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Cassiolato AP, Camargo CH, Piccoli Cecconi MC, Christakis S, Gonçalves CR, Rodrigues Campos K, Takenori Higa F, Andrade Pereira G, de Moraes C, Silva de Lemos AP. Genomic characterization of invasive meningococcal X isolates from Brazil, 1992-2022. Int Microbiol 2023:10.1007/s10123-023-00325-5. [PMID: 36626096 PMCID: PMC9838296 DOI: 10.1007/s10123-023-00325-5] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/12/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Invasive meningococcal disease (IMD) is a major health problem. Given the post-COVID-19 pandemic scenario with the loosening of the non-pharmacological measures to control the virus transmission and considering the observed global reduction of meningococcal vaccination coverage, an increase in IMD cases can be expected. METHODOLOGY Using whole-genome sequencing, we characterized six Neisseria meningitidis serogroup X (MenX) isolates recovered from IMD cases in Brazil in the last 30 years. RESULTS The predominance (66.6%, 4/6) of ST2888 presenting fHbp 160, NHBA 129, NadA 21, and PorA 19,15 was found on isolates. Two novel STs, 15458 and 15477, were described. CONCLUSION This study describes the circulation of MenX lineage ST2888 in Brazil, previously reported only in Europe. Continuous universal surveillance is crucial to implement prompt public health measures aiming to prevent and control non-vaccine preventable serogroup X IMD cases.
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Affiliation(s)
- Ana Paula Cassiolato
- grid.417672.10000 0004 0620 4215Center of Bacteriology, Instituto Adolfo Lutz (IAL), São Paulo, State of São Paulo Brazil
| | - Carlos Henrique Camargo
- grid.417672.10000 0004 0620 4215Center of Bacteriology, Instituto Adolfo Lutz (IAL), São Paulo, State of São Paulo Brazil
| | | | - Sandra Christakis
- Public Health Laboratory, Florianópolis, State of Santa Catarina Brazil
| | - Claudia Regina Gonçalves
- grid.417672.10000 0004 0620 4215Strategic Laboratory, Instituto Adolfo Lutz (IAL), São Paulo, State of São Paulo Brazil
| | - Karoline Rodrigues Campos
- grid.417672.10000 0004 0620 4215Strategic Laboratory, Instituto Adolfo Lutz (IAL), São Paulo, State of São Paulo Brazil
| | - Fabio Takenori Higa
- Center of Immunology, Institute Adolfo Lutz (IAL), São Paulo, State of São Paulo Brazil
| | - Gabriela Andrade Pereira
- grid.414596.b0000 0004 0602 9808Secretariat of Health Surveillance, Ministry of Health, Brasília, Federal District Brazil
| | - Camile de Moraes
- grid.414596.b0000 0004 0602 9808Secretariat of Health Surveillance, Ministry of Health, Brasília, Federal District Brazil
| | - Ana Paula Silva de Lemos
- grid.417672.10000 0004 0620 4215Center of Bacteriology, Instituto Adolfo Lutz (IAL), São Paulo, State of São Paulo Brazil
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Camargo CH, Gonçalves CR, Pagnoca EVRG, Campos KR, Montanha JOM, Flores MNP, Soares MMCN, Binhardi FMT, Ferreira PM, Yu ALF, Carvalhanas TRMP, Abbud A, Bugno A, Sacchi CT. SARS-CoV-2 reinfection in a healthcare professional in inner Sao Paulo during the first wave of COVID-19 in Brazil. Diagn Microbiol Infect Dis 2021; 101:115516. [PMID: 34425504 PMCID: PMC8377409 DOI: 10.1016/j.diagmicrobio.2021.115516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 07/14/2021] [Accepted: 07/28/2021] [Indexed: 02/08/2023]
Abstract
Coronavirus Disease 2019 pandemic remains a threat to public health. We report 2 cases of Coronavirus Disease 2019 infection in the same healthcare professional in Brazil. Genomic analysis identified that primoinfection was caused by the endemic lineage B.1.1.33 while reinfection by the lineage B.1.1.44, a lineage with an additional V1176F mutation in S protein.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Patrícia Marques Ferreira
- Divisão de Doenças de Transmissão Respiratórias, Centro de Vigilância Epidemiológica, Secretaria de Estado da Saúde, São Paulo, Brazil
| | - Ana Lucia Frugis Yu
- Divisão de Doenças de Transmissão Respiratórias, Centro de Vigilância Epidemiológica, Secretaria de Estado da Saúde, São Paulo, Brazil
| | | | - Adriano Abbud
- Instituto Adolfo Lutz, Laboratório Central, São Paulo, Brazil
| | - Adriana Bugno
- Instituto Adolfo Lutz, Laboratório Central, São Paulo, Brazil
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Dos Santos CA, Hernandes RT, Cunha MPV, Nagamori FO, Gonçalves CR, Sacchi CT, Tiba-Casas MR, Camargo CH. Two Novel Mutations Associated with Polymyxin-B Resistance in a Pandemic Lineage of Uropathogenic Escherichia coli of the Sequence Type 69. Chemotherapy 2021; 66:92-98. [PMID: 34325421 DOI: 10.1159/000517817] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/12/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Uropathogenic Escherichia coli (UPEC) are frequent pathogens worldwide, impacting on the morbidity and economic costs associated with antimicrobial treatment. OBJECTIVES We report two novel mutations associated with polymyxin-B resistance in an UPEC isolate collected in 2019. METHODS Isolate was submitted to antimicrobial susceptibility testing including broth microdilution for polymyxin B. Whole genome was sequenced and analyzed. RESULTS Polymyxin-B total inhibition occurred at 16 mg/L (resistant). UPEC isolate was assigned to the phylogroup D, serotype O117:H4, and Sequence Type 69. mcr genes were not detected, but two novel mutations in the pmrA/basS (A80S) and pmrB/basR (D149N) genes were identified. CONCLUSIONS The occurrence of non-mcr polymyxin resistance in E. coli from extraintestinal infections underscores the need of a continuous surveillance of this evolving pathogen.
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Affiliation(s)
| | - Rodrigo Tavanelli Hernandes
- Instituto de Biociências de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, Brazil
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de Lemos APS, Sacchi CT, Gonçalves CR, Camargo CH, Andrade AL. Genomic surveillance of Neisseria meningitidis serogroup B invasive strains: Diversity of vaccine antigen types, Brazil, 2016-2018. PLoS One 2020; 15:e0243375. [PMID: 33347452 PMCID: PMC7751880 DOI: 10.1371/journal.pone.0243375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022] Open
Abstract
Background Neisseria meningitidis serogroup B remains a prominent cause of invasive meningococcal disease (IMD) in Brazil. Because two novel protein-based vaccines against serogroup B are available, the main purpose of this study was to provide data on the diversity and distribution of meningococcal vaccine antigen types circulating in Brazil. Methodology Genetic lineages, vaccine antigen types, and allele types of antimicrobial-associated resistance genes based on whole-genome sequencing of a collection of 145 Neisseria meningitidis serogroup B invasive strains recovered in Brazil from 2016 to 2018 were collected. Results A total of 11 clonal complexes (ccs) were identified among the 145 isolates, four of which were predominant, namely, cc461, cc35, cc32, and cc213, accounting for 72.0% of isolates. The most prevalent fHbp peptides were 24 (subfamily A/variant 2), 47 (subfamily A/variant 3), 1 (subfamily B/variant 1) and 45 (subfamily A/variant 3), which were predominantly associated with cc35, cc461, cc32, and cc213, respectively. The NadA peptide was detected in only 26.2% of the isolates. The most frequent NadA peptide 1 was found almost exclusively in cc32. We found seven NHBA peptides that accounted for 74.5% of isolates, and the newly described peptide 1390 was the most prevalent peptide exclusively associated with cc461. Mutated penA alleles were detected in 56.5% of the isolates, whereas no rpoB and gyrA mutant alleles were found. Conclusion During the study period, changes in the clonal structure of circulating strains were observed, without a predominance of a single hyperinvasive lineage, indicating that an epidemiologic shift has occurred that led to a diversity of vaccine antigen types in recent years in Brazil.
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Affiliation(s)
| | | | | | | | - Ana Lúcia Andrade
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
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Tavares LCB, Cunha MPV, de Vasconcellos FM, Bertani AMDJ, de Barcellos TAF, Bueno MS, Santos CA, Sant'Ana DA, Ferreira AM, Mondelli AL, Montelli AC, Sadatsune T, Sacchi CT, Gonçalves CR, Tiba-Casas MR, Camargo CH. Genomic and Clinical Characterization of IMP-1-Producing Multidrug-Resistant Acinetobacter bereziniae Isolates from Bloodstream Infections in a Brazilian Tertiary Hospital. Microb Drug Resist 2020; 26:1399-1404. [PMID: 32155381 DOI: 10.1089/mdr.2019.0210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Acinetobacter baumannii is the main species of the Acinetobacter genus; however, non-baumannii Acinetobacter (NBA) species causing infections have been described for the past years, as well as antimicrobial resistance. In this study, we describe the occurrence of two multidrug-resistant (MDR) IMP-1-producing Acinetobacter bereziniae isolates recovered from bloodstream infections in different patients but in the same intensive care unit among 134 carbapenem-resistant Acinetobacter screened. Antimicrobial susceptibility testing revealed resistance to carbapenems, extended spectrum, and antipseudomonad cephalosporins, amikacin, and trimethoprim-sulfamethoxazole. Both A. bereziniae isolates shared the same ApaI-pulsed-field gel electrophoresis (PFGE) pattern. Whole-genome sequencing of both isolates revealed that blaIMP-1 was embedded into an In86 Class I integron carrying also sul1, aac(6')-31, and aadA genes. A new sequence type (ST1309 Pasteur) was deposited. The virulence genes lpxC and ompA, seen in A. baumannii, were detected in the A. bereziniae strains. Recognition of A. bereziniae causing invasive MDR infection underscores the role of NBA species as human pathogens especially in at-risk patients.
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Affiliation(s)
- Lais Calissi Brisolla Tavares
- Centro de Bacteriologia, Instituto Adolfo Lutz, São Paulo, Brazil.,Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Thays Almeida Franco de Barcellos
- Centro de Bacteriologia, Instituto Adolfo Lutz, São Paulo, Brazil.,Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mariana Sardinha Bueno
- Centro de Bacteriologia, Instituto Adolfo Lutz, São Paulo, Brazil.,Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | - Terue Sadatsune
- Instituto de Biociências de Botucatu, Universidade Estadual Paulista, Botucatu, Brazil
| | | | | | | | - Carlos Henrique Camargo
- Centro de Bacteriologia, Instituto Adolfo Lutz, São Paulo, Brazil.,Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Jesus JGD, Sacchi C, Candido DDS, Claro IM, Sales FCS, Manuli ER, Silva DBBD, Paiva TMD, Pinho MAB, Santos KCDO, Hill SC, Aguiar RS, Romero F, Santos FCPD, Gonçalves CR, Timenetsky MDC, Quick J, Croda JHR, Oliveira WD, Rambaut A, Pybus OG, Loman NJ, Sabino EC, Faria NR. Importation and early local transmission of COVID-19 in Brazil, 2020. Rev Inst Med Trop Sao Paulo 2020; 62:e30. [PMID: 32401959 PMCID: PMC7232955 DOI: 10.1590/s1678-9946202062030] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 11/26/2022] Open
Abstract
We conducted the genome sequencing and analysis of the first confirmed COVID-19 infections in Brazil. Rapid sequencing coupled with phylogenetic analyses in the context of travel history corroborate multiple independent importations from Italy and local spread during the initial stage of COVID-19 transmission in Brazil.
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Affiliation(s)
- Jaqueline Goes de Jesus
- Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Claudio Sacchi
- Laboratório Estratégico, Instituto Adolfo Lutz, São Paulo, São Paulo, Brazil
| | | | - Ingra Morales Claro
- Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Erika Regina Manuli
- Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | - Filipe Romero
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro,, Brazil
| | | | | | | | - Joshua Quick
- University of Birmingham, Birmingham, United Kingdom
| | - Julio Henrique Rosa Croda
- Coordenação Geral de Laboratórios de Saúde Pública, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, DF, Brazil.,Universidade Federal da Grande Dourados, Laboratório de Pesquisa em Ciências da Saúde, Dourados, Mato Grosso do Sul, Brazil,Fundação Osvaldo Cruz Campo Grande, Mato Grosso do Sul, Brazil
| | - Wanderson de Oliveira
- Coordenação Geral de Laboratórios de Saúde Pública, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, DF, Brazil
| | - Andrew Rambaut
- University of Edinburgh, Institute of Evolutionary Biology, Edinburgh, United Kingdom
| | - Oliver G. Pybus
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | | | - Ester Cerdeira Sabino
- Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Nuno Rodrigues Faria
- Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil.,Department of Zoology, University of Oxford, Oxford, United Kingdom.,Imperial College, School of Public Health, Department of Infectious Disease Epidemiology, London, United Kingdom
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8
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Machado JZ, De Miranda ACS, Gonçalves CR, Ikeda TI, Cruz AS. ISOENZYME ELECTROPHORESIS AND KARYOTYPE TECHNIQUES AS AN ALTERNATIVE FOR CELL LINE IDENTITY CONFIRMATION. VR&R 2014. [DOI: 10.17525/vrr.v19i1.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Favarato MH, Mease P, Gonçalves CR, Gonçalves Saad C, Sampaio-Barros PD, Goldenstein-Schainberg C. Hypertension and diabetes significantly enhance the risk of cardiovascular disease in patients with psoriatic arthritis. Clin Exp Rheumatol 2014; 32:182-187. [PMID: 24480317] [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] [Received: 05/03/2013] [Accepted: 11/12/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES New evidence has lightened the linkage between psoriatic arthritis (PsA) and the development of atherosclerosis and cardiovascular disease (CVD). We aimed to describe the prevalence of cardiovascular events and associated risk factors among patients with PsA. METHODS Retrospective evaluation of medical records from consecutive PsA patients who fulfilled the CASPAR criteria for PsA attending a specialised spondyloarthritis clinic at a single referral centre. CVD was defined based on the occurrence of coronary artery disease (CAD) or cerebrovascular ischaemic disease events. RESULTS We evaluated 158 PsA patients, 48.7% females and 51.3% males, aged 53.7±13.9 yrs. Mean PsA duration was 13.7±8.9 yrs and polyarticular subtype affected 66 (42%) patients. According to drug therapy, 85 (54%) were using NSAIDs and 21 (13%) low-dose prednisone; 32 (20%) were on anti-TNF agents, 94 (60%) metothrexate, 18 (11%) leflunomide, 13 (8%) sulfasalazine, 5 (3%) other immunossupressors and 4 (2.5%) were on chloroquine. Over half patients (87, 55%) had arterial hypertension (AH); 51 (32%) had dyslipidaemia (DLP), 38 (29%) hypertriglyceridemia and 36 (23%) diabetes mellitus (DM). Lipid profile was similar for both genders with mean total cholesterol= 186.5±38.6mg/dl, LDL=112.3±30.6 mg/dl, HDL= 47.89±14.6 and triglycerides= 127.4± 65.6 mg/dl. Of note, 14% PsA patients have had CVD, namely cerebrovascular or coronary heart disease. Sex, age, disease duration, joint involvement subtype, disease activity, CRP and lipid levels were similar among patients with and without CVD. The prevalence of AH (95% vs. 45%, p<0.001), DLP (75% vs. 27.7%, p<0.001) and DM (60% vs. 19%, p<0.001) were significantly greater in PsA patients who have had CVD compared to those without CVD, conferring an odds ratio of 21.0 for AH and of 5.4 for DM. CONCLUSIONS The high prevalence of CVD in PsA patients is influenced by increased AH and DM. Hence early recognition and specific treatment is mandatory in order to reduce the risk for CVD, avoiding early morbidity and mortality.
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Affiliation(s)
- M H Favarato
- Faculdade de Medicina da Universidade de São Paulo e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
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Skare TL, Leite N, Bortoluzzo AB, Gonçalves CR, da Silva JAB, Ximenes AC, Bértolo MB, Ribeiro SLE, Keiserman M, Menin R, Carneiro S, Azevedo VF, Vieira WP, Albuquerque EDN, Bianchi WA, Bonfiglioli R, Campanholo C, Carvalho HMS, Costa IP, Duarte AP, Gavi MBO, Kohem CL, Lima SAL, Meirelles ES, Pereira IA, Pinheiro MM, Polito E, Resende GG, Rocha FAC, Santiago MB, Sauma MDFLC, Sampaio-Barros PD. Effect of age at disease onset in the clinical profile of spondyloarthritis: a study of 1424 Brazilian patients. Clin Exp Rheumatol 2012; 30:351-357. [PMID: 22510473] [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] [Received: 05/02/2011] [Accepted: 10/25/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To analyse demographic and clinical variables in patients with disease onset before and after 40, 45 and 50 years in a large series of Brazilian SpA patients. METHODS A common protocol of investigation was prospectively applied to 1424 SpA patients in 29 centres distributed through the main geographical regions in Brazil. The mean age at disease onset was 28.56 ± 12.34 years, with 259 patients (18.2%) referring disease onset after 40 years, 151 (10.6%) after 45 years and 81 (5.8%) after 50 years. Clinical and demographic variables and disease indices (BASDAI, BASFI, BASRI, MASES, ASQoL) were investigated. Ankylosing spondylitis was the most frequent disease (66.3%), followed by psoriatic arthritis (18%), undifferentiated SpA (6.7%), reactive arthritis (5.5%), and enteropathic arthritis (3.5%). RESULTS Comparing the groups according to age of disease onset, those patients with later onset presented statistical association with female gender, peripheral arthritis, dactylitis, nail involvement and psoriasis, as well as negative statistical association with inflammatory low back pain, alternating buttock pain, radiographic sacroiliitis, hip involvement, positive familial history, HLA-B27 and uveitis. BASDAI, BASFI and quality of life, as well as physicians and patient's global assessment, were similar in all the groups. Radiographic indices showed worse results in the younger age groups. CONCLUSIONS There are two different clinical patterns in SpA defined by age at disease onset: one with predominance of axial symptoms in the group with disease onset ≤ 40 years and another favouring the peripheral manifestations in those with later disease onset.
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Affiliation(s)
- T L Skare
- Hospital Evangélico de Curitiba, Brazil.
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Caldas CAM, Borba EF, Bortolotto LA, Medeiros DM, Bonfa E, Gonçalves CR. Increased arterial stiffness assessed by pulse wave velocity in Behçet's disease and its association with the lipid profile. J Eur Acad Dermatol Venereol 2012; 27:454-9. [PMID: 22329367 DOI: 10.1111/j.1468-3083.2012.04458.x] [Citation(s) in RCA: 16] [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: 11/30/2022]
Abstract
OBJECTIVE To evaluate the structural and functional properties of vessels in Behçet's Disease (BD) using carotid-femoral pulse wave velocity (PWV) and an echo-tracking system. METHODS BD patients without traditional cardiovascular risk factors were selected. All BD patients performed PWV and carotid ultrasound. BD patients were divided into groups based on the presence of systemic (vascular and/or ocular and/or central nervous system involvement) and vascular involvement. Healthy controls age- and sex-matched with the same exclusion criteria were selected. RESULTS A total of 23 BD patients (mean age 35.0 ± 7.6 years) had significantly higher PWV levels compared with controls (8.48 ± 1.14 vs. 7.53 ± 1.40 m/s, P = 0.017). Intima-media thickness (594.87 ± 138.61 vs. 561.08 ± 134.26 μm, P = 0.371), diastolic diameter (6383.78 ± 960.49 vs. 6447.65 ± 1159.73 μm, P = 0.840), distension (401.95 ± 117.72 vs. 337.91 ± 175.36 μm, P = 0.225) and relative distension (6.26 ± 2.83 vs. 5.42 ± 2.46 μm, P = 0.293) were similar in both groups. The systemic disease group had significantly higher levels of PWV (8.79 ± 1.21 vs. 7.88 ± 0.72 m/s, P = 0.036) compared to those with exclusive mucocutaneous manifestations. BD patients with vascular involvement had similar PWV and echo-tracking parameters compared to those without vascular involvement (P > 0.05), but had higher total and LDL cholesterol levels (P = 0.019 and P = 0.012, respectively). The multivariate linear regression analysis identified triglycerides as the most important factor in increasing PWV levels (P = 0.001) in BD. CONCLUSIONS PWV is more useful than carotid ultrasound in detecting structural and functional vascular damage in BD and emphasizes the role of the disease itself in promoting these alterations. Our findings also reinforce the need for rigorous control of all risk factors in BD, particularly lipoproteins.
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Affiliation(s)
- C A M Caldas
- Rheumatology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Neves FS, Moraes JCB, Kowalski SC, Goldenstein-Schainberg C, Lage LV, Gonçalves CR. Cross-cultural adaptation of the Behçet's Disease Current Activity Form (BDCAF) to Brazilian Portuguese language. Clin Rheumatol 2006; 26:1263-7. [PMID: 17180637 DOI: 10.1007/s10067-006-0484-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Revised: 10/29/2006] [Accepted: 11/07/2006] [Indexed: 12/01/2022]
Abstract
The Behçet's Disease Current Activity Form (BDCAF) is a clinical instrument used to assess the activity of Behçet's disease (BD), which was originally developed in English. The aim of the present study was to perform a cross-cultural adaptation of the BDCAF to Brazilian Portuguese language and to evaluate its reliability in a population of Brazilian patients with BD. Brazilian Portuguese version of the BDCAF, named BR-BDCAF, was obtained according to established guidelines. Forty Brazilian patients with BD diagnosed according to the International Study Group for Behçet's Disease criteria were assessed by two rheumatologists in independent sessions and submitted to the BR-BDCAF. Inter- and intraobserver agreement were then evaluated by kappa scores (values higher than 0.6 indicated good agreement). Good inter- and intraobserver agreements were achieved for the most common manifestations of BD: kappa scores higher than 0.6 were obtained for oral and genital ulcerations, skin lesions, and articular and general complaints. Moderate interobserver agreement was obtained for ocular activity (kappa 0.483) and fair interobserver agreement was obtained for gastrointestinal (kappa 0.322), major vessel (kappa 0.281), and central nervous system activity (kappa 0.304). BR-BDCAF was found to be a reliable instrument for the classic mucocutaneous and articular manifestations of BD and for general complaints, but complementary assessment is needed to evaluate specific visceral involvement for disease activity.
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Affiliation(s)
- F S Neves
- Rheumatology Division, Faculty of Medicine, University of São Paulo, Av. Dr. Arnaldo 455, 3o andar, sala 3133, Pacaembu, São Paulo-SP, CEP 01246-903, Brazil.
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Shinzato MM, Bueno C, Trindade Viana VS, Borba EF, Gonçalves CR, Bonfá E. Complement-fixing activity of anticardiolipin antibodies in patients with and without thrombosis. Lupus 2006; 14:953-8. [PMID: 16425575 DOI: 10.1191/0961203305lu2252oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/05/2022]
Abstract
We have analysed in vitro the complement-fixing activity of anticardiolipin antibodies (C-fix aCL) from patients with persistent and moderate/high titres IgG aCL antibodies: 21 with thrombosis and 11 without thrombosis. Titre and C-fix ability of aCL were measured by ELISA. APS and non-APS patients were similar with regard to mean levels of IgG aCL (46 +/- 24 versus 51 +/- 30 GPL, P = 0.7), frequency of IgM aCL (P = 0.7) and a comparable predominance of IgG2 aCL reactivity on ELISA (95% versus 100%, respectively, P = 1.0). Remarkably, a high frequency of C-fix aCL (71% versus 92%, P = 0.35) was observed in both groups. Similarly, no difference was observed in the mean level of C-fix aCL in APS and non-APS patients (7 +/- 6 versus 9 +/- 8 SDunits, P = 0.3). Analysis of 10 primary and 11 secondary APS also revealed a comparable IgG aCL mean titre (57 +/- 29 versus 37 +/- 11, P = 0.06), frequency of IgM aCL (P = 0.6) and of C-fix aCL (70% versus 73%, P = 0.99). Among APS patients six had exclusive arterial events and seven exclusive venous events. The IgG aCL mean titre (36 +/- 10 versus 36 +/- 11 GPL, P = 0.9) and the frequency of IgM aCL antibodies (P = 0.56) in these subgroups of patients were comparable. There was a trend of higher frequency of C-fix aCL in patients with exclusive venous events (100%) compared to 50% of those with exclusive arterial events (p = 0.07). Importantly, C-fix aCL titre was higher in the former group compared to the later one (8 +/- 5 SDunits versus 2 +/- 2 SDunits, P = 0.016). Our data support the notion of a high frequency of C-fix aCL in APS. Although it does not discriminate those patients without thrombotic events with persistent moderate/high levels of aCL, this property seems to be more relevant in venous events and may provide the basis for further understanding the distinct pathogenic mechanisms underlying arterial and venous occlusive disorders of APS.
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Affiliation(s)
- M M Shinzato
- Division of Rheumatology, University of São Paulo, Brazil.
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15
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Sampaio-Barros PD, Carvalho MAP, Azevedo VF, Campos WR, Carneiro SCS, Giorgi RDN, Gonçalves CR, Hilário MOE, Keiserman MW, Leite NH, Pereira IA, Vieira WP, Vilela EG, Xavier RM, Ximenes AC. Espondiloartropatias: outras artropatias. Rev Bras Reumatol 2004. [DOI: 10.1590/s0482-50042004000600013] [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: 11/21/2022] Open
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16
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Sampaio-Barros PD, Carvalho MAP, Azevedo VF, Campos WR, Carneiro SCS, Giorgi RDN, Gonçalves CR, Hilário MOE, Keiserman MW, Leite NH, Pereira IA, Vieira WP, Vilela EG, Xavier RM, Ximenes AC. Espondiloartropatias: espondilite anquilosante e artrite psoriásica. Rev Bras Reumatol 2004. [DOI: 10.1590/s0482-50042004000600012] [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: 11/22/2022] Open
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17
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Irino K, Dias AM, Kano E, Vaz TM, Kato MA, Gonçalves CR, Vieira MA, Gomes TA. Metabolism of phenylpropionic acid in enteropathogenic Escherichia coli belonging to serogroup O111 and its application for diagnosis. FEMS Microbiol Lett 2001; 204:105-10. [PMID: 11682187 DOI: 10.1111/j.1574-6968.2001.tb10871.x] [Citation(s) in RCA: 2] [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: 11/29/2022] Open
Abstract
We evaluated a biochemical assay based on the ability to metabolise beta-phenylpropionic acid (PPA) as a diagnostic aid in the identification of typical enteropathogenic Escherichia coli (EPEC) strains. A total of 1061 E. coli strains of serogroups O55, O111, and O119 were initially characterised regarding their H types (serotypes) and the presence of EPEC DNA sequences, eae, EAF, and bfpA. In case of the serogroup O111 strains, 84.6% carried the typical EPEC markers, and the great majority of those (98.1%) were PPA-positive. In contrast, only 0.9% of the serogroups O55 and O119 strains carrying the typical EPEC markers (53.6% and 75.4%, respectively) were PPA-positive. We conclude that the PPA test is a useful method to detect typical EPEC strains only among strains of the O111 serogroup.
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Affiliation(s)
- K Irino
- Seção de Bacteriologia, Institute Adolpho Lutz, Av Dr Arnaldo, 351, CEP 01246-902, São Paulo, Brazil.
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18
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Gonçalves CR, Vaz TM, Araujo E, Boni RD, Leite D, Irino K. Biotyping, serotyping and ribotyping as epidemiological tools in the evaluation of Acinetobacter baumannii dissemination in hospital units, Sorocaba, São Paulo, Brazil. Rev Inst Med Trop Sao Paulo 2000; 42:277-82. [PMID: 11058938 DOI: 10.1590/s0036-46652000000500007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 11/22/2022] Open
Abstract
Dissemination of Acinetobacter baumannii strains in different units of a hospital in Sorocaba, São Paulo, Brazil was evaluated over a period of two years. By using biotyping, serotyping and ribotyping, 27 distinct clones were differentiated among 76 strains isolated between 1993-94, from clinical specimens of hospitalized patients. Two clones, 2:O4:A (biotype:serotype:ribotype) and 2:O29:A accounted for the majority of strains widely disseminated in the units during 1993. The introduction in the hospital setting, of a new clone, 6:O13:B, at the end of 1993 and its predominance through 1994 is discussed. Among 15 strains isolated from neonates, 6 (40%) belonged to the same clone, 2:O4:A. Interestingly, this clone was almost all recovered in neonatal intensive care unit, nursery and in pediatric unit. All strains were susceptible to imipenem and polymyxcin B. Multiresistant strains (up to 12 antimicrobial agents) accounted for 66.7% and 84.8% of the strains isolated in 1993 and in 1994, respectively.
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Affiliation(s)
- C R Gonçalves
- Seção de Bacteriologia, Instituto Adolfo Lutz, São Paulo, SP, Brazil.
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19
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Montenegro V, Chiamolera M, Launay P, Gonçalves CR, Monteiro RC. Impaired expression of IgA Fc receptors (CD89) by blood phagocytic cells in ankylosing spondylitis. J Rheumatol 2000; 27:411-7. [PMID: 10685807] [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: 02/15/2023]
Abstract
OBJECTIVE Expression of IgA Fc receptors (CD89, FcalphaR) and their occupancy by endogenous IgA were studied on blood monocytes and neutrophits to determine if FcalphaR defects could account for enhanced serum IgA and IgA-IC commonly found in patients with ankylosing spondylitis (AS). METHODS Peripheral blood samples were obtained from 34 patients with AS, 15 patients with rheumatoid arthritis, and 34 healthy individuals. Cell surface FcalphaR was analyzed using a quantitative flow cytometry method in which blood cells were stained with anti-FcalphaR monoclonal antibodies recognizing epitopes outside the IgA binding site and with F(ab')2 fragments of anti-IgA antibodies. Modulation of cell surface FcalphaR was evaluated after incubation of blood cells at 37 degrees C in absence of plasma. Biochemical characterization of iodinated FcalphaR molecules was determined by immunoprecipitation and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). RESULTS FcaR expression was significantly decreased on monocytes and neutrophils in patients with AS compared to control groups. FcalphaR levels were inversely correlated with serum IgA, suggesting its negative regulatory role. Modulation experiments resulted in rapid and higher FcalphaR upregulation in AS than in controls, indicating that these molecules were downregulated only at the cell surface. Moreover, analysis of the surface iodinated FcalphaR molecules by SDS-PAGE revealed higher Mr (60-90 kDa) in AS than controls (55-75 kDa), also suggesting an altered glycosylation. Analysis of receptor occupancy revealed high levels of endogenous IgA bound to monocytes and neutrophils in patients with AS, pointing to a saturation of IgA Fc receptors. CONCLUSION We observed impaired expression of FcalphaR in patients with AS that is characterized by a downregulation process associated with post-translational alterations and enhanced binding of endogenous IgA. These alterations might lead to a defective blood clearance by FcalphaR resulting in the enhancement of IgA and IgA-IC in AS patients. Decreased FcalphaR expression represents a new marker for this disease.
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Affiliation(s)
- V Montenegro
- Division of Rheumatology, University of São Paulo, Brazil.
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20
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Gonçalves CR, Vaz TM, Leite D, Pisani B, Simoes M, Prandi MA, Rocha MM, Cesar PC, Trabasso P, von Nowakonski A, Irino K. Molecular epidemiology of a nosocomial outbreak due to Enterobacter cloacae and Enterobacter agglomerans in Campinas, São Paulo, Brazil. Rev Inst Med Trop Sao Paulo 2000; 42:1-7. [PMID: 10742720 DOI: 10.1590/s0036-46652000000100001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 11/21/2022] Open
Abstract
A total of 73 isolates (57 Enterobacter cloacae and 16 Enterobacter agglomerans), recovered during an outbreak of bacteremia in the Campinas area, São Paulo, Brazil, were studied. Of these isolates, 61 were from parenteral nutrition solutions, 9 from blood cultures, 2 from a sealed bottle of parenteral nutrition solution, and one was of unknown origin. Of the 57 E. cloacae isolates, 54 were biotype 26, two were biotype 66 and one was non-typable. Of 39 E. cloacae isolates submitted to ribotyping, 87.2% showed the same banding pattern after cleavage with EcoRI and BamHI. No important differences were observed in the antimicrobial susceptibility patterns among E. cloacae isolates exhibiting the same biotype, serotype and ribotype. All E. agglomerans isolates, irrespective of their origin, showed same patterns when cleaved with EcoRI and BamHI. The results of this investigation suggest an intrinsic contamination of parenteral nutrition solutions and incriminate these products as a vehicle of infection in this outbreak.
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21
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Pereira IA, Pereira RM, Borba EF, Gonçalves CR, Yoshinari NY, Cossermelli W. [Low complement levels in urticarial vasculitis as first manifestation of systemic lupus erythematosus]. Rev Assoc Med Bras (1992) 1997; 43:311-3. [PMID: 9595743 DOI: 10.1590/s0104-42301997000400006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 02/07/2023] Open
Abstract
Hypocomplementaemic urticarial vasculitis syndrome is a leukocytoclastic vasculitis characterized by urticarial lesions, associated with fever, arthralgias, arthritis and abdominal pain. Other systemic manifestations include glomerulonephritis, uveitis, episcleritis, chronic obstructive pulmonary disease and neurological abnormalities. Some case associated with systemic lupus erythematosus have been described and SLE diagnosis was made by previous or concomitant diagnostic criteria before onset of urticarial vasculitis. Urticarial vasculitis prior to SLE diagnosis is rare. The development of anti-Ro/SS-A antibody for the diagnosis of SLE is emphasized. The authors alert to the importance of periodically searching for this marker in patients with urticarial vasculitis.
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Affiliation(s)
- I A Pereira
- Disciplina de Reumatologia do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
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22
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Salamea-Palacios FA, Laurindo IM, Torigoe DY, Gonçalves CR, Yoshinari NH. [Aminotransferase levels in rheumatoid arthritis patients treated with methotrexate]. Rev Hosp Clin Fac Med Sao Paulo 1997; 52:51-4. [PMID: 9435395] [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: 02/05/2023]
Abstract
Increase of the aminotransferase levels in 53 patients treated with methotrexate (MTX) were analysed in a retrospective study. The mean dose of MTX was 7.46 mg/week (range 2.5-15 mg) during at least 30 weeks (mean time of MTX use 124 weeks). The aminotransferase levels were transitorily increased in 13 patients, always less than three times the upper limit of normal. Only in three patients the AST and ALT levels were persistently increased and lead to the drug discontinuation in two cases. These results showed that increase of aminotransferases was a frequent observation (24.5%) during the first two-three years of follow-up, without interference in the overall clinical management.
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23
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Oliveira MG, Irino K, Vaz TM, Gonçalves CR, Levy CE. Biotypes, serovars and antimicrobial resistance patterns of Acinetobacter baumannii clinical isolates. Zentralbl Bakteriol 1996; 284:550-8. [PMID: 8899973 DOI: 10.1016/s0934-8840(96)80006-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
255 Acinetobacter strains, from clinical specimens of inpatients and outpatients, were identified phenotypically according to the new taxonomy proposed by Bouvet and Grimont. A. baumannii was the most frequent species (80.8%). This species underwent biotyping and serotyping according to the scheme of Bouvet and Grimont, and that of Traub, respectively, 81.2% of samples belonged to biotypes 2, 6 and 9 with a predominance of biotype 2. 86.6% of the strains could be serotyped; 2 new serotypes were encountered. The new serotype 29, being the most frequently isolated, was related to biotype 2 (86.6%), whereas serotype 13 was related to biotype 6 (84.8%). These clones presented marked multiple resistance patterns and were widespread in different wards. No outbreak was reported during the period studied. These phenotypical methods proved to be useful in differentiating strains of A. baumannii and, if used together, they showed a high discriminatory power.
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Affiliation(s)
- M G Oliveira
- Department of Microbiology, Universidade Federal de Juiz de Fora, Minas Gerais, Brazil
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24
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Heyman RE, Ferraz MB, Gonçalves CR, Atra E. Evaluation of the International Study Group for Behçet's Disease Criteria in Brazilian patients. Clin Rheumatol 1995; 14:526-30. [PMID: 8549090 DOI: 10.1007/bf02208149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- R E Heyman
- Department of Medicine, Escola Paulista de Medicina, São Paulo, Brazil
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25
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Pereira IA, Pereira RM, Borba EF, Gonçalves CR, Yoshinari NH, Cossermelli W. [Primary erythromelalgia]. Rev Assoc Med Bras (1992) 1992; 38:228-30. [PMID: 1340383] [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: 12/26/2022] Open
Abstract
Erythromelalgia is a rare disease characterized by intense erythema, burning pain and increased temperature in the distal of the extremities. Primary forms and secondary forms have been described, most commonly with essential thrombocythemia and policythemia vera. The authors describe a fifteen year old patient with primary erythromelalgia and discuss the pathogenic, clinical and therapeutic features of this disease.
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Affiliation(s)
- I A Pereira
- Disciplina de Reumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
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26
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Rodrigues CJ, Laurindo IM, Marchiori PE, Gonçalves CR. [Percutaneous synovial biopsy in the diagnostic evaluation of the patient with rheumatic disease]. Rev Hosp Clin Fac Med Sao Paulo 1989; 44:156-9. [PMID: 2623407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Forty seven percutaneous synovial biopsies from 22 patients with rheumatoid arthritis, four of whom with the juvenile form, 13 with indetermined polyarthritis and 12 with monoarthritis, were evaluated. The histopathological examination confirmed the clinical diagnosis in 76% of cases with rheumatoide arthritis and juvenile rheumatoid arthritis, and it suggested the diagnosis of rheumatoid arthritis in 80% of cases with indetermined polyarthritis. In two cases of monoarthritis it reveled acid-fast bacilli, and a granulomatous process in one. These resuls suggest that the synovial biopsies can be useful for the establishment of diagnosis in patients suffering from indetermined poly or monoarthritis.
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27
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Pereira RM, Gonçalves CR, Bueno C, Meirelles EDS, Cossermelli W, de Oliveira RM. Anticardiolipin antibodies in Behçet's syndrome: a predictor of a more severe disease. Clin Rheumatol 1989; 8:289-91. [PMID: 2758775 DOI: 10.1007/bf02030089] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [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: 01/02/2023]
Abstract
A high incidence of anticardiolipin antibodies were detected in 7 of 20 patients (35%) with Behçet's Syndrome. Three patients had IgG-ab, three had IgM-ab and one had both IgG and IgM antibodies. IgG-ACA was detected mainly in patients with ocular disease (30%) and one of them also has cerebral vascular disease. A lower incidence of ACA was found in the patients taking steroids compared with the ones taking other drugs. This work draws attention to the more severe disease present in patients with ACA and also the possibility of such tests become negative in patients taking immunosuppressive drugs.
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Affiliation(s)
- R M Pereira
- Department of Rheumatology, University of São Paulo School of Medicine, Brasil
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28
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Santiago MB, Maeda LC, Gonçalves CR, Baltazar PA, Carvalho C, Takagaki T. [Myositis and toxoplasmosis]. Rev Hosp Clin Fac Med Sao Paulo 1988; 43:121-3. [PMID: 3247556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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29
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Hirata MT, Scaff M, Marchiori PE, Gonçalves CR. [Pseudotumor cerebri in Behçet's syndrome: report of a case]. Arq Neuropsiquiatr 1987; 45:193-6. [PMID: 3426426 DOI: 10.1590/s0004-282x1987000200013] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The authors describe one patient with Behçet's disease who had pseudotumor cerebri as a neurological manifestation. The possibility of pseudotumor cerebri due cerebral venous thrombosis in Behçet's disease is emphasized.
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Affiliation(s)
- M T Hirata
- Departamento de Neurologia da Faculdade de Medicina, Universidade de São Paulo
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30
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Gonçalves CR, Campos FP, Mendonça LL, Santiago M, Diament J, Cossermelli W. [Clinical and therapeutic study of 13 cases of gonococcal arthritis]. Rev Hosp Clin Fac Med Sao Paulo 1986; 41:282-5. [PMID: 3110905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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31
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Fuller R, Gonçalves CR, Mendonça Neto EC, Thomazini ME, Nobre MR. [Aneurysm of the pulmonary artery in Behçet's syndrome. Report of a case]. Rev Hosp Clin Fac Med Sao Paulo 1986; 41:127-31. [PMID: 3563301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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32
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Missi SM, de Almeida Neto E, Schaf S, Gonçalves CR, Rodrigues CJ, Margarido LC. [Specific arthritis in patients with leprosy]. Rev Hosp Clin Fac Med Sao Paulo 1985; 40:22-6. [PMID: 4059781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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