph connected to a graded pipette. Immediately after the achievement of the desired pressure level (5, 15, 25 cm H2O during inflation, and 15 and 5 cm H2O during deflation), the tracheal cannula was occluded and lungs were quick-frozen by immersion in liquid nitrogen, and fixed using Carnoy's solution. Sections representing the central and peripheral areas of the lungs were sampled and processed for paraffin embedding and stained with hematoxylin-eosin. By means of stereological techniques, surface-to-volume ratio (S/V) and the fraction of large-volume gas-exchanging airspaces (LVGEAS) were determined. We observed in paraquat-treated animals evidence of alveolar instability close to the resting volume. Structural unevenness was minimized by massive recruitment followed by alveolar pressurization. In conclusion, this work demonstrates that morphological evidence of uneven distribution of inspired air may be partially reversed by applying larger alveolar pressures. These larger pressures applied at the end-expiration in vivo (positive end-expiratory pressure, PEEP) can minimize the distortion of lung microarchitecture during ventilation.
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Affiliation(s)
- M F Silva
- Laboratório de Poluição Atmosférica Experimental, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Silva MF, Fernandez LP, Olsina RA. Monitoring the elimination of gadolinium-based pharmaceuticals. Cloud point preconcentration and spectrophotometric determination of Gd(III)-2-(3,5-dichloro-2-pyridylazo)-5-dimethylaminophenol in urine. Analyst 1998; 123:1803-7. [PMID: 10071379 DOI: 10.1039/a804789h] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
An extraction methodology based on cloud point phase separation of non-ionic surfactants has been developed for the preconcentration of ppb amounts of gadolinium in urine as a prior step to its determination by an absorptiometric procedure. A method based on the formation of complexes with 2-(3,5-dichloro-2-pyridylazo)-5-dimethylaminophenol was used for the extraction of Gd(III) in the surfactant-rich phase of non-ionic surfactant polyethyleneglycolmono-p-nonylphenylether (PONPE 7.5). The variables affecting the combined preconcentration-absorptiometric method have been evaluated and optimised. The extraction efficiency, linearity, and the limit of detection (LOD) of the method were determined. The optimised procedure was applied to determine total and free Gd(III) contents in real urine samples of patients after the NMR imaging diagnostic examination with contrast agent.
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Affiliation(s)
- M F Silva
- Universidad Nacional de San Luis, Facultad de Química, Bioquímica y Farmacia, Departamento de Química Analítica, Chacabuco y Pedernera, Argentina
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Abstract
Since the most characteristic feature of paraquat poisoning is lung damage, a prospective controlled study was performed on excised rat lungs in order to estimate the intensity of lesion after different doses. Twenty-five male, 2-3-month-old non-SPF Wistar rats, divided into 5 groups, received paraquat dichloride in a single intraperitoneal injection (0, 1, 5, 25, or 50 mg/kg body weight) 24 h before the experiment. Static pressure-volume (PV) curves were performed in air- and saline-filled lungs; an estimator of surface tension and tissue works was computed by integrating the area of both curves and reported as work/ml of volume displacement. Paraquat induced a dose-dependent increase of inspiratory surface tension work that reached a significant two-fold order of magnitude for 25 and 50 mg/kg body weight (P < 0.05, ANOVA), sparing lung tissue. This kind of lesion was probably due to functional abnormalities of the surfactant system, as was shown by the increase in the hysteresis of the paraquat groups at the highest doses. Hence, paraquat poisoning provides a suitable model of acute lung injury with alveolar instability that can be easily used in experimental protocols of mechanical ventilation.
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Affiliation(s)
- M F Silva
- Laboratório de Poluição Atmosférica Experimental, Faculdade de Medicina, Universidade de São Paulo, Brasil.
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Silva MF, Bocca AL, Ferracini R, Figueiredo F, Silva CL. Cellular requirements for immunomodulatory effects caused by cell wall components of Paracoccidioides brasiliensis on antibody production. Clin Exp Immunol 1997; 109:261-71. [PMID: 9276521 PMCID: PMC1904746 DOI: 10.1046/j.1365-2249.1997.4431344.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In a previous study, we reported an increase in the number of immunoglobulin-secreting cells and the augmentation of antibody production (IgM and IgG3) against unrelated antigens (sheep erythrocytes or bovine serum albumin (BSA)) in mice infected with the fungus Paracoccidioides brasiliensis as well as in mice inoculated with its cell wall preparation (CW). The immunomodulatory effect of the live fungus and CW preparation was dose-dependent and mainly restricted to the i.p. inoculation simultaneously to the BSA challenge by the i.v. route. In the present study, we investigated the active component of CW preparation upon the phenotype and also the degree of activation of possible target peritoneal cells involved in those phenomena. An insoluble polysaccharide fraction (F1 fraction) mainly composed of beta-glucan and chitin, and the purified beta-glucan (BGPb) behaved as CW in the augmentation of early antibody production. The peritoneal mononuclear inflammatory cells induced by CW, F1 fraction and BGPb were highly positive to alpha-naphthyl esterase staining; released low H2O2; expressed high levels of MHC-Ia(d) molecules and produced inflammatory cytokines such as tumour necrosis factor-alpha (TNF-alpha) and IL-6. Phenotypic analysis by flow cytometry and immunohistochemical techniques of the inflammatory cells responding to F1 fraction showed a prevalence of (CD11b/CD18, Mac-1)+ peritoneal macrophages. In addition, s.c. inoculation of F1 fraction resulted in the formation of nodular, localized and not progressive granulomatous lesions with an accumulation of (CD11b/C18)+ macrophages. Adoptive transferred Mac-1 macrophages to immunized syngeneic recipient mice were able to cause an increase in anti-BSA antibody production. These results suggest that inflammatory (CD11b/CD18)+ macrophages may be related to immunological disturbances, caused by cell wall components of P. brasiliensis.
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Affiliation(s)
- M F Silva
- Department of Parasitology, Microbiology and Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
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37
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Silva MF, Ruiter JP, Illst L, Jakobs C, Duran M, de Almeida IT, Wanders RJ. Valproate inhibits the mitochondrial pyruvate-driven oxidative phosphorylation in vitro. J Inherit Metab Dis 1997; 20:397-400. [PMID: 9266365 DOI: 10.1023/a:1005398516208] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- M F Silva
- C.M.G., Faculdade de Farmácia, Universidade de Lisboa, Portugal
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38
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Carvalho JC, Silva MF, Maciel MA, Pinto AC, Nunes DS, Lima RM, Bastos JK, Sarti SJ. Investigation of anti-inflammatory and antinociceptive activities of trans-dehydrocrotonin, a 19-nor-clerodane diterpene from Croton cajucara. Part 1. Planta Med 1996; 62:402-404. [PMID: 8923802 DOI: 10.1055/s-2006-957925] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The anti-inflammatory and antinociceptive effects of trans-dehydrocrotonin, isolated from the bark of Croton cajucara (Euphorbiaceae), were investigated using several animal models. The trans-dehydrocrotonin produced a significant inhibition of carrageenin-induced paw edema and cotton pellet granuloma in rats. It also inhibited the writhings in mice induced by acetic acid, but did not show a significant effect in the hot-plate test in mice. The LD50 of t-DCTN was 555.0 mg/kg (p.o.) for mice.
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Affiliation(s)
- J C Carvalho
- Departamento de Princípios Ativos Naturais e Toxicologia, Faculdade de Ciências Farmacêuticas-UNESP, Araraquara, São Paulo, Brasil
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Silva CL, Silva MF, Pietro RC, Lowrie DB. Characterization of T cells that confer a high degree of protective immunity against tuberculosis in mice after vaccination with tumor cells expressing mycobacterial hsp65. Infect Immun 1996; 64:2400-7. [PMID: 8698458 PMCID: PMC174089 DOI: 10.1128/iai.64.7.2400-2407.1996] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Mice vaccinated by injection with tumor cells expressing the Mycobacterium leprae gene for hsp65 acquire a remarkably high degree of protection against challenge with Mycobacterium tuberculosis. We used limiting-dilution analysis to assess the frequency of CD4+ CD8- and CD4- CD8+ splenocytes responding to mycobacterial hsp65 in such vaccinated mice. Cells of both phenotypes were present at very high and equal frequencies (approximately 1:100). Vaccination with live Mycobacterium bovis BCG also increased the frequencies of both phenotypes of hsp65-reactive cells equally (to approximately 1:2,500), whereas vaccination procedures that were not protective, with either dead BCG, hsp65 protein in incomplete Freund's adjuvant, or hsp65 mixed with tumor cells, resulted in preferential increase in CD4+ CD8- cells. Twelve CD4+ CD8- and twelve CD4- CD8+ hsp65-responsive T-cell clones were obtained and characterized. All showed conventional antigen recognition via major histocompatibility complex class II and class I pathways but differed in secretion of gamma interferon and interleukin 4 and cytotoxicity. In tests of antimycobacterial activity against M. tuberculosis, both in infected macrophages in vitro and by adoptive transfer of protection with T-cell clones injected into irradiated mice, the most effective clones were the most cytotoxic and secretion of gamma interferon made only a secondary contribution.
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Affiliation(s)
- C L Silva
- Department of Parasitology, Microbiology and Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
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40
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Silva CL, Silva MF, Faccioli LH, Pietro RC, Cortez SA, Foss NT. Differential correlation between interleukin patterns in disseminated and chronic human paracoccidioidomycosis. Clin Exp Immunol 1995; 101:314-20. [PMID: 7648715 PMCID: PMC1553278 DOI: 10.1111/j.1365-2249.1995.tb08357.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
In an attempt to understand better the immunoregulatory disorders in paracoccidioidomycosis (PCM), the possible correlation between interleukin pattern, lymphoproliferation, C-reactive protein (CRP) and specific antibody levels was investigated in the polarized clinical forms of this disease. We studied 16 PCM patients, eight with the disseminated disease (four under treatment and four non-treated) and eight with the chronic disease. The patients with disseminated disease exhibited high antibody titres specific to Paracoccidioides brasiliensis antigen compared with patients with the chronic form of disease. Tumour necrosis factor (TNF), IL-1, IL-6 and CRP in the serum of non-treated disseminated PCM patients were increased, which correlated positively with the low mitogenic response of peripheral blood mononuclear cells (PBMC) to phytohaemagglutinin (PHA) (P < 0.01) and with the high antibody titres (P < 0.001) of these patients. Moreover, we found in the disseminated PCM patients positive correlations between IL-1 and IL-6 (P = 0.0007); IL-1 and TNF (P = 0.0045); IL-1 and IL-6 with the high antibody titres (P = 0.0834 and P = 0.0631, respectively); IL-1, IL-6 and TNF with CRP levels. By contrast, no correlations were found with those interleukins in the treated disseminated and chronic patients or in controls. It was interesting to find an inverse correlation between IL-4 and antibody production in non-treated disseminated PCM (r = -0.4770); moreover, a significant correlation (P = 0.0820) was found in chronic PCM patients with respect to the low level of either IL-4 and antibody titres against fungus antigen. Chronic PCM patients also had IL-2 levels inversely correlated with antibody production (r = -0.6313; P = 0.0628). Inverse correlations were also observed between IL-2 and IL-6 levels in non-treated disseminated patients (P = 0.0501) and between IL-2 and IL-4 in chronic patients (P = 0.0131). The inflammatory cytokines might have a pivotal role in the genesis and in control of some aspects of the disease, such as granulomatous reaction, hypergammaglobulinaemia and depression of T cell-mediated immunity in PCM.
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Affiliation(s)
- C L Silva
- Department of Parasitology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
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Silva MF, Silva CL. The role of somatic structure of the fungus Paracoccidioides brasiliensis upon B cell activation in experimental paracoccidioidomycosis. Clin Exp Immunol 1995; 101:321-7. [PMID: 7648716 PMCID: PMC1553260 DOI: 10.1111/j.1365-2249.1995.tb08358.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
In this study, we report an increase of the number of antibody-secreting cells and the augmentation of antibody production against unrelated antigens in mice infected with the fungus P. brasiliensis, as well as in mice inoculated with cell wall preparation isolated from P. brasiliensis (CW). The immunomodulatory effect of the live fungus and the CW preparation was dose-dependent, and their actions were mainly restricted to the i.v. or i.p. inoculation simultaneously with the sheep erythrocyte challenge by the i.v. route or restricted to i.p. inoculation of CW when bovine serum albumin (BSA) antigen was used. The dependence of antibody production on different routes of CW inoculation was correlated with the number of antigen-specific B cells in the spleen as determined by direct and reverse plaque-forming cell assays. The immunization schedules using CW preparation caused a preferential production of IgM and IgG3 antibodies. The results also showed that the hyperactive humoral immune response of mice induced by i.p. inoculation of CW was devoid of polyclonal B cell activation compared with the effects observed for the lipopolysaccharide (LPS)-treated groups. Paracoccidioides brasiliensis CW components may have potent immunological properties related to the non-specific B cell activation found in paracoccidioidomycosis.
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Affiliation(s)
- M F Silva
- Department of Parasitology, Microbiology and Immunology, University of São Paulo, Brazil
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42
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Glina S, Silva MF, Puech-Leão P, Reis JM, Lucon AM. Veno-occlusive dysfunction of corpora cavernosa: comparison of diagnostic methods. Int J Impot Res 1995; 7:1-10; discussion 11. [PMID: 7670587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pump cavernosometry, pharmaco-cavernosometry, gravity cavernosometry and the intracavernous pressure drop test are the most used tests for the diagnosis of venoocclusive dysfunction. To verify whether patients show equivalent results in each of these four tests, and to ascertain whether there is any influence of the sequence of the exams over the results, 123 male patients with erectile dysfunction, aged 21 to 82 years (mean 48), were evaluated. All were submitted to the four tests in randomized sequence. Two criteria were used to define the normal results of pump cavernosometry and pharmaco-cavernosometry, both based on patients with normal veno-occlusive function. The incidence of normal results varied from 6.5% in pump cavernosometry according to criterion I to 64.2% in pharmaco-cavernosometry according to criterion II. Results of the four tests agreed completely (all normal or all abnormal) in 43.9% of the patients when criteria I was used and 58.3% with criteria II. Incidence of normal results in each test did not vary according to the sequence in which the exams were done. Pump cavernosometry, pharmaco-cavernosometry, gravity cavernosometry and intracavernous pressure drop test did not show equivalent results for individual patients. Results were not influenced by the sequence of the tests.
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Affiliation(s)
- S Glina
- Instituto H. Ellis, São Paulo, Brasil
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43
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Mori T, Yoon HS, Iizuka FH, Myung JM, Sato HR, Silva MF, Okumura M. Intestinal transit and opaque enema study in chagasic mice. Rev Hosp Clin Fac Med Sao Paulo 1995; 50:63-6. [PMID: 7481459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The report concerns as experimental study utilizing thirty-three mice inoculated subcutaneously with 1000 blood forms of Trypanosoma cruzi. Intestinal transit and morphology of colon were studies by means of X-rays. In subacute stage intestinal transit was normal. In chronic stages the mice displayed a delay in evacuation time. In one out of 12 animals the opaque enema documented the existence of megacolon.
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Affiliation(s)
- T Mori
- Departament of Gastroenterologic Surgery, Hospital das Clínicas University of São Paulo Medical School
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Silva MF, Braz LM, Amato Neto V, Martins JE, Di Pietro AO, Mazzucati E. [Experimental evaluation in mice of vitamin B complex repellent activity against Culex quinquefasciatus]. Rev Hosp Clin Fac Med Sao Paulo 1995; 50:55-7. [PMID: 7481457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
One untested but widely held opinion in Brazil is that oral use of vitamin B complex is useful as a mosquito repellent. We exposed Balb-C mice to a large number of Culex quinquefasciatus females, after giving vitamin B complex to mice (drops by mouth). There was no difference between mice attractiveness to mosquitoes in the vitamin B group compared to normal, but very few of the females bite mice in both groups, so the experiment was inconclusive. We suggest further experiments in this subject, using other models were the animals are more attractive to mosquitoes.
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Affiliation(s)
- M F Silva
- Laboratório de Investigação Médica, Parasitologia do Hospital das Clínicas, da Faculdade de Medicina da Universidade de São Paulo
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Silva CL, Silva MF, Pietro RC, Lowrie DB. Protection against tuberculosis by passive transfer with T-cell clones recognizing mycobacterial heat-shock protein 65. Immunology 1994; 83:341-6. [PMID: 7835957 PMCID: PMC1415049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We have previously shown that mice vaccinated by injection with J774 macrophage-like tumour cells that expressed Mycobacterium leprae heat-shock protein (hsp) 65 as a transgene had acquired a remarkably high degree of protection against subsequent challenge with virulent M. tuberculosis. We show here that antigen-specific T cells cloned from spleens of such vaccinated animals can transfer a high level of protection to non-vaccinated recipients. The most efficient cells were of T-cell receptor (TCR) alpha beta+ and CD4- CD8+ type and specifically lysed mycobacteria-infected macrophages. These findings are consistent with the importance for protective immunity of engaging the endogenous antigen-presenting pathway to bias the immune response towards a cytolytic action against a mycobacterial antigen that is expressed at the surface of infected macrophages. TCR gamma delta+ and TCR alpha beta+ cells interacted synergistically.
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Affiliation(s)
- C L Silva
- Department of Parasitology, Microbiology and Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
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Campos R, Amato Neto V, Moreira AA, de Souza HB, Okumura M, Pinto PL, Braz LM, Silva MF, Matsubara L. [Evaluation of the therapeutic activity of fluconazole in acute experimental infection caused by Trypanosoma cruzi]. Rev Hosp Clin Fac Med Sao Paulo 1992; 47:174-5. [PMID: 1340597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
On hand of information that fluconazole can inhibit Trypanosoma cruzi, infection, an experimental investigation in acutely infected mice treated with 200 mg/kg daily of this drug during one month was carried out. Parasitemia patency, blood culture, sub-inoculation and histologic examination were the parameters used to evaluate the potential therapeutic activity of the drug. The results did not confirm the hypothesis, but it would be desirable to conduct new trials with this and other imidazole compounds.
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Affiliation(s)
- R Campos
- Laboratório de Investigação Médica Parasitologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
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Bortoluzo C, Wroclawski ER, Glina S, Silva MF. Urological evaluation of sexual partners of women with human papillomavirus (HPV) infection. Rev Paul Med 1992; 110:69-71. [PMID: 1369626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Cancer of the uterine cervix has been related to HPV infection, based on clinical and laboratory data. The high recurrence rate in couples undergoing treatment for HPV infection points to a probable viral reservoir, either in subclinical lesions or in male internal genital organs. We have evaluated 31 men, all sexual partners of women with HPV infection. Eleven patients (35.5%) had related lesions: 4 (12.9%) with condyloma acuminatum; 5 (16.1%) with lesions revealed by magnified examination after reaction with 5% acetic acid and 2 (6.5%) with condyloma and subclinical lesions. A short-term follow-up confirmed a successful treatment with podophyllin.
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de Almeida IT, Duran M, Silva MF, Portela R, Cabral A, Tasso T, Eusébio F, Silveira C. Mild form of methylmalonic aciduria misdiagnosed as propionic acidaemia during a ketotic crisis. J Inherit Metab Dis 1991; 14:259-62. [PMID: 1886409 DOI: 10.1007/bf01800600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- I T de Almeida
- Centro de Metabolismos e Genética (INIC), Faculdade de Farmácia, Lisboa, Portugal
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49
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Affiliation(s)
- I T de Almeida
- Centro de Metabolismos e Genética (I.N.I.C.), Faculdade de Farmácia, Lisboa, Portugal
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Silva MF, Burgess RC, Sandham HJ. Effects of cheese extract and its fractions on enamel demineralization in vitro and in vivo in humans. J Dent Res 1987; 66:1527-32. [PMID: 3476549 DOI: 10.1177/00220345870660100301] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
In order to isolate and identify the most active anti-cariogenic components(s) of aqueous cheese extract (CE), we separated it into low (LMW) (MW less than 500), medium (MMW) (500 less than MW less than 10,000), and high (HMW) (MW greater than 10,000) molecular weight fractions by means of the Amicon ultrafiltration system. These fractions were then tested in vitro with a bacterial system containing S. mutans, adapted from that of Turtola (1977). The LMW fraction reduced the demineralization caused by the fermentation of sucrose by 96% (p less than 0.001) as compared with the water control; this was not significantly different from a 50% concentration of the CE. The MMW and HMW fractions reduced demineralization by 36 and 42%, respectively. The concentrations of acid-soluble calcium and phosphorus in CE, LMW, MMW, and HMW were 1509 and 462, 991 and 310, 231 and 7, and 162 and 3 micrograms/mL, respectively. A solution containing the same levels of calcium and phosphorus as CE was somewhat more effective in reducing demineralization in vitro than was CE itself (p less than 0.01). In vivo, the addition of these same calcium and phosphorus levels to a 10% sucrose solution reduced its cariogenicity by 67% (p less than 0.001), as judged by the intra-oral cariogenicity test (ICT). Plaque calcium and phosphorus concentrations were significantly higher in the ICT plaque samples subjected to the sucrose-Ca,P solution (p less than 0.01) than in the sucrose control. The resting pH, minimum pH, and shape of the pH curves produced by the sucrose control and sucrose-Ca,P were similar.(ABSTRACT TRUNCATED AT 250 WORDS)
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