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- ItemAcesso aberto (Open Access)Análise do perfil de segurança do uso de tacrolimo em exposição reduzida e everolimo ou micofenolato de sódio em receptores de transplante renal(Universidade Federal de São Paulo (UNIFESP), 2020-01-30) Miranda, Tamiris Abait [UNIFESP]; Silva Junior, Helio Tedesco [UNIFESP]; Silva Jr., Helio Tedesco; http://lattes.cnpq.br/1621797721074970; http://lattes.cnpq.br/9499140257010568; Universidade Federal de São PauloMethodology: A sub - analysis of safety data not yet tested in the original study was performed. Adverse event data were classified according to Common Terminology Criteria for Adverse Events (CTCAE / meDRa) version 4.0 according to manual hierarchy levels and laboratory parameters were classified according to CTCAE scores according to scale from 1 to 5. being 1 (mild), 2 (Moderate), 3 (severe or clinically significant), 4 (life threatening) and 5 (death). Categorical variables were presented as absolute and relative frequency, and for comparison between groups, the chi-square test was performed, continuous variables were summarized by mean and standard deviation, and comparisons between groups at follow-up were performed using the mixed linear normal modal with a random effect of the individual, for the variables that violated the assumption of normality, comparisons between groups were performed using the gamma-distributed GEE model. Results: A total of 2741 adverse events (AEs) and 344 serious adverse events (SAEs) were observed, and approximately 100% of patients had at least 01 AE. When analyzing adverse events without seriousness criteria, between the r-ATG/EVR and BAS/EVR groups, a statistical difference was observed in the events related to gastrointestinal disorders, infections, nervous system disorders and skin. Between r-ATG/EVR and BAS/MPS groups, a statistical difference was observed in events related to gastrointestinal disorders, events related to procedural complications, metabolism, skin and general disorders. Between the BAS/EVR and BAS/MPS groups, a statistical difference was observed in the events related to infections and metabolism and general disorders. For serious adverse events only events related to gastrointestinal, renal and urinary disorders, besides infections had some statistical difference between the three groups. For laboratory analysis, 35% of the analyzes showed some alteration, from mild, moderate, severe and life threatening. Conclusion: The present safety analysis showed that adverse events and laboratory changes were in agreement with the literature for the three immunosuppressive regimens. Also, although well-established in its efficacy, the MPS regimen is associated with significant adverse events that result in worse renal transplant outcome as CMV infection, demonstrated in the main study, leading to intolerability of MPS use and drug changing, which may increase the risk of acute rejection.
- ItemAcesso aberto (Open Access)Efeitos do uso crônico do difosfato de primaquina sobre a prenhez da rata(Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 1998-10-01) Azevedo, Eliel Nina de [UNIFESP]; Santos, Alessandra Silva; Mendes, Eliane Terezinha Rocha; Simões, Manuel de Jesus [UNIFESP]; Kulay Júnior, Luiz [UNIFESP]; Universidade Federal do Pará Departamento de Assistência Materno-Infantil; Fundação Universitária do ABC Faculdade de Medicina Departamento de Saúde Materno-Infantil; Universidade Federal de São Paulo (UNIFESP)Purpose: to evaluate the chronic action of primaquine diphosphate on the pregnancy of female albino rats. Methods: sixty pregnant female rats, separated into six groups, were used. Group I received daily, by gavage, 1 ml of distilled water from day zero to the 20th day of pregnancy (control group). The female rats of the other groups also received daily, by gavage, during the same period of time the volume of 1 ml containing gradually concentrated primaquine diphosphate solution: 0.25 mg/kg, group II; 0.50 mg/kg, group III; 0.75 mg/kg, group IV; 1.5 mg/kg, group V and 3.0 mg/kg, group VI. The maternal weights were considered on day zero and on the 7th, 14th and 20th days of pregnancy, when the matrices were sacrificed. Results: the results showed that primaquine diphosphate, in the used doses, did not interfere with none of the following variables: maternal weight, newborn weight, medium individual weight of fetuses, weight of the group of placentas and medium individual weight of the placentas, implantation number, number of placentas and number of fetuses, when compared with the control group. Also there was no case of reabsorption, malformation, maternal mortality or intrauterine death, in any of the studied groups. Conclusion: in the conditions of the study there were no contraindications for the continuous use of primaquine diphosphate during the pregnancy of the female rat.
- ItemSomente MetadadadosExperiências de um centro de referência em Erros Inatos da Imunidade (EII) no interior de São Paulo(Universidade Federal de São Paulo (UNIFESP), 2021) Ain, Ana Carolina Da Matta [UNIFESP]; Condino Neto, Antonio [UNIFESP]; Universidade Federal de São PauloIntroduction: The Inborn Errors of Immunity (IEI) are a group of congenital, genetic and hereditary diseases that cause immunological alterations with an increase in infections, autoimmunity, autoinflammatory diseases, atopy or malignancy. Objective: To describe the clinical profile of patients in the Pediatric Immunology Service linked to the Municipal University Hospital of Taubaté (HMUT) and of patients who had an extended neonatal screening test altered for inborn errors of immunity (NSTIEII) performed at the HMUT. Methods: This was a retrospective cross-sectional study, carried out by collecting data from the medical records of patients with IEI followed up in the service between 2014 and 2020, analyzing the profile of these patients and those who presented changes in NSTIEII between 2016 and 2020. Results: Assessed - 112 patients with a diagnosis of EII attended at the service (study 1), divided into predominant antibody deficiencies (41.1%), combined immunodeficiency with associated or syndromic characteristics (10.7%), congenital phagocyte defects (3.6%), immunodeficiency affecting cellular and humoral immunity (1.8%), immune dysregulation diseases (0.9%), probable diagnosis of IEI (42.0%). Between 2016 and 2020, 2679 NSTIEII were performed and 33 altered results were found (study 2), with cases of severe combined immunodeficiency (SCID), agammaglobulinemia, actinopathy, trisomy 21 and hypogammaglobulinemia. Twelve patients are still under investigation and 9 with IIE later discarded. When describing the patients in study 1 and study 2, we could observe male prevalence, presence of allergies, hospitalization (79.5% x 75.8%), admission to the NICU (40.2% x 45.5%) and 22.3% in pediatric ICU (with p<0.001) x 30.3%. The use of intravenous immunoglobulin was 49.1% x 39.4% respectively. Mortality was 6.3% (study 1) x 18.2% (study 2). There was greater administration of immunoglobulin and mortality among patients who underwent postnatal TREC and KREC collection. Conclusion: The clinical profile of patients with IEI from the Pediatric Immunology Service linked to the HMUT was described,demonstrating that there was a great delay in diagnosis. The most frequent class of IEI was the predominant antibody deficiency and the presence of hospitalization, especially in the pediatric ICU, proved to be important among these patients. The performance of TNEII is feasible and can be used. It should be considered that it is possible to make the diagnosis and the appropriate treatment, in addition to setting up a reference center for IEI in the interior of the country.
- ItemSomente MetadadadosInfections in heart transplant recipients in Brazil: the challenge of Chagas' disease(Elsevier B.V., 2010-03-01) Godoy, Henrique Luiz dos de [UNIFESP]; Guerra, Carla Morales [UNIFESP]; Viegas, Ruy Felipe Melo [UNIFESP]; Diniz, Rosiane Viana Zuza [UNIFESP]; Branco, João Nelson Rodrigues [UNIFESP]; Amato-Neto, Vicente; Almeida, Dirceu Rodrigues de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)BACKGROUND: Despite the high incidence of infections after heart transplantation, there is limited information about its epidemiology in patients from countries where Chagas' disease is endemic.METHODS: We analyzed the occurrence of infections in 126 patients aged older than 18 years who underwent transplantation from 1986 through 2007 at a Brazilian University Hospital and who survived at least 48 hours.RESULTS: Heart failure diagnoses before transplantation were idiopathic dilated cardiomyopathy (38.6%), Chagas' disease (34.9%), coronary artery disease (19.8%), and others (6.3%). the respiratory tract was the most common site of infections (40.9%), followed by surgical wound site (18.1%). Trypanosoma cruzi reactivations occurred in, 38.8% of Chagas' disease patients: 47.0% had myocarditis, 23.5% had skin lesions, and 29.4% had both. New-onset ventricular dysfunction was observed in 47.0%, with complete response after specific treatment, and 41.0% were asymptomatic cases, diagnosed by routine endomyocardial biopsies. No patient died from such events. No differences in survival were found after 5 years of follow-up between recipients with and without Chagas' disease (p = 0.231).CONCLUSIONS: in a heart transplant population from a developing country, infectious complications occurred at a high rate. Tropical illnesses were uncommon, except for the high rate of Chagas' disease reactivations. Despite that, the overall outcome of these patients was similar to that of recipients with other cardiomyopathies. J Heart Lung Transplant 2010;29:286-90 (C) 2010 International Society for Heart and Lung Transplantation. All rights reserved.
- ItemAcesso aberto (Open Access)Lower respiratory tract infections among human immunodeficiency virus-exposed, uninfected infants(Elsevier B.V., 2010-09-01) Mussi-Pinhata, Marisa M.; Motta, Fabrizio; Freimanis-Hance, Laura; Souza, Ricardo de; Szyld, Edgardo; Succi, Regina Célia de Menezes [UNIFESP]; Christie, Celia D. C.; Rolon, Maria J.; Ceriotto, Mariana; Read, Jennifer S.; Universidade de São Paulo (USP); WESTAT Corp; Univ Caxias Sul; Hosp Diego Paroissien; Universidade Federal de São Paulo (UNIFESP); Univ W Indies; Hosp Juan Fernandez; Hosp Agudos Dra Cecilia Grierson; NICHDObjectives: To evaluate whether maternal HIV disease severity during pregnancy is associated with an increased likelihood of lower respiratory tract infections (LRTIs) in HIV-exposed, uninfected infants.Methods: HIV-exposed, uninfected, singleton, term infants enrolled in the NISDI Perinatal Study, with birth weight >2500 g were followed from birth until 6 months of age. LRTI diagnoses, hospitalizations, and associated factors were assessed.Results: of 547 infants, 103 (18.8%) experienced 116 episodes of LRTI (incidence = 0.84 LRTIs/100 child-weeks). Most (81%) episodes were bronchiolitis. Forty-nine (9.0%) infants were hospitalized at least once with an LRTI. There were 53 hospitalizations (45.7%) for 116 LRTI episodes. None of these infants were breastfed. the odds of LRTI in infants whose mothers had CD4% <14 at enrollment were 4.4 times those of infants whose mothers had CD4% >= 29 (p = 0.003). the odds of LRTI in infants with a CD4+ count (cells/ mm(3)) <750 at hospital discharge were 16.0 times those of infants with CD4+ >= 750 (p = 0.002). Maternal CD4+ decline and infant hemoglobin at the 6-12 week visit were associated with infant LRTIs after 6-12 weeks and before 6 months of age.Conclusions: Acute bronchiolitis is common and frequently severe among HIV-exposed, uninfected infants aged 6 months or less. Lower maternal and infant CD4+ values were associated with a higher risk of infant LRTIs. Further understanding of the immunological mechanisms of severe LRTIs is needed. (C) 2010 International Society for Infectious Diseases. Published by Elsevier B.V. All rights reserved.
- ItemSomente MetadadadosOral ciprofloxacin vs. intravenous ceftriaxone administered in an outpatient setting for fever and neutropenia in low-risk pediatric oncology patients: Randomized prospective trial(Wiley-Blackwell, 2000-02-01) Petrilli, Antonio Sergio [UNIFESP]; Dantas, Lenice Silva [UNIFESP]; Campos, Mônica Cypriano [UNIFESP]; Tanaka, Cristiana [UNIFESP]; Ginani, Valéria Cortez [UNIFESP]; Seber, Adriana [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background. infections are one of the major complications in children undergoing chemotherapy. Monotherapy with either ciprofloxacin or ceftriaxone is safe and efficient in low-risk patients (solid tumors and stage I/II lymphomas). the same drugs may be used in an outpatient setting, decreasing costs and the risk of nosocomial infections. Procedure. Low-risk patients (N = 70) with episodes of fever and neutropenia (N = 116) were randomized to receive either oral ciprofloxacin or intravenous ceftriaxone as outpatients. Only one patient had a central venous catheter. Results. Episodes of fever and neutropenia were classified as fever of unknown origin (41% vs. 32%) or clinically documented infection (56% vs. 63%) in the ciprofloxacin and ceftriaxone groups, respectively. Most of these infections were of upper respiratory tract, skin, or gastrointestinal origin. the mean duration of neutropenia was 5 vs. 6 days. Fever persisted for 1-9 days (mean 2 vs. 3 days). Therapy was successful with no modifications in 83% vs. 75% of the episodes. Patients were admitted in 7% vs. 4% of the episodes. No bone or joint side effects were seen in either group. All patients survived. Conclusions. Outpatient therapy with either oral ciprofloxacin or intravenous ceftriaxone for fever and neutropenia is effective and safe in pediatric patients with solid tumors and stage I/II non-Hodgkin lymphoma (low-risk patients). Med. Pediatr. Oncol. 34:87-91, 2000. (C) 2000 Wiley-Liss. Inc.
- ItemSomente MetadadadosOzonated mineral oil: preparation, characterization and evaluation of the microbicidal activity(Korean Acad Asthma Allergy & Clinical Immunology, 2016) Iorio, Fernanda B. R. D. [UNIFESP]; Liberatore, Ana M. A. [UNIFESP]; Koh, Ivan H. J.; Otani, Choyu; Camilo, Fernanda F. [UNIFESP]The ozonation of vegetable oils has been studied, since the produced ointments have antibacterial and fungicidal activities. However, the ozonation of mineral oils has not been reported in the literature yet, opening an interesting field for examination. In this work, we have shown the ozonation of a commercial mineral oil (Nujol). The main goal was to produce oils containing free ozone, so that this gas could act as antimicrobial agent. It was found that in Nujol, ozone remains for at least 40days and in the sample ozonized for 15h its concentration was 7.5mgmL(-1). Neat Nujol showed no antimicrobial activity against the tested microorganisms, however, when ozonated it showed antimicrobial activity against Enterococcus faecalis, Staphylococcus aureus and Escherichia coli.
- ItemSomente MetadadadosRisk factors for recurrent wheezing - international study of wheezing in infants (eisl) phase 3(Elsevier doyma sl, 2016) Aranda, Carolina Sanchez [UNIFESP]; Wandalsen, Gustavo Falbo [UNIFESP]; Fonzar, Ligia Furtado [UNIFESP]; Dela Bianca, Ana Caroline Cavalcanti; Mallol, Javier; Solé, Dirceu [UNIFESP]Background: We aimed to identify factors associated with recurrent wheezing (RW) in infants in the first year of life living in the Southern region of Sao Paulo city and participating in the "Estudio Internacional de Sibilancias en Lactantes (EISL)" - phase 3 (P3). Methods: 1335 parents of infants who were attended in primary care health units in the Southern region of Sao Paulo city from 2009 to 2010 answered the EISL-P3 written questionnaire. The wheezing group was stratified in accordance to the frequency of wheezing episodes as occasional wheezing (OW, less than three episodes), or RW (three or more episodes). Wheezing-associated factors were evaluated using multivariate analysis and were expressed as odds ratio (OR) and 95% confidence interval (95%CI). Results: The most relevant factors related to OW were pneumonia (OR = 3.10, 95%CI=1.68-5.73), hospitalisation due to pneumonia (OR = 2.88, 95%CI = 1.26-6.56) and recurrent upper respiratory infection (URI, OR = 1.87, 95%CI = 1.25-2.81). Regarding RW, recurrent URI (OR = 5.34, 95%CI = 3.83-7.45), pneumonia (OR= 4.06, 95%CI = 2.87-5.74) and asthmatic siblings (OR= 3.02, 95%CI = 1.67-5.45) were the most significantly associated factors. Conclusions: In the present study, we found that recurrent URI, positive history of pneumonia and familiar history of asthma were the most relevant factors associated with RW. The precocious knowledge of these factors can enable the identification of the probable asthmatic infants and can improve both prevention strategies and treatment of these patients. (C) 2014 SEICAP. Published by Elsevier Espana, S.L.U. All rights reserved.
- ItemAcesso aberto (Open Access)Significado clínico do sinal de "sludge" do líquido amniótico no parto pré-termo(Universidade Federal de São Paulo (UNIFESP), 2017-05-30) Hatanaka, Alan Roberto [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]; Mattar, Rosiane [UNIFESP]; http://lattes.cnpq.br/1993353561775961; http://lattes.cnpq.br/0197731060424158; http://lattes.cnpq.br/3509453567791268; Universidade Federal de São Paulo (UNIFESP)Objective: To determine the incidence and the clinical significance of amniotic fluid ‘sludge’. Study Design: A retrospective and prospective study was conducted between October 2010 and January 2015 in 395 pregnant women between 16 and 26 weeks. Of these, 49 patients were excluded. In 26 women it was not possible to obtain the perinatal results, in 18 the gestation was terminated before 37 weeks by medical indication, in 4 patients the fetuses were diagnosed with malformation and one pregnancy resulted in spontaneous late abortion at 18 weeks and 4 days. In all patients, transvaginal ultrasonography was performed for morphological assessment of the cervix according to the routine of the institution. The perinatal results were obtained in 346 pregnant women and were compared with the presence of amniotic fluid ‘sludge’, cervical length < 25mm and high risk for spontaneous preterm delivery. Results: Amniotic fluid ‘sludge’ affected 24.9% (86/346) of the pregnancies. A preliminary analysis was performed considering patients who were attended between October 2010 and October 2012, in a total of 130 pregnant women, of whom 22 presented amniotic fluid ‘sludge’. Pregnant women with ‘sludge’ had a higher risk of spontaneous birth before 35, 34, 32 and 28 weeks and the logistic regression analysis demonstrated that ‘sludge’ is an independent risk factor for spontaneous birth before 35 weeks with an odds ratio of 4,950 (95% CI, 1,110 - 22,222), 34 weeks with an odds ratio of 11,905 (95% CI, 1,634 - 9,091) and 32 weeks with an odds ratio fof 10,000 (95% CI, 1,130 - 90,909). After these results, the Department of Obstetrics of Federal University of São Paulo decided to institute antibiotic therapy for patients with "sludge". Considering all patients included, having used antibiotics or not, the presence of ‘sludge’ continued to increase the number of spontaneous preterm births before 35 weeks (14.0% (14/86) vs 5.8% (15/260), p = 0.014) (9/8), before 34 weeks (12.8% (11/86) vs 3.8% (10/260), p = 0.03) and before 32 weeks (9.3% (8/86) vs 3.5% (9/260), p = 0.029). Logistic regression analysis still demonstrated that the amniotic fluid "sludge" is an independent risk factor for spontaneous birth below 34 Abstract xviii weeks with an odds ratio of 2,611 (95% CI, 1,018 to 6,711). An historical cohort was performed comparing patients with sludge who did not use antibiotics (n = 22) and those who used (n = 64). In patients with amniotic fluid "sludge" who had a concomitant cervical length < 25mm or a history of high risk for spontaneous preterm delivery, the use of antibiotics reduced the chance of preterm birth before 34 weeks with an odds ratio of 0.242 (CI 95%, 0.058 to 0.998). Conclusion: Amniotic fluid "sludge" is an independent risk factor for spontaneous preterm delivery before 35, 34 and 32 weeks. After antibiotic therapy, it remains an independent risk factor for spontaneous birth before 34 weeks. In patients with a "sludge" signal associated with neck length <25mm or high risk for preterm labor, the use of antibiotics reduces the chance of spontaneous birth before 34 weeks.