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1.
Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital
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Fink, Thais T.
; Marques, Heloisa H.S.
; Gualano, Bruno
; Lindoso, Livia
; Bain, Vera
; Astley, Camilla
; Martins, Fernanda
; Matheus, Denise
; Matsuo, Olivia M.
; Suguita, Priscila
; Trindade, Vitor
; Paula, Camila S.Y.
; Farhat, Sylvia C.L.
; Palmeira, Patricia
; Leal, Gabriela N.
; Suzuki, Lisa
; Odone Filho, Vicente
; Carneiro-Sampaio, Magda
; Duarte, Alberto José S.
; Antonangelo, Leila
; Batisttella, Linamara R.
; Polanczyk, Guilherme V.
; Pereira, Rosa Maria R.
; Carvalho, Carlos Roberto R.
; Buchpiguel, Carlos A.
; Latronico, Ana Claudia
; Seelaender, Marilia
; Silva, Clovis Artur
; Pereira, Maria Fernanda B.
; Sallum, Adriana M. E.
; Brentani, Alexandra V. M.
; Neto, Álvaro José S.
; Ihara, Amanda
; Santos, Andrea R.
; Canton, Ana Pinheiro M.
; Watanabe, Andreia
; Santos, Angélica C. dos
; Pastorino, Antonio C.
; Franco, Bernadette D. G. M.
; Caruzo, Bruna
; Ceneviva, Carina
; Martins, Carolina C. M. F.
; Prado, Danilo
; Abellan, Deipara M.
; Benatti, Fabiana B.
; Smaria, Fabiana
; Gonçalves, Fernanda T.
; Penteado, Fernando D.
; Castro, Gabriela S. F. de
; Gonçalves, Guilherme S.
; Roschel, Hamilton
; Disi, Ilana R.
; Marques, Isabela G.
; Castro, Inar A.
; Buscatti, Izabel M.
; Faiad, Jaline Z.
; Fiamoncini, Jarlei
; Rodrigues, Joaquim C.
; Carneiro, Jorge D. A.
; Paz, Jose A.
; Ferreira, Juliana C.
; Ferreira, Juliana C. O.
; Silva, Katia R.
; Bastos, Karina L. M.
; Kozu, Katia
; Cristofani, Lilian M.
; Souza, Lucas V. B.
; Campos, Lucia M. A.
; Silva Filho, Luiz Vicente R. F.
; Sapienza, Marcelo T.
; Lima, Marcos S.
; Garanito, Marlene P.
; Santos, Márcia F. A.
; Dorna, Mayra B.
; Aikawa, Nadia E.
; Litvinov, Nadia
; Sakita, Neusa K.
; Gaiolla, Paula V. V.
; Pasqualucci, Paula
; Toma, Ricardo K.
; Correa-Silva, Simone
; Sieczkowska, Sofia M.
; Imamura, Marta
; Forsait, Silvana
; Santos, Vera A.
; Zheng, Yingying
.
OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.
2.
Molecular diagnosis of symptomatic toxoplasmosis: a 9-year retrospective and prospective study in a referral laboratory in São Paulo, Brazil
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Camilo, Lilian Muniz
; Pereira-Chioccola, Vera Lucia
; Gava, Ricardo
; Meira-Strejevitch, Cristina da Silva
; Vidal, Jose Ernesto
; Mattos, Cinara Cássia Brandão de
; Frederico, Fábio Batista
; De Mattos, Luiz Carlos
; Spegiorin, Lígia Cosentino Junqueira Franco
; Murata, Fernando Henrique Antunes
; Ferreira, Marina Neves
; Barbosa, Deusenia Machado Ulisses
; Gonçalves, Fausto da Silva
; Dias, Cristiane Moraes
; Catelan, Marcia Wakai
; Siqueira, Rubens Camargo
; Previato, Mariana
; Barbosa, Amanda Pires
; Cavallini, Danilo
.
ABSTRACT Symptomatic forms of toxoplasmosis are a serious public health problem and occur in around 10-20% of the infected people. Aiming to improve the molecular diagnosis of symptomatic toxoplasmosis in Brazilian patients, this study evaluated the performance of real time PCR testing two primer sets (B1 and REP-529) in detecting Toxoplasma gondii DNA. The methodology was assayed in 807 clinical samples with known clinical diagnosis, ELISA, and conventional PCR results in a 9-year period. All samples were from patients with clinical suspicion of several features of toxoplasmosis. According to the minimum detection limit curve (in CT), REP-529 had greater sensitivity to detect T. gondii DNA than B1. Both primer sets were retrospectively evaluated using 515 DNA from different clinical samples. The 122 patients without toxoplasmosis provided high specificity (REP-529, 99.2% and B1, 100%). From the 393 samples with positive ELISA, 146 had clinical diagnosis of toxoplasmosis and positive conventional PCR. REP-529 and B1 sensitivities were 95.9% and 83.6%, respectively. Comparison of REP-529 and B1 performances was further analyzed prospectively in 292 samples. Thus, from a total of 807 DNA analyzed, 217 (26.89%) had positive PCR with, at least one primer set and symptomatic toxoplasmosis confirmed by clinical diagnosis. REP-529 was positive in 97.23%, whereas B1 amplified only 78.80%. After comparing several samples in a Brazilian referral laboratory, this study concluded that REP-529 primer set had better performance than B1 one. These observations were based after using cases with defined clinical diagnosis, ELISA, and conventional PCR.
https://doi.org/10.1016/j.bjid.2017.07.003
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3.
Anti-Toxoplasma gondii antibodies in pregnant women and their newborn infants in the region of São José do Rio Preto, São Paulo, Brazil
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Mattos, Cinara de Cássia Brandão de
; Spegiorin, Lígia Cosentino Junqueira Franco
; Meira, Cristina da Silva
; Silva, Thaís da Costa
; Ferreira, Ana Iara da Costa
; Nakashima, Fabiana
; Pereira-Chioccola, Vera Lúcia
; Mattos, Luiz Carlos de
.
CONTEXTO E OBJETIVOS: A toxoplasmose, quando transmitida durante a gestação, pode causar graves sequelas em fetos e neonatos. Anticorpos maternos podem ser indicadores de risco ou de imunidade. O objetivo foi avaliar a positividade dos anticorpos das classes imunoglobulina M (IgM) e imunoglobulina G (IgG) anti-Toxoplasma gondii (anti-T. gondii), bem como a avidez de IgG em gestantes e seus neonatos. TIPO DE ESTUDO E LOCAL: Estudo transversal em ambulatório de gestação de alto risco. MÉTODOS: Anticorpos anti-T. gondii foram avaliados em amostras de soro de gestantes (n = 87) e seus respectivos neonatos (n = 87) com o uso dos métodos imunofluorescência indireta (IFI) (IgM e IgG), ensaio imunoenzimático (ELISA) (IgG) e avidez. RESULTADOS: Anticorpos anti-T. gondii foram identificados em 64,4% das amostras de soro das mães e seus bebês (56/87). Com exceção de duas amostras de soro materno (2,3%), todas as demais foram negativas anticorpos IgM anti-T. gondii determinado pela IFI. Os resultados mostraram que 92,9% das gestantes tinham índices elevados de avidez de IgG (> 30%) e 4 amostras apresentaram índices de avidez entre 16-30%. Duas gestantes no terceiro trimestre da gravidez eram positivas IgM anti-T. gondii; seus bebês apresentaram índices de avidez entre 16 e 30%. Os índices de avidez dos soros dos outros 83 recém-nascidos foram semelhantes àqueles encontrados nas amostras maternas. CONCLUSÕES: Os resultados mostraram que 2% das gestantes estavam sob risco de transmissão de T. gondii durante o período gestacional. Estes dados parecem refletir a real situação da toxoplasmose gestacional na região noroeste do Estado de São Paulo.
CONTEXT AND OBJECTIVE: Toxoplasmosis transmission during pregnancy can cause severe sequelae in fetuses and newborns. Maternal antibodies may be indicators of risk or immunity. The aim here was to evaluate seropositivity for anti-Toxoplasma gondii (anti-T. gondii) immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies and IgG avidity in pregnant women and their newborn infants. DESIGN AND SETTING: Cross-sectional study in a high-risk pregnancy outpatient clinic. METHODS: Serum samples from pregnant women (n = 87) and their respective newborns (n = 87) were evaluated for anti-T. gondii antibodies using indirect immunofluorescence (IIF) (IgM and IgG), enzyme-linked immunosorbent assay (ELISA) (IgG) and an avidity test. RESULTS: Anti-T. gondii antibodies were identified in 64.4% of the serum samples from the mothers and their infants (56/87). Except for two maternal serum samples (2.3%), all others were negative for anti-T. gondii IgM antibodies, using IIF. The results showed that 92.9% of the pregnant women had high IgG avidity indexes (> 30%) and four samples had avidity indexes between 16 and 30%. Two women in the third trimester of pregnancy were positive for anti-T. gondii IgM antibodies; their babies had avidity indexes between 16 and 30%. The avidity indexes of serum from the other 83 newborns were similar to the results from their mothers. CONCLUSIONS: The results showed that 2% of the pregnant women were at risk of T. gondii transmission during the gestational period. These data seem to reflect the real situation of gestational toxoplasmosis in the northwestern region of the state of São Paulo.
7012 downloads
4.
Fluoxetina: indícios de uso inadequado
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Carlini, Elisaldo A.
; Noto, Ana Regina
; Nappo, Solange Aparecida
; Sanchez, Zila van der Meer
; Franco, Vera Lúcia da Silva
; Silva, Luiz Carlos Franco
; Santos, Vilmar Ezequiel dos
; Alves, Décio de Castro
.
OBJETIVO: Investigar o uso da fluoxetina na cidade de Santo André, SP, por meio de coleta e análise das receitas especiais (RE) prescritas por médicos e arquivadas nas farmácias e drogarias daquela cidade. MÉTODOS: Foram coletadas as receitas especiais retidas durante os meses de agosto do ano de 2005 a julho de 2006, em 13 farmácias de manipulação e em 27 drogarias em diferentes regiões de Santo André. Cada receita especial foi analisada em relação à presença de fluoxetina, em associação ou não a outros princípios ativos, e o sexo do(a) paciente foi anotado. RESULTADOS: Foram analisadas 39.782 RE - 16.124 coletadas das farmácias magistrais e 23.658 das drogarias. Desses totais, 10.919 prescrições continham fluoxetina - 9.259 provenientes das farmácias magistrais (84,8%) e apenas 1.660 (15,2%) das drogarias. As prescrições de fluoxetina eram predominantemente destinadas a mulheres (79,8%). Na imensa maioria das RE, a fluoxetina foi prescrita em associação com um grande número de outras substâncias ativas, inclusive anfetaminas anoréticas, chegando a mais de dez outras em quase a metade das prescrições. Esse tipo de prescrição múltipla, principalmente para mulheres, é comparado com as prescrições de fórmulas magistrais para emagrecer, muito utilizadas no Brasil. CONCLUSÃO: Os dados obtidos sugerem que a utilização de fluoxetina teria um fim estético (perda de peso), e não um fim terapêutico (tratamento de depressão). Discute-se a relação risco-benefício desse possível uso, que poderia ser classificado de inadequado dado as conhecidas reações adversas da fluoxetina e a sua interferência no sistema citocromo P450.
OBJECTIVE: Investigate the use of fluoxetine in Santo André city, SP, by collecting and analyzing special prescriptions (SP) issued by physicians and filed in compounding pharmacies and drugstores of that city. METHODS: Special prescriptions were collected during August 2005 to July 2006 in 13 compounding pharmacies and 27 drugstores, in different regions of Santo André. Each prescription has been examined for the presence of fluoxetine, in combination or not with other active ingredients, and sex (a) patient was noted. RESULTS: We examined 39,782 SP; 16,124 of them were collected from compounding pharmacies and 23,658 from drugstores. Of these totals, 10,919 prescriptions contained fluoxetine as follows: 9,259 from the compounding pharmacies (84.8%) and only 1,660 (15.2%) from drugstores. Fluoxetine was manly prescribed for women (79.8%). In the vast majority of SP, fluoxetine was prescribed in combination with a large number of other active substances reaching more than ten others in almost half of the prescriptions. CONCLUSION: It is suggested that the large use of fluoxetine possibily aims to an aesthetic objective (to lose weight) and not as a therapeutic aim (treatment of depression). This work discusses the risk/benefit of this use which could be described as inappropriate, given the known adverse reactions of fluoxetine and its interference with the cytochrome P450 system.
35072 downloads
5.
IV Diretrizes Brasileiras de Hipertensão Arterial Grupos de trabalho
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Gomes, Marco Antonio Mota
; Pierin, Angela Maria Geraldo
; Sbissa, Antonio Silveira
; Nogueira, Armando da Rocha
; Brandão, Ayrton Pires
; Rodrigues, Cibeli I. Saad
; Mello, Edgar Pessoa de
; Mello Filho, José Xavier de
; Bodanese, Luiz Carlos
; Toscano, Paulo
; Ferreira Filho, Sebastião
; Nobre, Fernando
; Tavares, Agostinho
; Lopes, Antonio Carlos
; Ribeiro, Jorge Pinto
; Ayoub, José Carlos Aydar
; Ribeiro, José Márcio
; Introcaso, Luiz
; Corrêa, Marcelo
; Maranhão, Mario
; Jabur, Pedro
; Nascimento, Raimundo Marques
; Cunha, Roberto de Sá
; Mulinari, Rogério Andrade
; Machado, Carlos Alberto
; Avila, Adriana
; Andrade, Clóvis Oliveira
; Rocha, João Carlos
; Lopes, Margarida Maria Veríssimo
; Arruda, Maria Cecília G. Marinho
; Azevedo, Maria Fátima
; Carvalho, Maria Helena C.
; Lipp, Marilda Novaes
; Kohlmann, Nárcia Elisa B.
; Jesus, Neide de
; Jardim, Paulo César da Veiga
; Amodeo, Celso
; Negrão, Carlos Eduardo
; Ferreira, Celso
; Cunha, Cláudio Pereira da
; Toscano, Eli
; Lima, Eliuden Galvão de
; Monego, Estelamaris Tronco
; Braga, Fátima Lúcia Machado
; Chaves Jr., Hilton de Castro
; Heiman, Joel
; Carvalho, Tales de
; Kohlmann Jr., Osvaldo
; Avezum, Alvaro
; Ribeiro, Artur Beltrame
; Gomes, Carlos Alberto
; Giorgi, Dante Marcelo Artigas
; Feitosa, Gilson
; Ohashi, Harue
; Ramirez, José Antonio Franchini
; Machado, Marcelo Marcondes
; Salgado Filho, Natalino
; Luna, Rafael Leite
; Franco, Roberto Jorge da Silva
; Santos, Robson Augusto dos
; Oigman, Wille
; Pascoal, Istênio Fernandes
; Massaro, Airton
; Atallah, Álvaro Nagib
; Brandão, Andréa
; Freitas, Elizabete Viana de
; Cordovil, Ivan
; Oliveira, José Egídio Paulo de
; Ramos, José Geraldo L.
; Zanella, Maria Teresa
; Wajngarten, Maurício
; Miranda, Roberto Dischinger
; Kahhale, Soubihe
; Koch, Vera
; Mion Jr., Décio
; Guimarães, Armênio C.
; Palmeira, Catia Sueli
; Forjaz, Claudia Lucia de Moraes
; Coelho, Eduardo B.
; Almeida, Fernando Antonio
; Pellizari, Isabel Cristina Estefano
; Ribeiro, Marcos Ausenka
; Batlouni, Michel
; Lotufo, Paulo
; Capelari, Regina Teresa
; Magalhães, Lucélia C.
; Afiune Neto, Abrahão
; Cury, Abrão
; Moreira, Alci
; Souza, Ana Luisa de
; Fuchs, Flavio Danni
; Lessa, Ines
; Malachias, Marcus V. Bolívar
; Bezerra, Romero
; Fuchs, Sandra
; Praxedes, José Nery
; Cambara, Antonio
; Lucon, Antonio Marmo
; Mendonça, Berenice
; Borelli, Flavio
; Silva, Helio B.
; Romão Jr., João Egidio
; Carvalho, José Gastão Rocha
; Santello, José Luiz
; Bortolotto, Luiz
; Matavelli, Luis Celso
; Pinheiro, Maria Eliete
; Guimarães, Valéria
.
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