1
|
Oliveira KCE, Neto JC, Aragon DC, Antonini SR. Nutritional status and age at menarche in amazonian students. J Pediatr (Rio J) 2024:S0021-7557(24)00026-3. [PMID: 38522477 DOI: 10.1016/j.jped.2024.03.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVES Age at menarche (MA) is a proxy for biological maturation and a parameter of socioeconomic changes. Worldwide, anticipation of menarche is associated with nutritional transition and excess weight. The objective of this study was to evaluate the MA in Amazonian students and its association with nutritional status, ethnicity, and socioeconomic level. METHODS Cross-sectional study with 1,017 students aged 6 to 17 living in the city of Manaus, Brazil. MA was analyzed by status quo and recall; its association with body mass index (BMI), race, socioeconomic status, and adult height was examined. RESULTS 559 (51.9%) participants had already experienced menarche. In 91.7%, menarche occurred between 10 and 14 years of age; the mean age at the onset of menarche was 11.9 years. Overweight (11.6 years) and obese (11.4 years) participants reached menarche earlier than those with normal weight (12 years) and lean (12.7 years) participants. The associations between MA and nutritional status showed that overweight and obesity are risk factors for the early occurrence of menarche. MA was not associated with socioeconomic status/parental education or race. However, excess weight was associated with earlier MA in all races and social classes. The adult height was slightly lower in girls with menarche before 12 years old (157.9 vs 159.4 cm). CONCLUSION Regardless of socioeconomic level or ethnicity, excess weight was associated with earlier menarche in Amazonian students.
Collapse
Affiliation(s)
- Kettyuscia Coelho E Oliveira
- Universidade do Estado do Amazonas (UEA), Departamento de Clínica Médica, Manaus, AM, Brazil; Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil.
| | - José Cardoso Neto
- Universidade Federal do Amazonas (UFAM), Departamento de Estatística, Manaus, AM, Brazil
| | - Davi C Aragon
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil
| | - Sonir R Antonini
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil
| |
Collapse
|
2
|
Miyake MM, Valera FCP, Martins RB, Compagnoni IM, Fantucci MZ, Murashima AAB, da Silva LECM, de Lima TM, de Souza MVO, Melo SR, Dolci RLL, Floriano CG, de Campos CAC, Nakanishi M, Freire GSM, Valente AL, Fornazieri MA, da Silva JLB, Anzolin LK, Issa MJA, Souza TV, Lima BA, SantAnna GD, Abreu CB, Sakano E, Cassettari AJ, Avelino MAG, Goncalves MC, de Camargo LA, Romano FR, Alves RD, Roithmann R, Redeker NK, Filho LLB, Dassi CS, Meurer ATO, Garcia DM, Aragon DC, Tepedino MS, Succar ACS, Vianna PM, Dos Santos MCJ, Filho RHR, Kosugi EM, Villa JF, Gregorio LL, Piltcher OB, Meotti CD, Tamashiro E, Arruda E, Anselmo Lima WT. Smell loss associated with SARS-CoV-2 is not clinically different from other viruses: a multicenter cohort study. Rhinology 2024; 62:55-62. [PMID: 37772802 DOI: 10.4193/rhin23.116] [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: 09/30/2023]
Abstract
BACKGROUND Although the COVID-19 pandemic has increased the prevalence of cases with olfactory loss, other respiratory viruses can also cause this condition. We aimed to compare the prevalence of acute SARS-CoV-2 infection and other respiratory viruses in patients with sudden smell loss, and to assess the impact of SARS-CoV-2 viral load and co-infection on olfactory symptoms. METHODS Patients with sudden smell loss were recruited in a multicenter prospective cohort study in 15 hospitals in Brazil. Clinical questionnaire, Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test and nasopharyngeal swab to perform a PCR-based respiratory viral panel were collected at first visit (day 0) and 30 and 60 days after recruitment. RESULTS 188 of 213 patients presented positive test result for SARS-CoV-2, among which 65 were co-infected with other respiratory viruses (e.g., rhinovirus, enterovirus, and parainfluenza). 25 had negative test results for SARS-CoV-2. Patients in both SARSCoV-2 and non-SARS-CoV-2 groups had objective anosmia (less than 2 points according to the psychophysical olfactory CCCRC) at day 0, with no significant difference between them. Both groups had significant smell scores improvement after 30 and 60 days, with no difference between them. Co-infection with other respiratory viruses, and SARS-CoV-2 viral load did not impact olfactory scores. CONCLUSION Patients with sudden smell loss associated with SARS-CoV-2 and other respiratory viruses had similar presentation, with most participants initiating with anosmia, and total or near total recovery after 60 days. SARS-CoV-2 viral load and co-infections with other respiratory viruses were not associated with poorer olfactory outcomes.
Collapse
Affiliation(s)
- M M Miyake
- Ribeiro Preto Medical School, University of Sao Paulo, Ribeiro Preto, SP, Brazil and Santa Casa de Sao Paulo School of Medical Sciences, Sao Paulo, SP, Brazil
| | - F C P Valera
- Ribeiro Preto Medical School, University of Sao Paulo, Ribeiro Preto, SP, Brazil
| | - R B Martins
- Ribeiro Preto Medical School, University of Sao Paulo, Ribeiro Preto, SP, Brazil
| | - I M Compagnoni
- Ribeiro Preto Medical School, University of Sao Paulo, Ribeiro Preto, SP, Brazil
| | - M Z Fantucci
- Ribeiro Preto Medical School, University of Sao Paulo, Ribeiro Preto, SP, Brazil
| | - A A B Murashima
- Ribeiro Preto Medical School, University of Sao Paulo, Ribeiro Preto, SP, Brazil
| | - L E C M da Silva
- Ribeiro Preto Medical School, University of Sao Paulo, Ribeiro Preto, SP, Brazil
| | - T M de Lima
- Ribeiro Preto Medical School, University of Sao Paulo, Ribeiro Preto, SP, Brazil
| | - M V O de Souza
- Ribeiro Preto Medical School, University of Sao Paulo, Ribeiro Preto, SP, Brazil
| | - S R Melo
- Ribeiro Preto Medical School, University of Sao Paulo, Ribeiro Preto, SP, Brazil
| | - R L L Dolci
- Santa Casa de Sao Paulo School of Medical Sciences, Sao Paulo, SP, Brazil
| | - C G Floriano
- Santa Casa de Sao Paulo School of Medical Sciences, Sao Paulo, SP, Brazil
| | - C A C de Campos
- Santa Casa de Sao Paulo School of Medical Sciences, Sao Paulo, SP, Brazil
| | - M Nakanishi
- University of Brasilia, Brasilia, DF, Brazil
| | | | - A L Valente
- University of Brasilia, Brasilia, DF, Brazil
| | | | | | - L K Anzolin
- State University of Londrina, Londrina, PR, Brazil
| | - M J A Issa
- Mater Dei Hospital, Belo Horizonte, MG, Brazil
| | - T V Souza
- Mater Dei Hospital, Belo Horizonte, MG, Brazil
| | - B A Lima
- Mater Dei Hospital, Belo Horizonte, MG, Brazil
| | - G D SantAnna
- Santa Casa de Misericordia Hospital de Porto Alegre, Porto Alegre, RS, Brazil
| | - C B Abreu
- Santa Casa de Misericordia Hospital de Porto Alegre, Porto Alegre, RS, Brazil
| | - E Sakano
- State University of Campinas. Campinas, SP, Brazil
| | | | | | | | | | | | - R D Alves
- Hospital Moriah, Sao Paulo, SP, Brazil
| | - R Roithmann
- Lutheran University of Brazil, Canoas, RS, Brazil
| | - N K Redeker
- Lutheran University of Brazil, Canoas, RS, Brazil
| | - L L B Filho
- Hospital Edmundo Vasconcelos, Sao Paulo, SP, Brazil
| | - C S Dassi
- Hospital Edmundo Vasconcelos, Sao Paulo, SP, Brazil
| | - A T O Meurer
- Hospital Edmundo Vasconcelos, Sao Paulo, SP, Brazil
| | - D M Garcia
- Ribeirio Preto Medical School, University of Sao Paulo, Ribeiro Preto, SP, Brazil
| | - D C Aragon
- Ribeirio Preto Medical School, University of Sao Paulo, Ribeiro Preto, SP, Brazil
| | - M S Tepedino
- State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - A C S Succar
- State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - P M Vianna
- State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - E M Kosugi
- Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - J F Villa
- Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - L L Gregorio
- Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | | | - C D Meotti
- Hospital de Clinicas Porto Alegre, RS, Brazil
| | - E Tamashiro
- Ribeiro Preto Medical School, University of Sao Paulo, Ribeiro Preto, SP, Brazil
| | - E Arruda
- Ribeiro Preto Medical School, University of Sao Paulo, Ribeiro Preto, SP, Brazil
| | - W T Anselmo Lima
- Ribeiro Preto Medical School, University of Sao Paulo, Ribeiro Preto, SP, Brazil
| |
Collapse
|
3
|
Sella JA, Ferriani MP, Melo JM, Trevisan Neto O, Zanetti MET, Cordeiro DL, Lemos JE, Barros SA, Aragon DC, Arruda LK. Type I and type IIb autoimmune chronic spontaneous urticaria: Using common clinical tools for endotyping patients with CSU. J Allergy Clin Immunol Glob 2023; 2:100159. [PMID: 37781653 PMCID: PMC10509944 DOI: 10.1016/j.jacig.2023.100159] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/30/2023] [Accepted: 06/20/2023] [Indexed: 10/03/2023]
Abstract
Background Mechanisms triggering the pathogenesis of chronic spontaneous urticaria (CSU) have been identified as type I autoallergic (which is associated with IgE antibodies against autoantigens) and type IIb autoimmune (which is driven by autoantibodies to FceR1 and/or IgE). Objective Our aim was to define presumptive endotypes in patients with CSU by using tests amenable to use in routine clinical practice. Methods A retrospective analysis of the medical records of 394 patients with CSU with or without chronic inducible urticaria or angioedema was performed. Patients were assigned to 1 of 4 groups as follows: (1) type I endotype of CSU, if they presented at least 1 of the following: allergic disease, total IgE level of at least 40UI/mL, and positive result of skin tests to inhalant allergen(s), (2) type IIb endotype of CSU, if they presented at least 1 of following: autoimmune disease, low total IgE level less than 40 IU/mL, positive autologous serum skin test result, positive for antinuclear antibodies in a titer of at least 1:160, and elevated level of anti-thyroid peroxidase, (3) overlap of type I/type IIb endotypes of CSU, if they presented with at least 1 marker of both type I and type IIb, and (4) non-type I/type IIb endotype of CSU, if they presented with none of the markers of type I or type IIb. Results The mean age at onset of symptoms was 34 years; 82.2% of those with CSU were female, and angioedema and chronic inducible urticaria were found in 74.8% and 31.9% of patients, respectively. Of the patients with CSU, 38% presented with the type I endotype and 51% presented with type I/type IIb overlap, whereas 9% presented with the type IIb endotype and 2% presented with the non-type I/type IIb endotype. Eosinopenia was associated with type IIb and type I/type IIb overlap as opposed to the type I and non-type I/type IIb endotypes (P = .02). Conclusions Most patients with CSU presented with features of the type 1 (autoallergic) endotype, whether associated with type IIb (autoimmune) endotype or not.
Collapse
Affiliation(s)
- Juliana A. Sella
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Mariana P.L. Ferriani
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Janaina M.L. Melo
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Orlando Trevisan Neto
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Maria Eduarda T. Zanetti
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Daniel L. Cordeiro
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - José E. Lemos
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Sebastião A. Barros
- Department of Pathology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Davi C. Aragon
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - L. Karla Arruda
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| |
Collapse
|
4
|
Godoi JTAM, Negrini SFBM, Aragon DC, Rocha PRH, Amaral FR, Negrini BVM, Teixeira SR, Yamamoto AY, Bettiol H, Mussi-Pinhata MM. Normocephalic Children Exposed to Maternal Zika Virus Infection Do Not Have a Higher Risk of Neurodevelopmental Abnormalities around 24 Months of Age than Unexposed Children: A Controlled Study. Pathogens 2023; 12:1219. [PMID: 37887735 PMCID: PMC10609945 DOI: 10.3390/pathogens12101219] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023] Open
Abstract
Although very few controlled studies are available, in utero Zika virus (ZIKV)-exposed children are considered at risk for neurodevelopmental abnormalities. We aimed to identify whether there is an excess risk of abnormalities in non-microcephalic children born to mothers with confirmed ZIKV infection compared with ZIKV-unexposed children from the same population. In a cross-sectional study nested in two larger cohorts, we compared 324 ZIKV-exposed children with 984 unexposed controls. Outcomes were assessed using the Bayley Screening Test III applied around 24 months of age. Relative risks for classifying children as emergent or at-risk for neurodevelopmental delay in at least one of five domains were calculated, adjusting for covariates. In four of the five domains, few children were classified as emergent (4-12%) or at-risk (0.3-2.16%) but for the expressive communication domain it was higher for emergent (19.1-42.9%). ZIKV-exposed children were half as frequently classified as emergent, including after adjusting for covariates [RR = 0.52 (CI 95% 0.40; 0.66)]. However, no difference was detected in the at-risk category [RR = 0.83 (CI 95% 0.48; 1.44)]. Normocephalic children exposed to the Zika virus during pregnancy do not have a higher risk of being classified as at risk for neurodevelopmental abnormalities at two years of age.
Collapse
Affiliation(s)
- Juannicelle T. A. M. Godoi
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Silvia F. B. M. Negrini
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Davi C. Aragon
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Paulo R. H. Rocha
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Fabiana R. Amaral
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Bento V. M. Negrini
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Sara R. Teixeira
- Department of Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto CEP 14049-900, São Paulo, Brazil;
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Aparecida Y. Yamamoto
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Heloisa Bettiol
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Marisa M. Mussi-Pinhata
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| |
Collapse
|
5
|
Vélez JW, Aragon DC, Donadi EA, Carlotti APCP. Risk factors for mortality from sepsis in an intensive care unit in Ecuador: A prospective study. Medicine (Baltimore) 2022; 101:e29096. [PMID: 35356943 PMCID: PMC10684228 DOI: 10.1097/md.0000000000029096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/21/2022] [Indexed: 12/16/2022] Open
Abstract
ABSTRACT To investigate risk factors for mortality from sepsis in an intensive care unit (ICU) in Quito-Ecuador and their association to adherence to Surviving Sepsis Campaign recommendations.Prospective cohort study of patients with severe sepsis/septic shock admitted to the ICU of a public Ecuadorian hospital from March, 2018 to March, 2019. Demographic, clinical, treatment, and outcome data were collected from patients' health records. Patients were divided into 2 groups according to ICU survival or death. Log-binomial regression models were used to identify risk factors for mortality.In total, 154 patients were included. Patients who died in the ICU (n = 42; 27.3%) had higher sequential organ failure assessment score (median 11.5 vs 9; P<.01), more organ dysfunction (median 4 vs 3; P<.0001), and received greater volumes of fluid resuscitation in the first 6 hours (median 800 vs 600 mL; P = .01). Dysfunction of > 2 organs was a risk factor for mortality (relative risks [RR] 3.80, 95% CI 1.33-10.86), while successful early resuscitation (RR 0.32, 95% CI 0.15-0.70), successful empirical antibiotic treatment (RR 0.38, 95%CI 0.18-0.82), and antibiotic de-escalation (RR 0.28, 95%CI 0.13-0.61) were protective factors.Dysfunction of >2 organs was a risk factor for mortality from sepsis while successful early resuscitation and appropriate antibiotic treatment were protective.
Collapse
Affiliation(s)
- Jorge W Vélez
- Division of Education and Research, Hospital de Especialidades Eugenio Espejo,Universidad Central del Ecuador, Quito, Ecuador,Division of Pediatric Critical Care, Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil,Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | | |
Collapse
|
6
|
Canesin WC, Volpe FAP, Gonçalves-Ferri WA, Manso PH, Aragon DC, Sbragia L. Primary peritoneal drainage in neonates with necrotizing enterocolitis associated with congenital heart disease: a single experience in a Brazilian tertiary center. ACTA ACUST UNITED AC 2021; 54:e10220. [PMID: 34076139 PMCID: PMC8186373 DOI: 10.1590/1414-431x2020e10220] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 04/26/2021] [Indexed: 11/23/2022]
Abstract
Necrotizing enterocolitis (NEC) is a common condition in preterm infants. The risk factors that contribute to NEC include asphyxia, apnea, hypotension, sepsis, and congenital heart diseases (CHD). The objective of this study was to evaluate the association between the treatment (surgery or drainage) and unfavorable outcomes in neonates with NEC and congenital heart diseases (NEC+CHD). A 19-year retrospective cohort study was conducted (2000-2019). Inclusion criterion was NEC Bell II stage. Exclusion criteria were associated malformation or genetic syndrome and those who did not undergo echocardiography or had a Bell I diagnosis. We included 100 neonates: NEC (n=52) and NEC+CHD (n=48). The groups were subdivided into NEC patients undergoing surgery (NECS, n=31), NEC patients undergoing peritoneal drainage (NECD, n=19), NEC+CHD patients undergoing surgery (NECCAS, n=21), and NEC+CHD patients who were drained (NECCAD, n=29). Multivariate analysis was performed to estimate the relative risk of death and the length of stay. Covariates were birth weight and gestational age. The group characteristics were similar. The adjusted relative risk of death was higher in the drainage groups [NECD (Adj RR=2.70 (95%CI: 1.47; 4.97) and NECCAD (Adj RR=1.97 (95%CI: 1.08; 3.61)], and they had the shortest time to death: NECD=8.72 (95%CI: 3.10; 24.54) and NECCAD=5.32 (95%CI: 1.95; 14.44). We concluded that performing primary peritoneal drainage in neonates with or without CHD did not improve the number of days of life, did not decrease the risk of death, and was associated with a higher mortality in newborns with NEC and clinical instability.
Collapse
Affiliation(s)
- W C Canesin
- Laboratório de Cirurgia Experimental Fetal "Michael Harrison", Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anantomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - F A P Volpe
- Laboratório de Cirurgia Experimental Fetal "Michael Harrison", Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anantomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - W A Gonçalves-Ferri
- Departamento de Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - P H Manso
- Departamento de Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - D C Aragon
- Departamento de Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L Sbragia
- Laboratório de Cirurgia Experimental Fetal "Michael Harrison", Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anantomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| |
Collapse
|
7
|
Sobrinho FL, Aragon DC, Carlotti AP. Epidemiology and factors associated with the severity of viral acute lower respiratory infection in children hospitalized in Manaus, Amazonas, in 2017-2018: An observational study. Medicine (Baltimore) 2021; 100:e25799. [PMID: 33950979 PMCID: PMC8104226 DOI: 10.1097/md.0000000000025799] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/25/2021] [Accepted: 04/15/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT To investigate the epidemiology and factors associated with the severity of viral acute lower respiratory infection (ALRI) in children hospitalized in Manaus, Amazonas, in 2017 to 2018.Retrospective cohort study of children hospitalized at the Hospital and Emergency Room Delphina Rinaldi Abdel Aziz, in Manaus, from April 01, 2017 to August 31, 2018, with a clinical diagnosis of ALRI and nasopharyngeal aspirates positive for at least 1 respiratory virus.One hundred forty-six children aged 0.2 to 66 months (median 7 months) were included. Patients were divided into 2 groups according to the disease severity classified by an adapted Walsh et al score: moderate disease, score 0-4, n = 66 (45.2%) and severe disease, score 5-7, n = 80 (54.8%). A greater number of viral ALRI cases were observed in the rainiest months. Respiratory syncytial virus was the most prevalent (n = 103, 70.3%), followed by metapneumovirus (n = 24, 16.4%), influenza virus (n = 17, 11.6%), parainfluenza virus (n = 11, 7.5%), and adenovirus (n = 4, 2.7%). Co-detections of 2 to 3 viruses were found in 12 (8.2%) patients. The presence of viral coinfection was an independent risk factor for disease severity (adjusted relative risk [RR] 1.53; 95% CI 1.10-2.14). Twelve patients (8.2%) died, all with severe disease. Risk factors for death were shock (adjusted RR 10.09; 95% CI 2.31-43.90) and need for vasoactive drugs (adjusted RR 10.63; 95% CI 2.44-46.31).There was a higher incidence of viral ALRI in Manaus in the rainy season. Respiratory syncytial virus was the most prevalent virus. The presence of viral coinfection was an independent risk factor for disease severity.
Collapse
Affiliation(s)
| | - Davi C. Aragon
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ana P.C.P. Carlotti
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| |
Collapse
|
8
|
Medeiros PBS, Salomão RG, Teixeira SR, Rassi DM, Rodrigues L, Aragon DC, Fassini PG, Ued FV, Tostes RC, Monteiro JP, Ferriani VPL, de Carvalho LM. Disease activity index is associated with subclinical atherosclerosis in childhood-onset systemic lupus erythematosus. Pediatr Rheumatol Online J 2021; 19:35. [PMID: 33743717 PMCID: PMC7981852 DOI: 10.1186/s12969-021-00513-5] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is an independent risk factor for cardiovascular events. The present study determined the prevalence of subclinical atherosclerosis in childhood-onset SLE using the carotid intima-media thickness (CIMT) measurement and investigated associations between traditional and nontraditional risk factors for atherosclerosis, such as medications, SLE Disease Activity Index - SLEDAI-2 K and SLICC-ACR damage index and CIMT. METHODS Cross-sectional prospective study between 2017 and 2018. CIMT was assessed by ultrasonography. Data were collected by chart review, nutritional evaluation and laboratory tests and analyzed by Fisher, Wilcoxon-Mann-Whitney tests, multiple linear and log binomial regression. RESULTS Twenty-eight patients (mean age 13.9 years, SD 3) were enrolled. The prevalence of subclinical atherosclerosis was 32% (95% CI 14.8, 49.4). The mean CIMT was 0.43 ± 0.035 mm. The most common traditional risk factors observed were dyslipidemia (82.1%), uncontrolled hypertension (14.2%), obesity (14.3%), and poor diet (78.6%). Uncontrolled hypertension (p = 0.04), proteinuria (p = 0.02), estimated glomerular filtration rate < 75 ml /min/1.73 m2 (p = 0.02) and SLEDAI-2 K > 5 (P = 0.04) were associated with subclinical atherosclerosis. SLEDAI-2 K > 5 maintained association with CIMT after adjusting for control variables. CONCLUSION Subclinical atherosclerosis is frequently observed in cSLE, mainly in patients with moderate to severe disease activity.
Collapse
Affiliation(s)
- Priscila B. S. Medeiros
- grid.11899.380000 0004 1937 0722Department of Pediatrics, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo 14049-900 Brazil ,grid.11899.380000 0004 1937 0722Division of Pediatric Rheumatology, University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | - Roberta G. Salomão
- grid.11899.380000 0004 1937 0722Division of Nutrition and Metabolism, Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | - Sara R. Teixeira
- grid.11899.380000 0004 1937 0722Department of Medical Imaging, Oncology and Hematology, University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | - Diane M. Rassi
- grid.11899.380000 0004 1937 0722Department of Pharmacology, University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | - Luciana Rodrigues
- grid.11899.380000 0004 1937 0722Department of Pediatrics, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo 14049-900 Brazil
| | - Davi C. Aragon
- grid.11899.380000 0004 1937 0722Department of Pediatrics, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo 14049-900 Brazil
| | - Priscila G. Fassini
- grid.11899.380000 0004 1937 0722Department of Internal Medicine, Division of Nutrology, University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | - Fábio V. Ued
- grid.11899.380000 0004 1937 0722Division of Nutrition and Metabolism, Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | - Rita C. Tostes
- grid.11899.380000 0004 1937 0722Department of Pharmacology, University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | - Jacqueline P. Monteiro
- grid.11899.380000 0004 1937 0722Department of Pediatrics, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo 14049-900 Brazil ,grid.11899.380000 0004 1937 0722Division of Nutrition and Metabolism, Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | - Virgínia P. L. Ferriani
- grid.11899.380000 0004 1937 0722Department of Pediatrics, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo 14049-900 Brazil ,grid.11899.380000 0004 1937 0722Division of Pediatric Rheumatology, University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | - Luciana M. de Carvalho
- grid.11899.380000 0004 1937 0722Department of Pediatrics, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo 14049-900 Brazil ,grid.11899.380000 0004 1937 0722Division of Pediatric Rheumatology, University of São Paulo, Ribeirão Preto, São Paulo Brazil ,grid.11899.380000 0004 1937 0722Clinical Hospital of Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP 14049-900 Brazil
| |
Collapse
|
9
|
Anastasio ART, Yamamoto AY, Massuda ET, Manfredi AKS, Cavalcante JMS, Lopes BCP, Aragon DC, Boppana S, Fowler KB, Britt WJ, Mussi-Pinhata MM. Comprehensive evaluation of risk factors for neonatal hearing loss in a large Brazilian cohort. J Perinatol 2021; 41:315-323. [PMID: 32884104 DOI: 10.1038/s41372-020-00807-8] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/17/2020] [Accepted: 08/27/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To determine the incidence and risk factors of hearing loss (HL) in Brazilian neonates. STUDY DESIGN 11,900 neonates were screened for hearing and congenital CMV (cCMV). Low and high-risk babies who did not pass their hearing screening and infants with cCMV were scheduled for a diagnostic audiologic evaluation. RESULTS The incidence of HL was 2 per 1000 live-born infants (95% CI: 1-3). HL was higher in high-risk neonates than in low risk babies (18.6 vs. 0.3/1000 live births, respectively). Among infants exposed to isolated risk factors, association of HL with craniofacial abnormalities/syndromes (RR = 24.47; 95% CI: 5.9-100.9) and cCMV (RR = 9.54; 95% CI: 3.3-27.7) were observed. HL was 20 to 100-fold more likely in neonates exposed to ototoxic drugs in combination with cCMV or craniofacial/congenital anomalies. CONCLUSIONS Strategies for the prevention of cCMV and exposure to ototoxic drugs may decrease the incidence of HL in this population.
Collapse
Affiliation(s)
- Adriana R T Anastasio
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
| | - Aparecida Y Yamamoto
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Eduardo T Massuda
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School-University of São Paulo, São Paulo, Brazil
| | - Alessandra K S Manfredi
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Juliana M S Cavalcante
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Bruno C P Lopes
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School-University of São Paulo, São Paulo, Brazil
| | - Davi C Aragon
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Suresh Boppana
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Karen B Fowler
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - William J Britt
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Marisa M Mussi-Pinhata
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
10
|
Nogueira RL, Küpper DS, do Bonfim CM, Aragon DC, Damico TA, Miura CS, Passos IM, Nogueira ML, Rahal P, Valera FCP. HPV genotype is a prognosticator for recurrence of respiratory papillomatosis in children. Clin Otolaryngol 2020; 46:181-188. [PMID: 32869523 DOI: 10.1111/coa.13640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/18/2019] [Revised: 07/03/2020] [Accepted: 08/16/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to compare the prognosis according to age, genotype or human papillomavirus (HPV) variant in patients with recurrent respiratory papillomatosis (RRP). DESIGN Non-concurrent cohort. PARTICIPANTS Forty one patients with RRP. SETTING Tertiary referral hospital. MAIN OUTCOME MEASURES Disease severity was defined by the number of surgeries performed, and Derkay score at surgeries, obtained from medical records. HPV was detected and genotyped, and HPV-6 variants were also assessed. RESULTS Fifteen (36.58%) individuals belonged to the juvenile RRP group (JoRRP, less than 18 years), while 26 patients (63.41%) were allocated at the adult group (AoRRP, equal or more than 18 years). JoRRP patients needed, in average, a higher number of surgeries to control the disease than AoRRP patients (mean difference: 3.36). Also, JoRRP patients showed a higher Derkay score at each surgery (mean difference: 3.76). There was no significant difference in the number of surgeries when we compared patients infected with HPV-6 or HPV-11, neither in accordance to HPV-6 variants. Patients with HPV-11 presented a higher mean Derkay score at surgery than those with HPV-6 (mean difference: 4.39); when co-variated by age, we observed that this difference occurred only among JoRRP patients (mean difference: 6.15). CONCLUSIONS Age of onset of RRP has an important impact on number of surgeries to control disease. Patients with JoRRP and HPV-11 tend to present worse Derkay score at each surgery. HPV genotype among adults and HPV-6 variants had no impact on the outcome of the disease.
Collapse
Affiliation(s)
- Rodrigo L Nogueira
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
| | - Daniel S Küpper
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
| | - Caroline M do Bonfim
- Department of Biology, IBILCE, Institute of Bioscience, Language & Literature and Exact Science, University of São Paulo State (UNESP), Sao Jose do Rio Preto, Brazil
| | - Davi C Aragon
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
| | - Thiago A Damico
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
| | - Carolina S Miura
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
| | - Ivna M Passos
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
| | - Maurício L Nogueira
- Laboratory of Research in Virology, School of Medicine of São José do Rio Preto, FAMERP, Sao Jose do Rio Preto, Brazil
| | - Paula Rahal
- Department of Biology, IBILCE, Institute of Bioscience, Language & Literature and Exact Science, University of São Paulo State (UNESP), Sao Jose do Rio Preto, Brazil
| | - Fabiana C P Valera
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
| |
Collapse
|
11
|
Oliveira MM, Trevilato TMB, Segura-Muñoz SI, Aragon DC, Alves LG, Nadal M, Marquès M, Domingo JL, Sierra J, Camelo JS. Essential and toxic elements in human milk concentrate with human milk lyophilizate: A preclinical study. Environ Res 2020; 188:109733. [PMID: 32574850 PMCID: PMC7479503 DOI: 10.1016/j.envres.2020.109733] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/22/2020] [Indexed: 05/02/2023]
Abstract
Concentrated human milk (HM-concentrate) can be obtained from the simple and inexpensive method of donated breast milk direct lyophilization. A previous study reported that HM-concentrate contains the adequate amount of main macro- and micronutrients for use as a nutritional resource for preterm infants with very low birth weight admitted to neonatal intensive care units. However, further details need to be elucidated about HM-concentrate composition, particularly its content of essential and potentially toxic trace elements. Therefore, this study aimed to determine the concentration of essential and toxic elements in human milk considered baseline (HM-baseline) and HM-concentrate, as well as to quantify changes in concentration of these elements after the HM concentration process. The concentration of Aluminum, Arsenic, Cadmium, Chromium, Iron, Mercury, Manganese, Nickel, Lead, Selenium, Tin, and Thallium was analyzed by inductively coupled plasma-mass spectrometry (ICP-MS). Moreover, Bayesian linear mixed effect models were applied to estimate the mean difference between HM-baseline and HM-concentrate samples. After comparison (HM-concentrate versus HM-baseline), a significant increase in concentration was observed only for Manganese (0.80 μg/L; 95% CrI [0.16; 1.43]) and Selenium (6.74 μg/L; 95% CrI [4.66; 8.86]), while Lead concentration (-6.13 μg/L; 95% CrI [-8.63; -3.61]) decreased. This study provides latest and reliable information about HM composition. After milk concentration by lyophilization, there was a significant increase only in the essential elements Manganese and Selenium. The essential micronutrient content in HM-concentrate was similar or higher than that in preterm mothers' milk, which suggests it is viable for nutritional support of preterm infants. In addition, the low concentrations of potentially toxic elements in HM-concentrate indicates that it is safe for consumption by premature newborns.
Collapse
Affiliation(s)
- Mariana M Oliveira
- Department of Pediatrics, Childreńs Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Tânia M B Trevilato
- Section of Metals and Rare Diseases, Laboratory of Pediatrics, Clinics Hospital of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Susana I Segura-Muñoz
- Laboratory of Ecotoxicology and Environmental Parasitology, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Davi C Aragon
- Department of Pediatrics, Childreńs Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Larissa G Alves
- Human Milk Bank, Clinics Hospital of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Martí Nadal
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira I Virgili, Reus, Catalonia, Spain
| | - Montse Marquès
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira I Virgili, Reus, Catalonia, Spain
| | - José L Domingo
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira I Virgili, Reus, Catalonia, Spain
| | - Jordi Sierra
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira I Virgili, Reus, Catalonia, Spain; Laboratory of Soil Science, Faculty of Pharmacy, Universitat de Barcelona, Catalonia, Spain
| | - José Simon Camelo
- Department of Pediatrics, Childreńs Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| |
Collapse
|
12
|
Pimenta JRR, Grandi C, Aragon DC, Cardoso VC. Comparison of birth weight, length, and head circumference between the BRISA-RP and Intergrowth-21st cohorts. J Pediatr (Rio J) 2020; 96:511-519. [PMID: 31026416 PMCID: PMC9432049 DOI: 10.1016/j.jped.2019.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES (a) To determine the 3rd, 50th, and 97th percentiles of weight, length, and head circumference of newborns from the Ribeirão Preto BRISA cohort, according to gender and gestational age, and compare them with the Intergrowth-21st standard; (b) To estimate the small for gestational age (<3rd percentile), large for gestational age (>97th percentile), stunting (length<3rd percentile), and wasting (body mass index<3rd percentile). METHODS Observational study of a cohort of 7702 newborns between 01/01/2010 and 12/31/2010 in the city of Ribeirão Preto, SP, Brazil. The 3rd, 50th, and 97th percentiles were determined for the anthropometric measurements using fractional polynomial regression. RESULTS The weight difference between Ribeirão Preto and Intergrowth-21st was small, being more pronounced in preterm infants (mean difference between the two populations of +266g); for full-term newborns, there was a mean difference of +66g, and for post-term infants, of -113g. For length, the mean variation was always <1cm; whereas for head circumference, preterm newborns showed a variation >1cm, and full-term and post-term newborns showed a variation of <1cm. The small and large for gestational age detection rates were 2.9% and 4.3%, respectively. Stunting affected 6.5% of all newborns and wasting, 1.5%, with a predominance in girls and in full-term pregnancies; both conditions were present in 0.4% of the sample. CONCLUSIONS Newborns from Ribeirão Preto, when compared to the Intergrowth-21 standard, are heavier, longer, and have a larger head circumference until they reach full-term.
Collapse
Affiliation(s)
- João Roberto R Pimenta
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Departamento de Farmacologia, Ribeirão Preto, SP, Brazil
| | - Carlos Grandi
- Sociedade Argentina de Pediatria, Comissão de Pesquisa, Buenos Aires, Argentina
| | - Davi C Aragon
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Departamento de Puericultura e Pediatria, Ribeirão Preto, SP, Brazil
| | - Viviane Cunha Cardoso
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Departamento de Puericultura e Pediatria, Ribeirão Preto, SP, Brazil.
| |
Collapse
|
13
|
Stecchini MF, Bueno AC, Ramalho LNZ, Ramalho FS, Calado RT, Coeli-Lacchini FB, Campos MR, Aragon DC, Moreira AC, Brandalise SR, Castro M, Yunes JA, Antonini SR. SAT-179 Increased Telomere Length in Adrenocortical Tumors Is Associated with Abnormal Expression of Chromatin Remodelling Factors. J Endocr Soc 2020. [PMCID: PMC7207279 DOI: 10.1210/jendso/bvaa046.1369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: The pathogenesis of adrenocortical tumors (ACTs) in the pediatric population is partially known, and few prognostic factors have been identified in this age group. Recently, ATRX and DAXX have been implicated in the pathogenesis and prognosis of a variety of cancers. Their altered function has been shown to affect telomere length through a telomerase-independent mechanism. Objective: To investigate ATRX and DAXX gene expression, ATRX and DAXX protein expression, and telomere length, as well as their clinical significance, in ACT samples from pediatric patients. Methods: The records of 110 pediatric patients with available ACT samples were reviewed. ATRX, DAXX, TERT and TERC gene expression was assessed by qPCR (n = 100 ACTs; n = 12 normal adrenals). ATRX and DAXX protein expression was assessed by IHC (n = 45 ACTs). Telomere length was assessed by qPCR (n = 64 ACTs). For survival analysis, Kaplan-Meier curves were obtained. For association analysis, simple linear regression models were adjusted. Results: Most patients were female (70.9%) and harbored germline TP53 mutations (90.2%). Median age at diagnosis was 21.1 months (2.1 – 199). Younger patients (< 3 years) had better survival (p < 0.01), while those with metastasis at diagnosis and carcinomas (classified by the Wieneke score) had worse survival (p < 0.01). ATRX gene expression was decreased (p < 0.01), while DAXX gene expression was increased (p < 0.01) in ACTs, compared to normal adrenals. ATRX gene expression was even lower in the context of the germline TP53 (R337H) mutation (p < 0.01). TERT expression was not detected in ACTs or normal adrenals, and TERC expression was not altered (p = 0.69). ATRX protein expression was lost in the majority of ACTs (95.6%), while DAXX was lost in a minority (21.1%). There was no association between gene or protein expression and disease-free or overall survival. There was a significant association between decreased ATRX and DAXX gene expression and increased telomere length (p < 0.01 and p = 0.03, respectively). Conclusion: In pediatric ACTs, decreased ATRX and DAXX gene expression was associated with increased telomere length, independently of TERT or TERC expression. In these tumors, ATRX gene expression was decreased and ATRX protein expression was overall lost, while DAXX gene expression was increased and DAXX protein expression was overall retained. No significant association between these alterations and prognosis was found in this cohort. These findings suggest that ATRX and DAXX altered function may be more involved in the pathogenesis of pediatric ACTs than in the prognosis of the affected patients.
Collapse
Affiliation(s)
- Monica F Stecchini
- Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Ana Carolina Bueno
- Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Leandra N Z Ramalho
- Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Fernando S Ramalho
- Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Rodrigo T Calado
- Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | | | - Mateus R Campos
- Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Davi C Aragon
- Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Ayrton C Moreira
- Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | | | - Margaret Castro
- Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Jose A Yunes
- Boldrini Children’s Center, University of Campinas, Campinas, SP, Brazil
| | - Sonir R Antonini
- Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| |
Collapse
|
14
|
Abstract
We proposed a Bayesian analysis of pseudo-compositional data in presence of a latent factor, assuming a spatial structure. This development was motivated by a dataset containing information on the number of newborns of primiparous mothers living in each of the microregions of the state of Sao Paulo, Brazil, in the year of 2015, stratified by the age of the mothers (15-18, 19-29 and 30 years or more). Considering that data on newborns are not stochastically distributed among the three age groups, but they are explained in relation to women's population structure, we adopted the expression "pseudo-compositional data" to refer to this data structure. The hypothesis of interest establishes that the age of the first pregnancy is associated with the economic conditions of the geographic area where the mother lives. The incidence of poverty was included as an independent variable. Additive log-ratio (alr) and isometric log-ratio (ilr) transformations were considered, as is usually done in the analysis of compositional data. The model included a random effect related to the spatial effect assumed to have a conditional autoregressive structure. A Bayesian Markov Chain Monte Carlo (MCMC) simulation procedure was used to get the posterior summaries of interest. The model based on the (ilr) transformation was well fitted to the data, showing that in the microregions with the highest incidence of poverty, there are higher proportions of women who have their first child in adolescence, while in the microregions with the lowest incidence of poverty, there are higher proportions of women who have their first child after the age of 30 years. From these results it is possible to conclude that this Bayesian approach was very useful in the estimation of the parameters of the proposed model. The proposed method should have a broad application to other problems involving pseudo-compositional data.
Collapse
Affiliation(s)
- Edson Z Martinez
- Ribeirão Preto Medical School, University of São Paulo (USP), Brazil
| | - Jorge A Achcar
- Ribeirão Preto Medical School, University of São Paulo (USP), Brazil
| | - Davi C Aragon
- Ribeirão Preto Medical School, University of São Paulo (USP), Brazil
| | | |
Collapse
|
15
|
Mantovani FD, de Carla Bassetto M, de Souza CHB, Aragon DC, de Santana EH, Pimentel TC, Aragon-Alegro LC. Is there an impact of the dairy matrix on the survival of Lactobacillus casei Lc-1 during shelf life and simulated gastrointestinal conditions? J Sci Food Agric 2020; 100:32-37. [PMID: 31414474 DOI: 10.1002/jsfa.9988] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/26/2019] [Accepted: 08/08/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The selection of the food matrix to be used as a vehicle for a probiotic culture is important because its chemical composition and physicochemical characteristics can affect probiotic survival during the shelf-life of the product and under simulated gastrointestinal conditions (SGIC). The present study aimed to evaluate the influence of the dairy matrix (chocolate fermented milk beverage, chocolate flan or passion fruit flan) on the survival of Lactobacillus casei Lc-1 during refrigerated storage (4 °C for 21 days) and SGIC. RESULTS Chocolate fermented milk beverage and chocolate and passion fruit flans could be considered as matrices for the incorporation of L. casei, providing suitable counts (6.38-7.84 log cfu g-1 ) during storage. The type of matrix had an impact on the inicial probiotic counts in the products and on the probiotic resistance to the SGIC. The chocolate fermented milk beverage presented higher initial probiotic counts (7.72 versus 6.65-7.28 log cfu g-1 ). The higher pH (5.3-6.8), solid matrix and increased fat content (65.0-72.9 g 100 g-1 ) contributed to the higher resistance to the SGIC of the chocolate and passion fruit flans, allowing recovery of viability during the enteric phase (increases of 1-1.5 log cycles). CONCLUSION The type of dairy matrix has an impact on the inicial probiotic counts in the products and on the probiotic resistance to the SGIC. Chocolate and passion fruit flans proved to be more suitable options than chocolate fermented milk beverage for the incorporation of Lactobacillus casei Lc-1. © 2019 Society of Chemical Industry.
Collapse
Affiliation(s)
- Fernanda D Mantovani
- Master Program in Science and Technology of Milk and Dairy Products, University Pitágoras Unopar, Londrina, Brazil
| | - Maira de Carla Bassetto
- Master Program in Science and Technology of Milk and Dairy Products, University Pitágoras Unopar, Londrina, Brazil
| | - Cínthia H B de Souza
- Master Program in Science and Technology of Milk and Dairy Products, University Pitágoras Unopar, Londrina, Brazil
| | - Davi C Aragon
- Department of Pediatrics, Childrens's Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Elsa Hw de Santana
- Master Program in Science and Technology of Milk and Dairy Products, University Pitágoras Unopar, Londrina, Brazil
| | - Tatiana C Pimentel
- Master Program in Science and Technology of Milk and Dairy Products, University Pitágoras Unopar, Londrina, Brazil
- Federal Institute of Paraná (IFPR) - Campus Paranavaí, Paraná, Brazil
| | - Lina C Aragon-Alegro
- Master Program in Science and Technology of Milk and Dairy Products, University Pitágoras Unopar, Londrina, Brazil
| |
Collapse
|
16
|
Warisaia V, Pansarim V, Aragon DC, Zucoloto FS, Schmidt A. Female and Male Wistar Rats (Rattus norvegicus) Discriminate Diets According to Energetic Quantity. IJCP 2020. [DOI: 10.46867/ijcp.2020.33.00.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The food choice of animals is influenced by several factors including the quantity and nutrients available. It is not known, however, whether faced with alternatives that present the same amount of food, with similar flavor and obtained with the same response cost, rats would discriminate between diets with different energetic quantities. The aim was to verify whether female and male Wistar rats (Rattus norvegicus) discriminate between three types of food that differ in their energetic content (whether or not they prefer one) and whether the flavor could affect the choice between two diets with equal energetic quantities. Twelve Wistar rats (six of each sex) underwent tests of choice between pairs of diets of different energetic values. After the tests, the animals had at their disposal, in the home cage, two diets with the same energetic content, which differed in flavor (one contained sucrose) - Flavor test. The consumption of each diet was measured for five consecutive days. All the subjects demonstrated a preference for the more energetic alternative, regardless of the combination of diets presented. In the Flavor test the animals did not show significant preference for any diet, i.e., the consumption of both the S and N diets were statistically equal for all subjects. It was concluded that the animals, regardless of sex, discriminated between the diets with different energetic values and that the flavor did not seem to be a determinant variable in the food choice.
Collapse
|
17
|
Sousa-Santos ACAF, Moreno AS, Santos ABR, Barbosa MCR, Aragon DC, Sales VSF, Arruda LK. Parasite Infections, Allergy and Asthma: A Role for Tropomyosin in Promoting Type 2 Immune Responses. Int Arch Allergy Immunol 2019; 181:221-227. [PMID: 31865358 DOI: 10.1159/000504982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/21/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The relationship of parasite infections and promotion or protection from allergy and asthma is controversial. Currently, over 1.5 billion people are infected with parasites worldwide, and Ascaris lumbricoides is the most frequent soil-transmitted helminth. OBJECTIVES To evaluate the biological activity of recombinant A. lumbricoides tropomyosin and investigate IgE cross-reactive responses to tropomyosins by means of microarray methodology for the detection of sensitization to allergen components. METHODS Forty patients 12-75 years of age (25 males) with asthma and/or rhinitis and 10 nonallergic control subjects participated in this study. All patients presented positive skin tests to cockroach extracts and underwent skin prick testing (SPT) with recombinant (r) tropomyosins rPer a 7 from Periplaneta americana and rAsc l 3 from A. lumbricoides, at 10 μg/mL. IgE to cockroach and parasite tropomyosins were measured by chimeric ELISA and ImmunoCAP-ISAC, and total IgE was quantitated by ImmunoCAP. Agreement of results was assessed by κ statistics. RESULTS Recombinant A. lumbricoides showed biological activity, inducing positive skin tests in 50% patients with asthma and/or rhinitis. IgE to cockroach and parasite tropomyosins were detected in 55-62% of patients. There was good-to-excellent agreement of results of SPT and IgE measurements by ELISA and ImmunoCAP-ISAC, with κ indices of 0.66-0.95. No skin test reactivity or IgE antibodies to tropomyosins were found in nonallergic individuals. CONCLUSIONS Our results suggest that IgE responses to tropomyosin from A. lumbricoides may enhance reactivity to homologous allergens upon exposure by inhalation or ingestion, promoting allergic reactions and asthma, or increasing the severity of these clinical conditions.
Collapse
Affiliation(s)
| | - Adriana S Moreno
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Beatriz R Santos
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Instituto de Ciências da Saúde ICS, Universidade Paulista UNIP Campus Campinas, Campinas, Brazil
| | - Michelle C R Barbosa
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Escola de Medicina e Ciências da Saúde, Universidade Anhembi Morumbi - Laureate International Universities Campus Piracicaba, Piracicaba, Brazil
| | - Davi C Aragon
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Valeria S F Sales
- Department of Immunology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - L Karla Arruda
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil,
| |
Collapse
|
18
|
Barbosa NG, Yamamoto AY, Duarte G, Aragon DC, Fowler KB, Boppana S, Britt WJ, Mussi-Pinhata MM. Cytomegalovirus Shedding in Seropositive Pregnant Women From a High-Seroprevalence Population: The Brazilian Cytomegalovirus Hearing and Maternal Secondary Infection Study. Clin Infect Dis 2019; 67:743-750. [PMID: 29490030 DOI: 10.1093/cid/ciy166] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 02/26/2018] [Indexed: 01/01/2023] Open
Abstract
Background Most congenital cytomegalovirus (CMV) infections in highly seropositive populations occur in infants born to women with preexisting CMV seroimmunity. Although essential for developing prevention strategies, CMV shedding patterns in pregnant women with nonprimary infections have not been characterized. We investigated correlates of CMV shedding in a cohort of seropositive pregnant women. Methods In a prospective study, saliva, urine, vaginal swabs, and blood were collected from 120 CMV-seropositive women in the first, second, and third trimesters and 1 month postpartum. Specimens were tested for CMV DNA by polymerase chain reaction. We analyzed the contribution of the specific maternal characteristics to viral shedding. Results CMV shedding was detected at least once in 42 (35%) women. Mothers living with or providing daily care to young children (3-6 years) were twice as likely to shed CMV at least once compared to women with less exposure to young children (58% vs 26%; adjusted relative risk [aRR], 2.21; 95% confidence interval [CI], 1.37-3.56). Living in crowded households (≥2 people per room) was associated with viral shedding (64% vs 31%; aRR, 1.99; 95% CI, 1.26-3.13). Sexual activity as indicated by the number of sexual partners per year or condom use was not found to be a correlate of viral shedding. Conclusions CMV shedding is relatively frequent in seropositive pregnant women. The association between virus shedding and caring for young children as well as crowded living conditions may provide opportunities for increased exposures that could lead to CMV reinfections in seropositive women.
Collapse
Affiliation(s)
- Nayara G Barbosa
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Aparecida Y Yamamoto
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Geraldo Duarte
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Davi C Aragon
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Karen B Fowler
- Department of Pediatrics, University of Alabama at Birmingham
| | - Suresh Boppana
- Department of Pediatrics, University of Alabama at Birmingham
| | - William J Britt
- Department of Pediatrics, University of Alabama at Birmingham
| | - Marisa M Mussi-Pinhata
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| |
Collapse
|
19
|
Sella GCP, Tamashiro E, Sella JA, Aragon DC, Mendonça TND, Arruda LKDP, Anselmo Lima WT, Valera FCP. Asthma Is the Dominant Factor for Recurrence in Chronic Rhinosinusitis. J Allergy Clin Immunol Pract 2019; 8:302-309. [PMID: 31425833 DOI: 10.1016/j.jaip.2019.08.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/22/2019] [Accepted: 08/08/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Factors associated with recurrence of chronic rhinosinusitis (CRS) are still poorly recognized. OBJECTIVE To evaluate which risk factors could influence the risk of recurrence among patients undergoing endoscopic sinus surgery in long-term follow-up. METHODS Patients with CRS who underwent endoscopic sinus surgery were followed for an average period of 12 years in a nonconcurrent cohort. After surgery, patients were considered to an additional endoscopic sinus surgery if appropriate medical therapy failed during this period. The presence of nasal polyps, asthma, nonsteroidal anti-inflammatory drug-exacerbated respiratory disease, smoking habits, peripheral blood eosinophilia, and atopy were assessed. The recurrence-free interval between groups (with or without these risk factors) was analyzed by Kaplan-Meyer curves, and the indication for a revisional surgery was considered to be the unfavorable event. RESULTS A total of 201 patients were enrolled in this study. Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) were more likely than patients with chronic rhinosinusitis without nasal polyps (CRSsNP) to need revisional surgery (adjusted hazard ratio, 2.02). Asthma was the only factor that was significantly related to recurrence both in patients with CRSsNP (hazard ratio, 5.54) and in patients with CRSwNP (hazard ratio, 3.27). Although eosinophilia itself was not related to a higher chance of recurrence, its presence influenced the outcome of CRSwNP compared with CRSsNP and the impact of asthma among patients with CRSwNP. CONCLUSIONS Prognosis in patients with CRSwNP was inferior to that in patients with CRSsNP. Asthma was the only factor that increased the chance of recurrence in patients with either CRSsNP or CRSwNP.
Collapse
Affiliation(s)
- Guilherme Constante Preis Sella
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Edwin Tamashiro
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Juliana Augusta Sella
- Department of Allergology and Immunology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Davi C Aragon
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Thais Nociti de Mendonça
- Department of Allergology and Immunology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Luisa Karla de Paula Arruda
- Department of Allergology and Immunology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Wilma Terezinha Anselmo Lima
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Fabiana Cardoso Pereira Valera
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
| |
Collapse
|
20
|
Aniceto V, Dias MM, Melo JML, Trevisan-Neto O, Aragon DC, Maia LSM, Moreno AS, Arruda LK. Serum Baseline Tryptase Level as a Marker for the Severity of Anaphylaxis. Int Arch Allergy Immunol 2019; 179:201-208. [PMID: 30893687 DOI: 10.1159/000497235] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 12/01/2018] [Accepted: 01/25/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Anaphylaxis is a severe and potentially fatal allergic disease or hypersensitivity reaction with variable clinical presentation. Biomarkers in anaphylaxis could be useful to improve diagnosis, to allow endotyping of patients, and to predict risk. OBJECTIVE To investigate the role of serum basal tryptase (sBT) levels in the management of patients with anaphylaxis. METHODS Patients with at least 1 episode of anaphylaxis were selected among those who attended the Allergy Clinics of the Clinical Hospital of the Ribeirão Preto Medical School, University of São Paulo, Brazil, upon evaluation by allergy/immunology specialists of our medical staff. Demographic and clinical data were obtained using a structured questionnaire. sBT levels were determined using the ImmunoCAP Tryptase immunoassay. RESULTS 57 patients (56.1% female) with a median age of 35 years (range 7-87 years) participated in the study. sBT levels ranged from 2.57 to 21.19 ng/mL (mean 5.17 ng/mL), with no significant differences in patients with anaphylaxis due to different triggers. Mean levels were 4.93; 5.2; 5.41, and 5.24 ng/mL for patients who had anaphylaxis due to Hymenoptera venom (n = 17), foods (n = 13), drugs (n = 13), and idiopathic disease (n = 14), respectively. Significantly higher sBT levels were observed in patients with severe anaphylaxis (grade IV) than in patients with mild-moderate disease (grades II/III) (mean levels 6.61 vs. 4.71 ng/mL, respectively). CONCLUSION High sBT levels may help to identify patients at increased risk of more severe anaphylaxis, prompting physicians to initiate immediate therapy to avoid further acute episodes.
Collapse
Affiliation(s)
- Vinicius Aniceto
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Marina M Dias
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Janaina M L Melo
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Davi C Aragon
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Luana S M Maia
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Adriana S Moreno
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Luisa Karla Arruda
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil,
| |
Collapse
|
21
|
Braga AA, Valera FCP, Faria FM, Rossato M, Murashima AAB, Fantucci MZ, Aragon DC, Queiroz DLC, Anselmo-Lima WT, Tamashiro E. An Experimental Model of Eosinophilic Chronic Rhinosinusitis Induced by Bacterial Toxins in Rabbits. Am J Rhinol Allergy 2019; 33:737-750. [DOI: 10.1177/1945892419865642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The pathophysiology of chronic rhinosinusitis (CRS) is still not well known due to the multifactorial etiologies involved. Bacteria play a role in the pathogenesis of CRS by various means, including biofilm adhesion, intracellular persistence, or inducing inflammation secondary to toxins. Endotoxins and exotoxins, especially Staphylococcus aureus superantigens, can produce significant immune responses in the host and are implicated in patients with CRS. The majority of animal models described for CRS revalidates the pathophysiology of acute sinusitis, ostium occlusion, or foreign body associated infection. Objectives To evaluate an experimental model of eosinophilic CRS using prolonged exposure to bacterial toxins. The histological changes in rabbits exposed to S. aureus enterotoxin B (SEB), lipopolysaccharide (LPS), or lipoteichoic acid (LTA) were compared. Methods After induction with ovalbumin (OVA) sensitization with subcutaneous injection for 2 weeks, rabbits underwent surgery to insert an indwelling catheter into the maxillary sinus. The sinus was irrigated with OVA 3 times weekly for 2 weeks, followed by sinus irrigation with bacterial toxin (SEB: 1 µg/mL, LPS: 100 ng/mL, or LTA: 100 ng/mL) 3 times weekly for 4 weeks. The histological changes in the treated sinus were compared with control rabbits. Results Sinuses exposed to bacterial toxins (SEB, LPS, and LTA) produced significant mucosal thickening with infiltration of inflammatory cells, notably eosinophils. SEB was the only toxin that promoted a mixed pattern of inflammation, including eosinophilic and neutrophilic infiltration. Conclusion Our experimental model of eosinophilic CRS in rabbits produced significant mucosal thickening and inflammation in the sinuses exposed to bacterial toxins, with histological changes analogous to what is observed in patients with CRS with nasal polyps. This model may serve as a basis for future investigation of the pathogenesis of eosinophilic CRS in relation to bacterial toxins or as a model for testing new therapeutic modalities for this disease.
Collapse
Affiliation(s)
- Andréa A. Braga
- Department of Ophthalmology, Otolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fabiana C. P. Valera
- Department of Ophthalmology, Otolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Francesca M. Faria
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Maria Rossato
- Department of Ophthalmology, Otolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Adriana A. B. Murashima
- Department of Ophthalmology, Otolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Marina Z. Fantucci
- Department of Ophthalmology, Otolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Davi C. Aragon
- Departament of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Danielle L. C. Queiroz
- Department of Ophthalmology, Otolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Wilma T. Anselmo-Lima
- Department of Ophthalmology, Otolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Edwin Tamashiro
- Department of Ophthalmology, Otolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| |
Collapse
|
22
|
Gonçalves-Ferri WA, Jauregui A, Martins-Celini FP, Sansano I, Fabro AT, Sacramento EMF, Aragon DC, Ochoa JM. Analysis of different levels of positive end-expiratory pressure during lung retrieval for transplantation: an experimental study. ACTA ACUST UNITED AC 2019; 52:e8585. [PMID: 31314854 PMCID: PMC6644527 DOI: 10.1590/1414-431x20198585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 04/24/2019] [Indexed: 11/22/2022]
Abstract
Atelectasis and inadequate oxygenation in lung donors is a common problem during the retrieval of these organs. Nevertheless, the use of high positive end-expiratory pressure (PEEP) is not habitual during procedures of lung retrieval. Twenty-one Sprague-Dawley male consanguineous rats were used in the study. The animals were divided into 3 groups according to the level of PEEP used: low (2 cmH2O), moderate (5 cmH2O), and high (10 cmH2O). Animals were ventilated with a tidal volume of 6 mL/kg. Before lung removal, the lungs were inspected for the presence of atelectasis. When atelectasis was detected, alveolar recruitment maneuvers were performed. Blood gasometric analysis was performed immediately. Finally, the lungs were retrieved, weighed, and submitted to histological analysis. The animals submitted to higher PEEP showed higher levels of oxygenation with the same tidal volumes PO2=262.14 (PEEP 2), 382.4 (PEEP 5), and 477.0 (PEEP 10). The occurrence of atelectasis was rare in animals with a PEEP of 10 cmH2O, which therefore required less frequent recruitment maneuvers (need for recruitment: PEEP 2=100%, PEEP 5 =100%, and PEEP 10=14.3%). There was no change in hemodynamic stability, occurrence of pulmonary edema, or other histological injuries with the use of high PEEP. The use of high PEEP (10 cmH2O) was feasible and probably a beneficial strategy for the prevention of atelectasis and the optimization of oxygenation during lung retrieval. Clinical studies should be performed to confirm this hypothesis.
Collapse
Affiliation(s)
- W A Gonçalves-Ferri
- Departamento de Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A Jauregui
- Department of Thoracic Surgery, Hospital Vall d'Hebron, Barcelona, Spain
| | - F P Martins-Celini
- Departamento de Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - I Sansano
- Department of Pathology, Hospital Vall d'Hebron, Barcelona, Spain
| | - A T Fabro
- Departamento de Patologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - E M F Sacramento
- Departamento de Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - D C Aragon
- Departamento de Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - J M Ochoa
- Department of Thoracic Surgery, Hospital Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
23
|
de Siqueira Caldas JP, Ferri WAG, Marba STM, Aragon DC, Guinsburg R, de Almeida MFB, Diniz EMA, Silveira RCS, Alves Junior JMS, Pavanelli MB, Bentlin MR, Ferreira DMLM, Vale MS, Fiori HH, Duarte JLMB, Meneses JA, Cwajg S, Carvalho WB, Ferrari LSL, Silva NMM, da Silva RPGVC, Anchieta LM, Santos JPF, Kawakami MD. Admission hypothermia, neonatal morbidity, and mortality: evaluation of a multicenter cohort of very low birth weight preterm infants according to relative performance of the center. Eur J Pediatr 2019; 178:1023-1032. [PMID: 31056716 DOI: 10.1007/s00431-019-03386-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 04/08/2019] [Accepted: 04/16/2019] [Indexed: 11/29/2022]
Abstract
This prospective cohort study aimed to assess the association of admission hypothermia (AH) with death and/or major neonatal morbidities among very low birth weight (VLBW) preterm infants based on the relative performance of 20 centers of the Brazilian Network of Neonatal Research. This is a retrospective analysis of prospectively collected data using the database registry of the Brazilian Network on Neonatal Research. Center performance was defined by the relative mortality rate using conditional inference trees. A total of 4356 inborn singleton VLBW preterm infants born between January 2013 and December 2016 without malformations were included in this study. The centers were divided into two groups: G1 (with lower mortality rate) and G2 (with higher mortality rate). Crude and adjusted relative risks (RR) and 95% confidence intervals (95%CI) were estimated by simple and multiple log-binomial regression models. An AH rate of 53.7% (19.8-93.3%) was significantly associated with early neonatal death in G1 (adjusted RR 1.41, 95% CI 1.09-1.84) and G2 (adjusted RR 1.29, 95%CI 1.01-1.65) and with in-hospital death in G1 (adjusted RR 1.29, 95%CI 1.07-1.58). AH was significantly associated with a lower frequency of necrotizing enterocolitis (adjusted RR 0.58, 95%CI 38-0.88) in G2.Conclusion: AH significantly associated with early neonatal death regardless of the hospital performance. In G2, an unexpected protective association between AH and necrotizing enterocolitis was found, whereas the other morbidities assessed were not significantly associated with AH. What is Known: • Admission hypothermia is associated with early neonatal death. • The association of admission hypothermia with major neonatal morbidities has not been fully established. What is New: • Admission hypothermia was significantly associated with early neonatal and in-hospital death in centers with the lowest relative mortality rates. • Admission hypothermia was not associated with major neonatal morbidities and with in-hospital death but was found to be a protective factor against necrotizing colitis in centers with the highest relative mortality rates.
Collapse
Affiliation(s)
- Jamil Pedro de Siqueira Caldas
- Department of Pediatrics, Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, Brazil. .,, Campinas, Brazil.
| | - Walusa A G Ferri
- Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Sérgio T M Marba
- Department of Pediatrics, Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, Brazil.,, São Paulo, Brazil
| | - Davi C Aragon
- Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Ruth Guinsburg
- , São Paulo, Brazil.,Division of Neonatal Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Maria F B de Almeida
- , São Paulo, Brazil.,Division of Neonatal Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Edna M A Diniz
- Department of Pediatrics, University of São Paulo, School of Medicine, São Paulo, Brazil.,Instituto da Criança, Av Dr. Enéas de Carvalho Aguiar, 647, Pinheiros, São Paulo, São Paulo, 05403-000, Brazil
| | - Rita C S Silveira
- Division of Neonatology, Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre -HCPA, Rua Silva Jardim 1155/701, Porto Alegre, Rio Grande do Sul, 90450071, Brazil
| | - José M S Alves Junior
- Department of Pediatrics, Maternidade Hilda Brandão - Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil.,, Belo Horizonte, Brazil
| | - Marco B Pavanelli
- , São Paulo, Brazil.,Neonatal Unit, Hospital Geral de Pirajussara, Taboão da Serra, Brazil
| | - Maria R Bentlin
- , São Paulo, Brazil.,Division of Neonatology, Faculdade de Medicina de Botucatu da, Universidade Estadual Paulista, Botucatu, Brazil
| | - Daniela M L M Ferreira
- Department of Pediatrics, Universidade Federal de Uberlândia, Uberlândia, Brazil.,, Uberlândia, Brazil
| | - Marynéa S Vale
- Department of Pediatrics, Universidade Federal do Maranhão, São Luís, Brazil.,, São Luís, Brazil
| | - Humberto H Fiori
- Department of Pediatrics, Hospital São Lucas - Faculdade de Medicina da, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.,, Porto Alegre, Brazil
| | - José L M B Duarte
- Department of Pediatrics, Hospital Universitário Pedro Ernesto - Universidade do Estado de Rio de Janeiro, Rio de Janeiro, Brazil.,, Rio de Janeiro, Brazil
| | - Jucille A Meneses
- Department of Pediatrics, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil.,, Recife, Brazil
| | - Silvia Cwajg
- , Rio de Janeiro, Brazil.,Division of Neonatology, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Werther B Carvalho
- Department of Pediatrics, University of São Paulo, School of Medicine, São Paulo, Brazil.,Instituto da Criança, Av Dr. Enéas de Carvalho Aguiar, 647, Pinheiros, São Paulo, São Paulo, 05403-000, Brazil
| | - Lígia S L Ferrari
- Department of Pediatrics, Hospital Universitário - Universidade Estadual de Londrina, Curitiba, Brazil.,, Londrina, Brazil
| | - Nathalia M M Silva
- Neonatal Unit, Hospital Estadual de Diadema, Diadema, Brazil.,, Diadema, Brazil
| | - Regina P G V C da Silva
- Department of Pediatrics, Hospital de Clínicas - Universidade Federal do Paraná, Curitiba, Brazil.,, Curitiba, Brazil
| | - Leni M Anchieta
- Division of Neonatology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,, Belo Horizonte, Brazil
| | - Juliana P F Santos
- Neonatal Division, Hospital Estadual Sumaré, Sumaré, Brazil.,, Sumaré, Brazil
| | - Mandira D Kawakami
- Division of Neonatal Medicine, Federal University of São Paulo, São Paulo, Brazil.,, Atibaia, Brazil
| |
Collapse
|
24
|
Matsuno AK, Gagliardi TB, Paula FE, Luna LKS, Jesus BLS, Stein RT, Aragon DC, Carlotti APCP, Arruda E. Human coronavirus alone or in co-infection with rhinovirus C is a risk factor for severe respiratory disease and admission to the pediatric intensive care unit: A one-year study in Southeast Brazil. PLoS One 2019; 14:e0217744. [PMID: 31158256 PMCID: PMC6546210 DOI: 10.1371/journal.pone.0217744] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 05/19/2019] [Indexed: 12/16/2022] Open
Abstract
Objective We aimed to assess the profile of respiratory viruses in young children hospitalized for acute lower respiratory tract infection (ALRI) and its association with disease severity, defined as need for pediatric intensive care unit (PICU) admission. Design Prospective observational cohort study. Setting A tertiary-care university hospital in Brazil. Patients Children younger than three years attending the pediatric emergency room with ALRI who were admitted to the hospital. Interventions None. Measurements and main results Nasopharyngeal aspirates were collected from patients from June 1st, 2008 to May 31st, 2009within the first 48 hours of hospitalization. Nasopharyngeal aspirates were tested for 17humanrespiratory viruses by molecular and immunofluorescence based assays. Simple and multiple log-binomial regression models were constructed to assess associations of virus type with a need for PICU admission. Age, prematurity, the presence of an underlying disease and congenital heart disease were covariates. Nasopharyngeal aspirates were positive for at least one virus in 236 patients. Rhinoviruses were detected in 85.6% of samples, with a preponderance of rhinovirus C (RV-C) (61.9%). Respiratory syncytial virus was detected in 59.8% and human coronavirus (HCoV) in 11% of the samples. Co-detections of two to five viruses were found in 78% of the patients. The detection of HCoV alone (adjusted relative risk (RR) 2.18; 95% CI 1.15–4.15) or in co-infection with RV-C (adjusted RR 2.37; 95% CI 1.23–4.58) was independently associated with PICU admission. Conclusions The detection of HCoV alone or in co-infection with RV-C was independently associated with PICU admission in young children hospitalized for ALRI.
Collapse
Affiliation(s)
- Alessandra K. Matsuno
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- * E-mail:
| | - Talita B. Gagliardi
- Department of Cell Biology and Virology Research Center, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Flavia E. Paula
- Department of Cell Biology and Virology Research Center, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Luciano K. S. Luna
- Department of Cell Biology and Virology Research Center, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Bruna L. S. Jesus
- Department of Cell Biology and Virology Research Center, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Renato T. Stein
- Department of Pediatrics,Pontifícia Universidade Católica do Rio Grande do Sul School of Medicine, Porto Alegre, Brazil
| | - Davi C. Aragon
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana P. C. P. Carlotti
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Eurico Arruda
- Department of Cell Biology and Virology Research Center, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| |
Collapse
|
25
|
Stecchini MF, Braid Z, More CB, Aragon DC, Castro M, Moreira AC, Antonini SR. Gonadotropin-dependent pubertal disorders are common in patients with virilizing adrenocortical tumors in childhood. Endocr Connect 2019; 8:579-589. [PMID: 30959478 PMCID: PMC6499918 DOI: 10.1530/ec-19-0141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/04/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the impact of early exposure to androgen excess on gonadotropin-dependent puberty (GDP) and final height (FH) of patients with androgen-secreting adrenocortical tumors (ACT) in childhood. METHODS Retrospective cohort study. Occurrence of GDP and achievement of FH were evaluated. Central precocious puberty (CPP) and early fast puberty (EFP) were considered pubertal disorders. Patients with normal puberty and pubertal disorders were compared. RESULTS The study included 63 patients (44F), followed in a single institution from 1975 until 2017. At diagnosis of ACT, median age was 25.8 months; duration of signs, 6 months; stature SDS, 0.5 (-3.6 to 3.9) and bone age advancement, 14.7 months (-27.9 to 85.4). To date, 37 patients developed GDP: 26 had normal puberty; one, precocious thelarche; seven, CPP and three, EFP. GnRHa effectively treated CPP/EFP. Tall stature and older age at diagnosis of ACT were associated with risk of CPP alone (RR 4.17 (95% CI 1.17-14.80)) and CPP/EFP (RR 3.0 (95% CI 1.04-8.65)). Recurrence/metastasis during follow-up were associated with risk of CPP alone (RR 4.17 (95% CI 1.17-14.80)) and CPP/EFP (RR 3.0 (95% CI 1.12-8.02)). Among the 19 patients that reached FH, stature SDS dropped from 1.4 to -0.02 since diagnosis of ACT (P = 0.01). Seventeen achieved normal FH. There was no difference in FH SDS between patients with normal puberty and pubertal disorders (P = 0.75). CONCLUSIONS Gonadotropin-dependent pubertal disorders are common in patients with androgen-secreting ACT in childhood. FH is usually not impaired. The study reinforces the importance of close follow-up after surgery to identify and treat consequences of early exposure to androgen excess.
Collapse
Affiliation(s)
- Monica F Stecchini
- Department of Pediatrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Zilda Braid
- Department of Pediatrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Candy B More
- Department of Pediatrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Davi C Aragon
- Department of Pediatrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Margaret Castro
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Ayrton C Moreira
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Sonir R Antonini
- Department of Pediatrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
- Correspondence should be addressed to S R Antonini:
| |
Collapse
|
26
|
Moreno A, Nunes FL, Januario YC, Maia LS, Ferriani MP, Dias MM, Aragon DC, Suffritti C, Cicardi M, da Silva LL, Arruda LKP. Cleaved High Molecular Weight Kininogen Correlates With Hereditary Angioedema Due To C1-Inhibitor Deficiency. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.127] [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: 11/17/2022]
|
27
|
Aragon DC, Achcar JA, Martinez EZ. Maximum likelihood and Bayesian estimators for the double Poisson distribution. Journal of Statistical Theory and Practice 2018. [DOI: 10.1080/15598608.2018.1489919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Davi C. Aragon
- Department of Pediatrics, University of São Paulo (USP), Ribeirão Preto Medical School, Ribeirão Preto, Brazil
| | - Jorge A. Achcar
- Department of Social Medicine, University of São Paulo (USP), Ribeirão Preto Medical School, Ribeirão Preto, Brazil
| | - Edson Z. Martinez
- Department of Social Medicine, University of São Paulo (USP), Ribeirão Preto Medical School, Ribeirão Preto, Brazil
| |
Collapse
|
28
|
Mussi-Pinhata MM, Yamamoto AY, Aragon DC, Duarte G, Fowler KB, Boppana S, Britt WJ. Seroconversion for Cytomegalovirus Infection During Pregnancy and Fetal Infection in a Highly Seropositive Population: "The BraCHS Study". J Infect Dis 2018; 218:1200-1204. [PMID: 29868783 PMCID: PMC6129109 DOI: 10.1093/infdis/jiy321] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 05/25/2018] [Indexed: 12/29/2022] Open
Abstract
We determined the risk of seroconversion in seronegative pregnant women living in a high seroprevalence population. Cytomegalovirus (CMV)-immunoglobulin G reactivity was determined at the 1st trimester in all women and sequentially for seronegative women. A total of 1915 of 1952 (98.1%; 95% confidence interval [CI], 97.4%-98.7%) women were seropositive, and 36 (1.8%; 95% CI, 1.3%-2.6%) were seronegative. Five of the 36-seronegative women seroconverted for a cumulative rate of 13.9% (95% CI, 4.8%-30.6%). Congenital CMV infection was diagnosed in 1 of 36 infants (2.8%; 95% CI, 0.5%-63.9%) born to seronegative women compared with 8 of 1685 (0.5%; 95% CI, 0.2%-1.0%) infants born to seropositive mothers. Even with a high risk of primary infection in seronegative women, most CMV-infected infants were born to women with pre-existing seroimmunity.
Collapse
Affiliation(s)
| | | | - Davi C Aragon
- Departments of Pediatrics, University of São Paulo, Brazil
| | - Geraldo Duarte
- Departments of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Karen B Fowler
- Department of Pediatrics, The University of Alabama at Birmingham
| | - Suresh Boppana
- Department of Pediatrics, The University of Alabama at Birmingham
| | - William J Britt
- Department of Pediatrics, The University of Alabama at Birmingham
| |
Collapse
|
29
|
Corradi AMB, Valarelli LP, Grechi TH, Eckeli AL, Aragon DC, Küpper DS, Almeida LA, Sander HH, Trawitzki LVV, Valera FCP. Swallowing evaluation after surgery for obstructive sleep apnea syndrome: uvulopalatopharyngoplasty vs. expansion pharyngoplasty. Eur Arch Otorhinolaryngol 2018; 275:1023-1030. [DOI: 10.1007/s00405-018-4898-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 02/01/2018] [Indexed: 11/28/2022]
|
30
|
Martins-Celini FP, Gonçalves-Ferri WA, Aragon DC, Bernichi JP, Calixto C, Sacramento EMF, Santos MA, Martinez FE. Association between type of feeding at discharge from the hospital and nutritional status of very low birth weight preterm infants. Braz J Med Biol Res 2018. [PMID: 29513880 PMCID: PMC5912099 DOI: 10.1590/1414-431x20176540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The ideal feeding for premature babies has been the source of extensive debate. The aim of this study was to assess the association between type of feeding at discharge and the nutritional status of very low birth weight infants. This was a retrospective cohort of preterm babies with birth weight ≤1500 g, born between January 2006 and December 2013. The infants were divided into 3 groups according to type of feeding at discharge: exclusive breast milk (group 1), mixed feeding (group 2) and exclusive artificial formula (group 3). Frequencies of each group were calculated, as well as mean Z-score differences in weight, length and head circumference. Six hundred and forty-nine newborns were included. The mean weight of groups 1, 2, and 3 was 1338.7, 1104.0, and 1254.7 g, respectively, and their mean gestational age was 31.9, 30, and 31.2 weeks, respectively. The Z-score differences (means±SD) for groups 1, 2, and 3 were: −0.84±0.68, −1.02±0.75, and −0.86±0.71 for weight, −0.21±1.23, −0.52±1.64 and −0.08±1.34 for head circumference, and −1.10±1.18, −1.54±1.37, and −0.97±1.21 for length. A significant difference was observed between groups 2 and 3 in the adjusted Z-score model for length, with no significant differences in anthropometric measurements for the other comparative analyses. Because of its many advantages, breastfeeding should be stimulated within neonatal units since nutritional status was not influenced by the different types of feeding.
Collapse
|
31
|
Santini MSS, Koga EC, Aragon DC, Santana EHW, Costa MR, Costa GN, Aragon-Alegro LC. Dried Tomato-Flavored Probiotic Cream Cheese withLactobacillus paracasei. J Food Sci 2012; 77:M604-8. [DOI: 10.1111/j.1750-3841.2012.02931.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
32
|
Nakiri GS, Santos AC, Abud TG, Aragon DC, Colli BO, Abud DG. A comparison between magnetic resonance angiography at 3 Teslas (time-of-flight and contrast-enhanced) and flat-panel digital subtraction angiography in the assessment of embolized brain aneurysms. Clinics (Sao Paulo) 2011; 66:641-8. [PMID: 21655760 PMCID: PMC3093796 DOI: 10.1590/s1807-59322011000400020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 01/25/2011] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To compare the time-of-flight and contrast-enhanced- magnetic resonance angiography techniques in a 3 Tesla magnetic resonance unit with digital subtraction angiography with the latest flat-panel technology and 3D reconstruction in the evaluation of embolized cerebral aneurysms. INTRODUCTION Many embolized aneurysms are subject to a recurrence of intra-aneurismal filling. Traditionally, imaging surveillance of coiled aneurysms has consisted of repeated digital subtraction angiography. However, this method has a small but significant risk of neurological complications, and many authors have advocated the use of noninvasive imaging methods for the surveillance of embolized aneurysms. METHODS Forty-three aneurysms in 30 patients were studied consecutively between November 2009 and May 2010. Two interventional neuroradiologists rated the time-of-flight-magnetic resonance angiography, the contrast-enhanced-magnetic resonance angiography, and finally the digital subtraction angiography, first independently and then in consensus. The status of aneurysm occlusion was assessed according to the Raymond scale, which indicates the level of recanalization according to degrees: Class 1: excluded aneurysm; Class 2: persistence of a residual neck; Class 3: persistence of a residual aneurysm. The agreement among the analyses was assessed by applying the Kappa statistic. RESULTS Inter-observer agreement was excellent for both methods (K = 0.93; 95 % CI: 0.84-1). Inter-technical agreement was almost perfect between time-of-flight-magnetic resonance angiography and digital subtraction angiography (K = 0.98; 95 % CI: 0.93-1) and between time-of-flight-magnetic resonance angiography and contrast-enhanced-magnetic resonance angiography (K = 0.98; 95% CI: 0.93-1). Disagreement occurred in only one case (2.3%), which was classified as Class I by time-of-flight-magnetic resonance angiography and Class II by digital subtraction angiography. The agreement between contrast-enhanced-magnetic resonance angiography and digital subtraction angiography was perfect (K = 1; 95% CI: 1-1). In three patients, in-stent stenosis was identified by magnetic resonance angiography but not confirmed by digital subtraction angiography. CONCLUSION Digital subtraction angiography and both 3T magnetic resonance angiography techniques have excellent reproducibility for the assessment of aneurysms embolized exclusively with coils. In those cases also treated with stent remodeling, digital subtraction angiography may still be necessary to confirm eventual parent artery stenosis, as identified by magnetic resonance angiography.
Collapse
Affiliation(s)
- Guilherme S Nakiri
- Division of Radiology, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, SP, Brazil.
| | | | | | | | | | | |
Collapse
|