Repositório Institucional - Unifesp :: Navegando por Palavras-chave "Schistosomiasis"

Navegando por Palavras-chave "Schistosomiasis"

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Análise do índice esplênico como preditor de sangramento e recidiva varicosa no seguimento tardio de pacientes esquistossomóticos após tratamento endoscópico exclusivo
(Universidade Federal de São Paulo (UNIFESP), 2019-09-26) Borgheresi, Alexandre [UNIFESP]; Colleoni Neto, Ramiro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Introduction: Endoscopic treatment for esophageal varices has been used as the main intervention in patients with portal hypertension secondary to schistosomiasis, but with significant rates of recurrence of esophageal varices and rebleeding. The long-term results of exclusive endoscopic treatment are poorly studied as the relationship of the splenic dimensions in this context. Objective: To identify, through ultrasonography, cut-off values for splenic index and longitudinal (craniocaudal) dimension of the spleen as predictors of rebleeding and varicose recurrence in late follow up of nonoperated schistosomiasis patients, after endoscopic eradication of esophageal varices. Methodology: Retrospective observational study by analysis of medical records of patients diagnosed with hepatosplenic schistosomiasis. The ROC Curve was used to determine the best cutoff point for the mean splenic index as predictor of recurrence and bleeding. Statistical analysis was performed in the SAS 9.1 program, and a significance level of 5% was adopted. Results: A follow-up of 54 patients was analyzed during the period from 2002 to 2018. Mean follow-up time was 8 years regarding abdomen doppler ultrasonography, endoscopic exams and laboratory tests. The splenic index proved to be a sensitive test in values above 144 as a predictor of rebleeding. (VP-85%, AUC = 0.70, p = 0.044). In the analysis of the longitudinal dimension, the value above 20 cm showed a very specific and statistically significant test for recurrence of varices (VP + of 100%, AUC 0.71, p = 0.047) and a value above 19 cm presented as a very sensitive and statistically significant test for rebleeding (VP-100%, AUC 0.76, p = 0.008). Conclusion: Splenic index and craniocaudal dimension analysis, obtained by ultrasonography exam, can predict recurrence of varicose veins and rebleeding after exclusive endoscopic eradication, contributing to the therapeutic planning of schistosomiasis patients with portal hypertension.
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Anicteric cholangiopathy in schistosomiasis patients
(Elsevier B.V., 2008-11-01) Brant, Paulo Eugenio [UNIFESP]; Aguiar, Luciane Aparecida Köpke de [UNIFESP]; Shigueoka, David Carlos [UNIFESP]; Sales, Danilo [UNIFESP]; D'Ippolito, Giuseppe [UNIFESP]; Kouyoumdjian, Maria [UNIFESP]; Borges, Durval R. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
We previously reported that in anicteric patients with the isolated form of schistosomiasis (without comorbidities) an ursodeoxycholic acid-sensitive increase in serum gamma-glutamyltransferase activity (gamma GT) occurs. We now describe the presence of cholangiopathy in these patients.Methods: Sixteen adult anicteric patients with the isolated form of schistosomiasis mansoni were carefully selected: nine with increased gamma GT and seven with normal gamma GT. High sensitive C-reactive protein (CRP), to exclude inflammatory status, hyaluronic acid (HA), and other laboratory parameters were determined. the ultrasonographic study measured spleen length, portal vein and splenic vein diameters, and the portal flow. Magnetic resonance cholangiopancreatography (MRCP) images were interpreted by a blind observer. MRCP was deemed abnormal when focal narrowing and/or paucity of second and third order biliary branches and/or irregularities in the contours of biliary pathways were identified.Results: Both groups (normal and elevated gamma GT) have preserved hepatic function tests (HA, serum albumin, prothrombin time) and clinical significant portal hypertension (low platelet count and ultrasonographic parameters). MRCP was abnormal in all patients with elevated gamma GT but in only 3 of the 7 patients with normal gamma GT (p = 0.003).Conclusion: Magnetic resonance cholangiopancreatography characterized a cholangiopatic disorder in anicteric patients with the isolated form of schistosomiasis, even preceding laboratory test alterations. (c) 2008 Elsevier B.V. All rights reserved.
Acesso aberto (Open Access)
Avaliação da capacidade anti-helmíntica in vitro e in vivo do deidrodieugenol B isolado de Nectandra leucantha (Lauraceae)
(Universidade Federal de São Paulo, 2023-05-02) Rocha, Vinicius Cavalcante [UNIFESP]; Lago, João Henrique Ghilardi [UNIFESP]; http://lattes.cnpq.br/2325513222088331; http://lattes.cnpq.br/1979673028442503
A Esquistossomose é uma doença negligenciada que afeta mais 200 milhões de pessoas em todo o mundo. Sendo o praziquantel o único fármaco disponível para tratamento desta doença, faz-se necessária a busca por novas entidades bioativas. Considerando a ampla biodiversidade brasileira, o presente estudo teve como objetivo avaliar a atividade anti-helmíntica do extrato hexânico das folhas de Nectandra leucantha, o qual apresentou 100% de morte do parasito a 300 μg/mL. Em vista disso, foi realizado um estudo químico totalmente biomonitorado que permitiu o isolamento da neolignana deidrodieugenol B, cuja identificação estrutural foi realizada via analise dos espectros de RMN e de massas. Posteriormente, foi avaliada a atividade anti-S. mansoni in vitro do deidrodieugenol B cujo valor de CE50 foi determinado como 31,9 μM, com reduzida toxicidade para células do tipo Vero (CC50 > 100 μM). Visando observar a ação do grupo fenólico, foi realizado a metilação do deidrodieugenol B cujo produto se mostrou totalmente inativo no modelo in vitro (CE50 > 50 μM). Sequencialmente, foi avaliada a eficácia do deidrodieugenol B em modelo murino (ensaio in vivo) sendo a análise de eficácia terapêutica baseada na carga parasitária e produção de ovos nas fezes e no tecido do intestino do animal tratado. Como resultado, animais albergando vermes adultos foi detectada redução de vermes de 29,27 %, a redução de ovos nas fezes foi de 35,36 % (método Kato-Katz) enquanto que a redução de ovos imaturos foi de 25,23 %, por meio da avaliação por oograma (análise morfológica por microscopia). Animais albergando vermes na fase juvenil, a redução da carga parasitária (RCP), da carga de ovos (RCO) nas fezes e nos tecidos foram mais significativas, apesentando valores de 48,20, 48,81 e 49,38 %, respectivamente. Assim os resultados obtidos podem ser considerados promissores no que tange a ação anti-helmíntica do deidrodieugenol B, em especial pela destacada ação in vivo, e podem contribuir para o desenvolvimento de novos protótipos moleculares para o avanço na produção de drogas para o tratamento da esquistossomose.
Acesso aberto (Open Access)
Avaliação da concordância entre ressonância magnética de ultra-sonografia na classificação de fibrose periportal em esquitossomóticos, segundo a classificação de Niamey
(Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2007-10-01) Scortegagna Junior, Eduardo [UNIFESP]; Leão, Alberto Ribeiro de Souza [UNIFESP]; Santos, José Eduardo Mourão [UNIFESP]; Sales, Danilo Moulin [UNIFESP]; Shigueoka, David Carlos [UNIFESP]; Aguiar, Luciane Aparecida Kopke de [UNIFESP]; Brant, Paulo Eugênio [UNIFESP]; Colleoni Neto, Ramiro [UNIFESP]; Borges, Durval Rosa [UNIFESP]; D'Ippolito, Giuseppe [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE: To evaluate the reproducibility of magnetic resonance imaging and the agreement between ultrasound and magnetic resonance imaging in the classification of periportal fibrosis in patients with schistosomiasis based on Niamey's qualitative criteria. MATERIALS AND METHODS: A prospective, double-blinded study was conducted between February 2005 and June 2006 with 20 patients (10 men and 10 women, with ages ranging between 24 and 60 years, mean age 42.7 years) diagnosed with schistosomiasis mansoni. Both ultrasound and magnetic resonance images were independently evaluated by two experienced observers. Interobserver agreement was evaluated for findings of periportal fibrosis on magnetic resonance images and in a comparison between magnetic resonance and ultrasound images. RESULTS: The analysis of magnetic resonance images showed total interobserver agreement in 14 patients (70%). The comparison between ultrasound and magnetic resonance imaging showed agreement between images in only six cases (30%) by observer 1, and in eight cases (40%) by observer 2. CONCLUSION: Magnetic resonance imaging presents a good reproducibility in the evaluation of periportal fibrosis in later stages of schistosomiasis, however, the correlation between magnetic resonance imaging and ultrasound is poor.
Acesso aberto (Open Access)
Avaliação da Fibrose Hepática por Elastografia nos pacientes portadores de Esquistossomose Mansônica
(Universidade Federal de São Paulo (UNIFESP), 2019-06-11) Lima, Leila Maria Soares Tojal De Barros [UNIFESP]; Parise, Edison Roberto [UNIFESP]; Lacet, Celina Maria Costa [UNIFESP]; http://lattes.cnpq.br/2511547113985954; http://lattes.cnpq.br/8624120197731317; Universidade Federal de São Paulo (UNIFESP)
Introduction: Schistosomiasis persists as an important public health problem. Its main pathogenic event is hepatic fibrosis, associated with disease progression and its prognosis. The applicability of hepatic elastography in the evaluation of schistosomal fibrosis remains undefined. Objectives: To correlate the degree of fibrosis obtained by transient liver elastography (TE) with sonographic graduation and clinical forms of patients with schistosomiasis mansoni (SM). Methods: A cross sectional study with prospective inclusion of patients with SM, in all its forms, coming from the hepatology outpatient clinic of the University Hospital of the Federal University of Alagoas and from active search in Alagoas municipalities with high endemicity. Clinical and laboratory characteristics (clinical form, AST dosage, ALT, gammaGT, alkaline phosphatase and platelet count) were evaluated. The patients were classified according to the degree of hepatic fibrosis of the Niamey sonographic protocol, adopted by the World Health Organization, gold standard in this study. The TE, performed with FIBROSCAN ECHOSENS 502 device, was correlated with sonographic findings and its performance was calculated as area under the ROC curve (AUC). Results: A total of 117 patients with schistosomiasis mansoni, 55.6% female and 44.4% male, with mean age of 47 + 15 years were studied, 37 patients with intestinal forms, 12 with hepatointestinal form and 68 with compensated hepatosplenic form. Applying the Niamey sonographic protocol, the patients were regrouped for a better statistical analysis in absent fibrosis (A) 34.2%, mild to moderate fibrosis (MM) 27.4% and intense fibrosis (I) 38.5% of the sample. The median value of TE in the entire study population was 8.0 kPa; in the hepatointestinal form 4.4 kPa, in the hepatointestinal form 5.8 kPa and in the hepatosplenic form 10.6 kPa, with statistical differentiation between the clinical forms (p<0.01). In the correlation between TE and ultrasonography (US), patients in group A presented a median of 4.7 kPa; group MM 9.3 kPa and group I 10.3 kPa. There was a significant difference in TE values between groups A and MM and between groups A and I (p <0.05). TE was not able to differentiate patients from the MM and I groups. In the bivariate analysis between the markers of fibrosis and the clinical and laboratory characteristics, the TE and the sonographic classification of Niamey showed a strong and direct correlation with the clinical form (r>=0.77) and moderate and direct with the levels of AST and GGT (0.45<=r<=0.56). The cut-off point of TE to define the presence of fibrosis according to the sonographic classification that presented the best sensitivity and specificity ratio was 6.1 kPa (AUC 0.92) and for advanced fibrosis 8.9 kPa (AUC 0.791). Conclusions: The TE had a direct correlation with the sonographic classification of Niamey and was able to differentiate the clinical forms of SM. Based on the AUC value, TE has proven to be effective in detecting the presence of schistosomiasis fibrosis and may assist in the identification of advanced forms of liver disease caused by Schistosoma mansoni.
Acesso aberto (Open Access)
Características clínicas dos pacientes com hipertensão pulmonar em dois centros de referência em São Paulo
(Associação Médica Brasileira, 2006-06-01) Lapa, Monica Silveira; Ferreira, Eloara Vieira Machado [UNIFESP]; Jardim, Carlos; Martins, Barbara do Carmo dos Santos; Ota-Arakaki, Jaquelina Sonoe [UNIFESP]; Souza, Rogerio; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
OBJECTIVES: Describe the clinical profile of PH patients from two pulmonary hypertension centers. METHODS: Retrospective chart analysis. RESULTS: One hundred and twenty three PH patients were included in the study; 62% of these presented functional class III or IV (NYHA). Mean right ventricle systolic pressure (RVSP) was 83.48±24.61 mmHg. There was no correlation between functional class and RVSP. About 50% of the patients were diagnosed as IPAH; 30% as pulmonary hypertension associated to schistosomiasis; 10% as PH associated to connective tissue diseases. Mean time of dyspnea until diagnosis was variable with no correlation with functional class (p>0.05). No difference was found in the clinical presentation in spite of the diverse etiologies. CONCLUSION: Based upon our findings, we stressed the need for an active investigation of PH patients prior to administration of any therapeutic alternative. We emphasized that a better understanding of PH related to schistosomiasis is needed due to the high prevalence of this condition among PH patients as shown in the Brazilian population.
Somente Metadadados
Detecção De Varizes Gástricas E De Trombose De Veia Porta Em Doentes Portadores De Esquistossomose Hepatoesplênica Após Tratamento Endoscópico Com Erradicação De Varizes Esofágicas
(Universidade Federal de São Paulo (UNIFESP), 2017-05-25) Aniche, Marcelo Finavaro [UNIFESP]; Colleoni Neto, Ramiro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
an expressive problem of public health. The main impact of this disease on health occurs in patients with hepatosplenic form, high morbidity and mortality. Currently in the literature, there is a lack of data on long-term follow-up of these patients, especially those submitted to exclusive endoscopic treatment with eradication of esophageal varices. Objective: To evaluate the incidence of variceal vein thrombosis and gastric varices as well as the association between these events. Methods: We evaluated 50 patients diagnosed with schistosomiasis in the hepatosplenic form who underwent to endoscopic treatment with eradication of esophageal varices. Patients followed in our clinic from April 1, 1983 to December 31, 2016. Inclusion criterion was a minimum follow-up period of 24 months after eradication of esophageal varices, endoscopic and ultrasonographic abdominal Doppler examinations; Patients with liver disease and/or cirrhosis of another etiology were excluded. Results: We identified gender equality with mean age of 52 years and outpatient follow-up averaged 181 months. Regarding gastric varices, eight patients had primary gastric varices and 18 developed secondary ones after the eradication. The mean time of onset of gastric varices after eradication was 103 months. When analyzing ultrasonography, we observed that three patients had portal vein thrombosis and during follow-up was detected in 23 patients, the mean time of thrombus onset after esophageal variceal eradication was 69 months. We observed that portal vein thrombosis generated was 5.25 times more likely to present gastric varices compared to those without thrombosis (CI [1.4, 21.9], Fisher's Exact Test = 0.01). The mortality rate was 10%, with three deaths due to to high varicose digestive hemorrhage. Conclusion: We consider that the follow-up of the patients should be long-lasting, since the formation of portal vein thrombosis was approximately five years on average, and the average onset of gastric variceswas eight years; In addition, we conclude that the appearance of gastric varices is intimately related to portal thrombosis, and these events should be evaluated in the follow-up and treatment of the disease, given its high frequencies and may be associated with morbidity an mortality.
Acesso aberto (Open Access)
Diagnóstico diferencial das lesões inflamatórias e infecciosas do cone medular utilizando a ressonância magnética
(Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2013-02-01) Carvalho, Gustavo Balthazar Da Silveira [UNIFESP]; Sandim, Gabriel Barbosa [UNIFESP]; Tibana, Luis Antônio Tobaru [UNIFESP]; Tertulino, Franklin Freitas [UNIFESP]; Idagawa, Marcos Hideki [UNIFESP]; Abdala, Nitamar [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
The conus medullaris is frequently affected by inflammatory and infectious lesions which many times are hardly differentiated because of the similarity of their clinical history and physical examination among the different etiologies. Magnetic resonance imaging presents high sensitivity in the detection of these lesions and plays a relevant role in the diagnosis as well as in the evolutive control of the condition. The present pictorial essay with selected cases from the archives of the authors' institution is aimed at demonstrating imaging findings which might help in the diagnosis of a specific etiology amongst inflammatory an infectious conditions and in the differentiation with diseases of neoplastic and vascular etiologies, for example. Findings such as enhancement pattern, presence of cysts, edema and involvement of other regions of the central nervous system are important for this differentiation, and may define a specific etiology as associated with clinical and laboratory tests findings.
Acesso aberto (Open Access)
Estudo da circulação hepatomesentérica pela angiografia por ressonância magnética com gadolínio: comparação entre doses simples e dupla no estudo de pacientes esquistossomóticos
(Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2006-08-01) Caldana, Rogério Pedreschi [UNIFESP]; Bezerra, Alexandre Sérgio de Araújo [UNIFESP]; D'Ippolito, Giuseppe [UNIFESP]; Szejnfeld, Jacob [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE: To evaluate the visibility of hepatomesenteric vascular segments by 3D gadolinium-enhanced magnetic resonance (MR) angiography and to compare the method effectiveness between two different gadolinium doses (single and double doses). MATERIALS AND METHODS: A prospective study was performed with 36 schistosomiasis patients who were submitted to 3D contrast-enhanced MR angiography. Scans were performed in a high-field equipment (1.5 T), with body coil and power injector for intravenous contrast administration. Contrast double doses (Gd-DTPA 0.2 mmol/kg) and single doses (0.1 mmol/kg) were randomly used respectively in 21 and 15 patients. Studies were interpreted by consensus between two observers who have rated the visualization degree of 25 proximal vascular segments without knowing the dose used. RESULTS: Proximal and calibrous vascular segments have presented higher visualization degree in the greatest part of the sample studied. The celiac trunk, common hepatic artery, splenic artery, proximal and medium third of superior mesenteric artery, portal vein, splenic vein and superior mesenteric vein have presented grade 2 visualization in more than 70% of the sample studied. As regards comparison between different doses, there was no significant difference (p < 0.05) in the visualization degree of several structures evaluated, between double dose and single dose groups, except for an isolate case of evaluation of right hepatic artery (p = 0.008) in which the single dose group has presented a higher frequency of grade 2 visualization with statistical significance. CONCLUSION: The visualization degree of hepatomesenteric vascular segments by 3D gadolinium-enhanced MR angiography is high, especially in the proximal and calibrous segments. The comparison between groups using single and double contrast doses has demonstrated similar results.
Acesso aberto (Open Access)
Hepatitis E virus seroprevalence among schistosomiasis patients in Northeastern Brazil
(Elsevier Brazil, 2016) Passos-Castilho, Ana Maria [UNIFESP]; Sena, Anne de [UNIFESP]; Domingues, Ana Lucia Coutinho; Lopes-Neto, Edmundo Pessoa; Medeiros, Tiberio Batista; Granato, Celso Francisco Hernandez [UNIFESP]; Ferraz, Maria Lucia [UNIFESP]
Background: Hepatitis E virus (HEV) can cause chronic infection with rapid progression to liver cirrhosis in immunocompromised patients. HEV seroprevalence in patients with Schistosoma mansoni in Brazil is unknown. We evaluated the prevalence of past or present HEV infection in schistosomiasis patients in Recife, Pernambuco, Brazil. A total of 80 patients with Schistosoma mansoni were consecutively enrolled in a cross-sectional study. Serum samples were tested for the presence of anti-HEV IgG antibodies by enzyme immunoassay (Wan tai anti-HEV IgG, Beijing, China) and for the presence of HEV RNA using real time reverse transcriptase-polymerase chain reaction with primers targeting the HEV ORF2 and ORF3. Clinical and laboratory tests as well as abdominal ultrasound were performed at the same day of blood collection. Results: Anti-HEV IgG was positive in 18.8% (15/80) of patients with SM. None of the samples tested positive for anti-HEV IgM or HEV-RNA. Patients with anti-HEV IgG positive presented higher levels of alanine aminotranferase (p = 0.048) and gama-glutamil transferase (p = 0.022) when compared to patients without anti-HEV IgG antibodies. Conclusion: This study demonstrates that the seroprevalence of HEV is high in patients with Schistosoma mansoni in Northeastern of Brazil. Past HEV infection is associated with higher frequency of liver enzymes abnormalities. HEV infection and its role on the severity of liver disease should be further investigated among patients with Schistosoma mansoni. (C) 2016 Elsevier Editora Ltda.
Acesso aberto (Open Access)
Hypoprothrombinemia in the compensated form of hepatosplenic schistosomiasis: further studies
(Instituto de Medicina Tropical, 1988-08-01) Forones, Nora Manoukian [UNIFESP]; Borges, Durval Rosa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Coagulation abnormality is frequently observed in schistosomiasis patients but its pathophysiology has not been established. We measured, by immunodiffusion. the prothrombin-antigen concentration in 56 individuals; of these 19 with demonstrated compensated form of hepatosplenic schistosomiasis, 17 with cirrhosis and 20 were control subjects. Transaminases, albumin, transthyretin, prothrombin time, antithrombin III, factor VII, and fibrinogen were also evaluated. All parameters were altered in the cirrhotic group but only albumin, prothrombin and antithrombin III levels were altered in the schistosomiasis group. Ninety percent of the patients with cirrhosis and sixty percent of the patients with schistosomiasis had abnormal plasma levels of albumin, transthyretin, prothrombin-antigen, and/or antithrombin III; an impaired hepatic synthesis was responsible for these results. Conversely forty percent of the schistosomiasis patients with normal plasma concentrations of both albumin and transthyretin had decreased mean plasma levels of both prothrombin and antithrombin III. These results suggest that either proth rombin and antithrombin III are more sensitive markers of impaired hepatic synthesis in schistosomiasis than are levels of albumin and transthyretin combined, or a low grade chronic consumption of clotting proteins also occurs. Considering the latter hypothesis it is possible that the thrombin formed would be inhibited by antithrombin III with the complexed thrombin-antithrombin III being cleared by the liver. Consequently the plasma levels of both prothrombin and antithrombin would be decreased, but the level of fibrinogen would be preserved.
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Inverse association between skin response to aeroallergens and Schistosoma mansoni infection
(Karger, 2000-10-01) Araujo, M. I.; Lopes, A. A.; Medeiros, M.; Cruz, A. A.; Sousa-Atta, L.; Sole, Dirceu [UNIFESP]; Carvalho, E. M.; Universidade Federal da Bahia (UFBA); Universidade Federal de São Paulo (UNIFESP)
Background: Helminthic infections and allergic disease are highly prevalent in many areas of the world. It is known that IgE antibodies are involved in the pathogenesis of both helminthiasis and atopy. However, the consequences of the presence of helminthic infections in atopic patients are still not completely understood. Methods: Subjects infected by Schistosoma mansoni with more than 200 eggs/g of feces (n = 42) and uninfected subjects (n = 133) were selected from an endemic area of schistosomiasis. the history of allergy and results of the immediate hypersensitivity prick tests with inhalant allergen extracts were registered. Total IgE and IgE specific to S. mansoni and aeroallergens were measured in serum by ELISA. Results: the proportion of individuals with a positive skin test to allergens was higher in the uninfected group (24.3%) than in the group with more than 200 eggs/g of feces (4.8%). the odds of atopy (defined as a positive test for at least one of the antigens) were 5 times higher (odds ratio = 7.0; 95% confidence interval = 1.6-31.1%; p = 0.01) in the un infected group, after taking into account the potential influence of gender and age. While there was a tendency for higher total and S. mansoni-specific IgE levels in infected patients, an opposite trend, that is higher aeroallergen-specific IgE, was observed in uninfected subjects. Conclusions: There was a strong and statistically significant inverse association between the immediate skin test response to common aeroallergens and infection by S. mansoni. the results indicate that immediate hypersensitivity reactions may be suppressed in S. mansoni-infected individuals. Copyright (C) 2000 S. Karger AG,Basel.
Acesso aberto (Open Access)
Large intestine obstruction complicated with perforation: a rare manifestation of Schistosoma mansoni infection
(Associação Paulista de Medicina - APM, 1998-07-01) Atik, Fernando Antibas [UNIFESP]; Lopes Filho, Gaspar de Jesus [UNIFESP]; Linhares, Marcelo Moura [UNIFESP]; Seda Neto, João [UNIFESP]; Mansur, Nacime Salomão [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
The authors report a case of a 25 year old Brazilian man with a history of crampy abdominal pain in the left iliac fossa for 2 weeks, abdominal distention, mucous diarrhea and anorexia. The patient presented signs of hemodynamic instability and a hard mass palpated in the left iliac fossa presented peritoneal irritation. At laparotomy, fecal peritonitis and a punched-out perforation of the midsigmoid colon were found. A left hemicolectomy was performed with terminal colostomy. Specimen examination revealed a thickened rectosigmoid wall, narrow lumen and multiple mucosal polyps. Microscopically, chronic granulomatous colitis with Schistosoma mansoni eggs confirmed the etiology. To the authors' knowledge, this is the first case of obstruction complicated with perforation due to mansoni schistosomiasis reported in the literature.
Embargo
Planejamento racional e síntese de híbridos de hidrazonas na busca de compostos ativos contra helmintíases e viroses
(Universidade Federal de São Paulo, 2023-12-01) Pavani, Thaís Fernanda Amorim [UNIFESP]; Rando, Daniela Gonçales Galasse [UNIFESP]; Moraes, Carolina Borsoi; http://lattes.cnpq.br/2856012942943418; http://lattes.cnpq.br/0444555512774012; http://lattes.cnpq.br/4535861349516350
Neste projeto, foram exploradas duas abordagens para encontrar novos compostos no combate a verminoses e viroses. No caso das verminoses, o foco é a esquistossomose, uma doença que afeta milhões de pessoas globalmente, a pesquisa buscou alternativas ao praziquantel, o único medicamento disponível, a fim de evitar resistência. Para as viroses, com destaque para o SARS-CoV-2, causador da COVID-19, o objetivo foi encontrar compostos eficazes no tratamento da doença, uma vez que ainda não existe um fármaco específico para este fim. Frente ao exposto, este trabalho tem por finalidade explorar uma série de N-acilidrazonas derivadas de tiossemicarbazidas e vinilsulfonas previamente reportadas na literatura como potenciais agentes esquistossomicidas, e uma série de hidrazonas e hidrazidas derivadas de quinolinas, para serem testadas contra vermes adultos de S. mansoni in vitro e in vivo e para triagem experimental por High Content Screening (HCS) contra SARS-CoV-2. Foram sintetizados 50 compostos sendo 16 derivados N-acilidrazônicos, 27 hidrazonas derivadas da 7-cloroquinolina e sete hidrazidas também derivadas da 7-cloroquinolina. Nove das Nacilidrazonas foram testadas contra S. mansoni in vitro, destas, apenas o GPQF-817 apresentou atividade e, a partir desse resultado, novas alterações estruturais foram realizadas visando a melhoria da atividade esquistossomicida. 26 quinolinas também foram testadas contra S. mansoni in vitro, cinco apresentaram atividade, sendo o composto GPQF-8Q10 o mais ativo, levando a morte de 100 % dos vermes em 24h a 25 μM. O GPQF-8Q8 se mostrou o composto mais promissor nos ensaios in vivo, levando a redução dos ovos encontrados nas fezes em 52,8% e nos ovos encontrados no intestino em 45,8%. Os derivados quinolínicos exibiram baixa citotoxicidade em células Vero e no ensaio in vivo empregando modelo animal C. elegans, indicando um índice de seletividade favorável. Os compostos foram ainda submetidos a ensaios contra SARS-CoV-2 e o vírus da Chikungunya, todavia, tanto os derivados N-acilidrazônicos quanto os derivados quinolínicos não apresentaram atividade significativa. Os resultados sugerem, ao menos para os compostos híbridos de quinolinas e hidrazonas, um potencial para o desenvolvimento de novos candidatos para o tratamento da esquistossomose. Outros estudos ainda são necessários para elucidar o alvo específico de atuação desses compostos, no entanto, os achados neste trabalho oferecem um ponto de partida.
Acesso aberto (Open Access)
Programa educativo em esquistossomose: modelo de abordagem metodológica
(Faculdade de Saúde Pública da Universidade de São Paulo, 2004-06-01) Ribeiro, Patrícia de Jesus [UNIFESP]; Aguiar, Luciane Aparecida Köpke de [UNIFESP]; Toledo, Carlos Fischer de [UNIFESP]; Barros, Sonia Maria Oliveira de [UNIFESP]; Borges, Durval Rosa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE: Lack of knowledge is one of the factors responsible for the persistence of infectious diseases in Brazil. This study had the objective of developing, implementing and evaluating a low-cost educational program using schistosomiasis patients as a model. METHODS: This was a descriptive study developed using a population of healthy people (group 1) and schistosomiasis patients (groups 2 and 3), with 20 individuals in each group. Teaching material (illustrated manual and album of leaflets) and a questionnaire consisting of 17 questions to evaluate the groups' knowledge were devised. The questionnaire was applied to groups 1 and 2 before and to group 3 after the educational program. The variables studied were the educational program, level of schooling, age, clinical form of schistosomiasis, symptoms, and the subject's performance when answering the questionnaire. For the statistical analysis, Fisher's exact test and variance analysis with one fixed factor were utilized. RESULTS: The educational program was evaluated in the form of four topics: cycle, clinical presentation, treatment and prevention of the disease. The median number of correct responses to the questionnaire was higher for group 3 than for groups 1 and 2, for all the topics dealt with. This median was also higher for group 2 than for group 1, for all topics except for the item prevention. CONCLUSIONS: The educational process applied was efficient and improved the knowledge of the disease. It may provide an effective low-cost methodological model that can also be applied to combating other endemic diseases.
Acesso aberto (Open Access)
Reação de imunofluorescência indireta e reação imunoenzimática no diagnóstico da neuroesquistossomose mansônica
(Universidade Federal de São Paulo (UNIFESP), 1998-09-30) Matas, Sandro Luiz de Andrade [UNIFESP]; Reis Filho, João Baptista dos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
A neuroesquistossomose é uma das manifestações ectópicas da esquistossomose. Das cinco principais espécies que causam doença no homem, apenas a espécie Schistosoma mansoni está presente no Brasil. E uma estimativa atual da prevalência desta parasitose em nosso meio gira é de 9 a 10%. Portanto, a manifestação neurológica da esquistossomose, apesar de pouco comum, em nosso meio assume relevada importância principalmente por ser muito incapacitante e por atingir uma população jovem. Apesar destes argumentos, a neuroesquistossomose é geralmente diagnosticada tardiamente. O diagnóstico é feito por exclusão de outras doenças e por suposição, quando há esquistossomose associado a alteração neurológica característica que esta espécie determina. Estes procedimentos podem induzir erro além de retardar o diagnóstico, principalmente em regiões endêmicas. Portanto, este trabalho prospectivo visou determinar o valor das reações de imunofluorescência indireta e reação imunoenzimática no líquido cefalorraquiano para o diagnóstico da neuroesquistossomose. Após apreciação e aprovação do protocolo de investigação pela Comissão de Ética Médica do Hospital São Paulo / Universidade Federal de São Paulo, foram coletadas amostras de líquido cefalorraquiano de pacientes de 4 grupos distintos: Grupo I: pacientes com diagnóstico clínico de neuroesquistossomose, com protoparasitológico positivo para Schistosoma mansoni; líquido cefalorraquiano sem bloqueio do espaço subaracnoideo, mostrando processo inflamatório linfomonocitário predominante; excelente resposta clínica à terapêutica com praziquantel e decadron, com recuperação completa ou com discretas seqüelas. Grupo II: pacientes com esquistossomose mansônica diagnostica por exame protoparasitológico positivo para Schistosoma mansoni, sem queixa neurológica e com o exame neurológico normal. Grupo III: pacientes com neurocisticercose diagnosticada por reações imunobiológicas no líquido cefalorraquiano ou exame neurorradiológico compatível, sem esquistossomose. Grupo IV: pacientes do ambulatório geral da neurologia, com doenças neurológicas variadas, que realizaram exame de líquido cefalorraquiano como parte da investigação neurológica. Estes pacientes não apresentavam esquistossomose nem cisticercose, comprovados por reações imunobiológicas e por exames radiológicos. As amostras de LCR foram submetidas às reações de imunofluorescência indireta, usando conjugados anti-IgG e anti-IgM, frente a preparados parafinados e congelados de antígenos de verme adulto macho e ovos maduros viáveis de Schistosoma mansoni. As amostras também foram submetidas ao exame imunoenzimático, utilizando conjugado anti-IgG, em antígenos solúveis de vermes adultos de Schistosoma mansoni. A análise dos resultados mostrou que reação mais indicada para o diagnóstico da neuroesquistossomose é a reação de imunofluorescência em corte parafinado de verme adulto de Schistosoma mansoni, usando como conjugado fluoresceínico o anti-IgM humano porque, das reações com alta especificidade (90,8%), é a que tem maior valor preditivo positivo (88,2%). A reação de imunofluorescência indireta em corte parafinado não detecta anticorpos anti-Schistosoma mansoni no líquido cefalorraquiano de pacientes esquistossomóticos sem comprometimento neurológico. A reação de imunofluorescência indireta em cortes congelados de antígenos, com conjugado anti-imunoglobulina humana G, pode ser positiva em pacientes com esquistossomose sem neuroesquistossomose. Nas amostras de LCR de pacientes com neurocisticercose, ocorreram reações inespecíficas independentemente do antígeno utilizado, especialmente na reação imunoenzimática, que chegou a ter 1/3 das amostras positivas neste grupo.
Acesso aberto (Open Access)
Reprodutibilidade da classificação ultra-sonográfica de Niamey na avaliação da fibrose periportal na esquistossomose mansônica
(Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2007-12-01) Santos, Germana Titonelli [UNIFESP]; Sales, Danilo Moulin [UNIFESP]; Leão, Alberto Ribeiro de Souza [UNIFESP]; Santos, José Eduardo Mourão; Aguiar, Luciane Aparecida Kopke de [UNIFESP]; Brant, Paulo Eugênio [UNIFESP]; Shigueoka, David Carlos [UNIFESP]; Colleoni Neto, Ramiro [UNIFESP]; D'Ippolito, Giuseppe [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE: To determine the intra- and interobserver agreement in the classification of periportal fibrosis, according to the criteria defined at the Niamey Workshop of 1996. MATERIALS AND METHODS: A prospective, observational and transverse study was developed in the period between February, 2005 and March, 2006, in 30 schistosomal patients with no other hepatic findings associated, submitted to abdominal ultrasound. Ultrasonographic studies were independently performed and reviewed by two radiologists at three different moments: the dynamic examination itself (first moment), 30 and 90 days later (second and third moments), by means of the images review performed in a workstation. Intra- and interobserver agreement was evaluated by means of the kappa test. RESULTS: Intraobserver agreement was 0.43 for the first, and 0.57 for the second observer. Interobserver agreement as regards the dynamic examination and images review was respectively 0.46 and 0.71. CONCLUSION: Ultrasonography demonstrated moderate to substantial reproducibility in the classification of periportal fibrosis according to the Niamey criteria.
Acesso aberto (Open Access)
Sôbre os trabalhos da campanha de combate à esquistossomose no Estado de São Paulo, Brasil
(Faculdade de Saúde Pública da Universidade de São Paulo, 1971-12-01) Ramos, Alberto Da Silva [UNIFESP]; Piza, José De Toledo; Universidade Federal de São Paulo (UNIFESP); Campanha de Combate à Esquistossomose
The data about Schistosomiasis in the São Paulo State, Brazil, shows that the disease is now here at an expansive stage. To conclude by this, are the discorvery of new active foci in counties where it had been found before and its recrudescence very year producing new autochthonous case. The detection, at the beginning, of other active foci, it is very suggestive too. This was obtained by collecting naturally infected planorbids at places where no autochthonous cases was announced up to date. As a picture of the Schistosomiasis incidence in the State, some data are presented. From 1951 until 31st July 1970, 4499 autochthonous cases were recorded distributed at 30 counties. During the period were imported from other Brazilian places.
Acesso aberto (Open Access)
TRH-TSH test in patients with schistosomiasis chronic forms
(Instituto de Medicina Tropical, 1996-06-01) Traina, Évelyn [UNIFESP]; Camacho-Lobato, Luciana [UNIFESP]; Borges, Durval Rosa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Diversas alterações na concentração sérica dos hormônios tiroidianos têm sido descritas em associação a doenças crônicas não-tiroidianas. Com relação às doenças hepáticas crônicas, a síndrome do T3 baixo foi descrita em pacientes cirróticos, enquanto a síndrome do T4 elevado foi encontrada em esquistossomóticos com a forma hepatoesplênica compensada. Com o intuito de verificar se as alterações relatadas na esquistossomose mansônica eram de origem periférica ou central, realizamos a prova do TRH-TSH em 12 pacientes esquistossomóticos puros (6 hepatointestinais e 6 hepatoesplênicos compensados) e em 5 indivíduos controle. Os resultados obtidos demonstram que o eixo hipotálamo-hipofisário é normal nas formas crônicas da esquistossomose e que provavelmente as alterações previamente relatadas devem ser 'periféricas e nãocentrais.

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