Publications by authors named "Ana Paula Percicote"

10 Publications

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Atypical oral viral coinfection after allogeneic hematopoietic stem cell transplantation: Diagnosis and treatment challenge.

Spec Care Dentist 2021 Jul 3. Epub 2021 Jul 3.

Stomatology Department, Universidade Federal do Paraná, Curitiba, Brazil.

Background: Viral reactivation in patients undergoing immunosuppressive therapy after hematopoietic stem cell transplantation (HSCT) is a serious complication associated with significant morbidity and mortality. Infections caused by human herpes viruses such as herpes simplex virus (HSV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) can result in oral lesions.

Case Presentation: A 40-year-old male patient who had undergone HSCT presented with ulcerated lesions in different areas of the mouth, for 7 months. The lesions had evolved to painful exophytic nodules with an erythematous, ulcerated surface. They were present on the tongue margins and soft and hard palate. Histological, immunohistochemical (IHC), and polymerase chain reaction analyses were performed, and the results were compatible with HSV-1 and -2 and CMV infections. Treatment comprised five sessions of antimicrobial photodynamic therapy (aPDT) and oral valganciclovir. Thirty days after combined antiviral therapy and aPDT, the lesions were completely resolved. Patient was followed up for 12 months without recurrence.

Conclusion: Diagnosis and treatment of atypical oral infections in immunosuppressed patients is challenging. Assessment of both clinical and laboratory findings is mandatory for a conclusive diagnosis. The use of local antimicrobial and systemic therapies contributes to positive clinical response in such cases.
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http://dx.doi.org/10.1111/scd.12624DOI Listing
July 2021

Association Between COVID-19 Pregnant Women Symptoms Severity and Placental Morphologic Features.

Front Immunol 2021 26;12:685919. Epub 2021 May 26.

Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná-PUCPR, Curitiba, Brazil.

Since the beginning of the pandemic, few papers describe the placenta's morphological and morphometrical features in SARS-CoV-2-positive pregnant women. Alterations, such as low placental weight, accelerated villous maturation, decidual vasculopathy, infarcts, thrombosis of fetal placental vessels, and chronic histiocytic intervillositis (CHI), have been described.

Objective: To analyze clinical data and the placental morphological and morphometric changes of pregnant women infected with SARS-CoV-2 (COVID-19 group) in comparison with the placentas of non-infected pregnant women, matched for maternal age and comorbidities, besides gestational age of delivery (Control group).

Method: The patients in the COVID-19 and the Control group were matched for maternal age, gestational age, and comorbidities. The morphological analysis of placentas was performed using Amsterdam Placental Workshop Group Consensus Statement. The quantitative morphometric evaluation included perimeter diameter and number of tertiary villi, number of sprouts and knots, evaluation of deposition of villous fibrin, and deposition of intra-villous collagen I and III by Sirius Red. Additionally, Hofbauer cells (HC) were counted within villi by immunohistochemistry with CD68 marker.

Results: Compared to controls, symptomatic women in the COVID-19 group were more likely to have at least one comorbidity, to evolve to preterm labor and infant death, and to have positive SARS-CoV-2 RNA testing in their concepts. Compared to controls, placentas in the COVID-19 group were more likely to show features of maternal and fetal vascular malperfusion. In the COVID-19 group, placentas of symptomatic women were more likely to show CHI. No significant results were found after morphometric analysis.

Conclusion: Pregnant women with symptomatic SARS-CoV-2 infection, particularly with the severe course, are more likely to exhibit an adverse fetal outcome, with slightly more frequent histopathologic findings of maternal and fetal vascular malperfusion, and CHI. The morphometric changes found in the placentas of the COVID-19 group do not seem to be different from those observed in the Control group, as far as maternal age, gestational age, and comorbidities are paired. Only the deposition of villous fibrin could be more accentuated in the COVID-19 group (p = 0.08 borderline). The number of HC/villous evaluated with CD68 immunohistochemistry did not show a difference between both groups.
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http://dx.doi.org/10.3389/fimmu.2021.685919DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8187864PMC
July 2021

Intra- and interobserver agreement of histopathological findings in pediatric patients with eosinophilic esophagitis.

J Pediatr (Rio J) 2021 May 6. Epub 2021 May 6.

Universidade Federal do Paraná, Departamento de Pediatria, Curitiba, PR, Brazil.

Objective: To assess intra- and interobserver agreement among non-expert pathologists in identifying features of the eosinophilic esophagitis histologic scoring system (EoEHSS) in pediatric patients.

Patients And Methods: The authors used 50 slides from patients (aged 1-15 years; 72% male) with EoE. EoEHSS evaluates eosinophilic inflammation and other features including epithelial basal zone hyperplasia, eosinophilic abscesses, eosinophil surface layering, dilated intercellular spaces, surface epithelial alteration, dyskeratotic epithelial cells, and lamina propria fibrosis. Grade and stage of abnormalities are scored using a 4-point scale (0 normal; 3 maximum change). Four pathologists determined EoEHSS findings on two occasions. Intra- and interobserver agreement was assessed using Kappa (κ) statistics and intra-class correlation coefficients.

Results: Intra- and interobserver agreement for the identification of eosinophil counts ≥ 15/high power field (HPF) was excellent, however varied when assessing additional features of the EoEHSS. For the more experienced pathologist, agreement for most EoEHSS items and the composite scores was substantial to excellent. For the less experienced pathologists, intraobserver agreement ranged from absent to substantial for individual features and ranged from moderate to substantial for the composite scores.

Conclusion: Most items of the EoEHSS had substantial to excellent reliability when assessed by a pathologist experienced in the diagnosis of EoE but presented lower repeatability among less experienced pathologists. These findings suggest that specific training of pathologists is required for the identification of EoEHSS characteristics beyond eosinophil count, as these features are considered useful in the evaluation of response to treatment and correlation with clinical manifestations and endoscopic findings.
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http://dx.doi.org/10.1016/j.jped.2021.03.004DOI Listing
May 2021

Comparison between non-invasive methods and liver histology to stratify liver fibrosis in obese patients submitted to bariatric surgery.

Obes Res Clin Pract 2021 Mar-Apr;15(2):152-156. Epub 2021 Feb 27.

Hospital Nossa Senhora das Graças - Curitiba, Paraná, Brazil.

Background: Obesity is a multifactorial disease characterized by fat accumulation, usually associated with non-alcoholic fatty liver disease, which can lead to advanced fibrosis or even cirrhosis. Bariatric surgery (BS) is a treatment approved for weight loss in morbidly obese patients. However, complications from this modality of treatment have been reported and liver cirrhosis connotes more risk procedure.

Aims: Evaluate non-invasive methods transient elastography (THE) and scores to establish the degree of liver fibrosis in patients submitted to BS, comparing their performance with liver histology.

Methods: We calculated liver fibrosis by non-invasive scores AST to platelet ration index (APRI), fibrosis-4 (FIB-4) and non-alcoholic fatty liver disease (NAFLD) score and THE before and 6 months after the bariatric surgery. The results were compared to liver histology.

Results: We included 85 patients, 69.4% females, with a mean age of 36 years, with a mean body mass index (BMI) of 41 kg/m. The non-invasive scores were able to exclude clinically significant fibrosis in 85.9% (APRI) and advanced fibrosis in 96.5% (FIB-4) and 51.8% (NAFLD score). When comparing with the histological findings, the correlation with elastography was 45.9% for the same degree of fibrosis, with high negative predictive value (94.4%) in pre-surgical analysis. In the post-surgical analysis, the correlation with histology was 69.4% for THE and the negative predictive value to exclude clinically significant fibrosis was 98.5%.

Conclusion: THE showed low correlation with histology in the pre-surgical analysis. All the methods had better results in post bariatric evaluation comparing with pre-bariatric data and the non-invasive FIB-4 score showed the best of them.
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http://dx.doi.org/10.1016/j.orcp.2021.02.004DOI Listing
September 2021

Intrauterine Transmission of SARS-CoV-2.

Emerg Infect Dis 2021 Feb 13;27(2):638-641. Epub 2020 Nov 13.

We documented fetal death associated with intrauterine transmission of severe acute respiratory syndrome coronavirus 2. We found chronic histiocytic intervillositis, maternal and fetal vascular malperfusion, microglial hyperplasia, and lymphocytic infiltrate in muscle in the placenta and fetal tissue. Placenta and umbilical cord blood tested positive for the virus by PCR, confirming transplacental transmission.
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http://dx.doi.org/10.3201/eid2702.203824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853547PMC
February 2021

The importance of staged surgery for giant atypical central neurocytoma.

Acta Neurol Belg 2020 Aug 28. Epub 2020 Aug 28.

Neurosurgery Department of Pequeno Príncipe Hospital, 1070 Desembargador Motta street, Água Verde, Curitiba-PR, 80250-060, Brazil.

The aim of this article is to discuss the importance of staged surgeries when approaching atypical central neurocytoma in children. Also, we show the preoperative embolization of the lesion as a maneuver to reduce the intraoperative bleeding. Central neurocytomas represent less than 0.5% of all intracranial tumors, and atypical central neurocytomas usually have unfavorable outcome, with high recurrence rate. The intraventricular location is frequent, with a predilection for the lateral ventricles. When completely resected, these lesions have a good prognosis. We report a case of a 12-year old male patient that presented with a history of headache for about 6 months, which worsened for 1 week prior to admission. Magnetic resonance imaging (MRI) brain showed a massive lesion occupying both lateral ventricles. He underwent a microsurgical treatment of a highly vascularized lesion, but the perioperative bleeding required interruption of the surgery. Thus, a preoperative embolization was able to occlude most arterial feeders and allowed subtotal resection in a second surgery. The patient had complete neurological recovery despite immediate post-operative deficits, and the histopathology was suggestive of atypical neurocytoma. Two-stage surgery with preoperative adjuvant embolization is a feasible strategy for treatment of large central neurocytomas in children.
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http://dx.doi.org/10.1007/s13760-020-01480-6DOI Listing
August 2020

Conservation of both hematocrit and liver regeneration in hepatectomies: a vascular occlusion approach in rats.

Arq Bras Cir Dig 2020 30;33(1):e1484. Epub 2020 Mar 30.

Department of Surgery, Health Sciences Sector.

Background: Hepatectomies promote considerable amount of blood loss and the need to administrate blood products, which are directly linked to higher morbimortality rates. The blood-conserving hepatectomy (BCH) is a modification of the selective vascular occlusion technique. It could be a surgical maneuver in order to avoid or to reduce the blood products utilization in the perioperative period.

Aim: To evaluate in rats the BCH effects on the hematocrit (HT) variation, hemoglobin serum concentration (HB), and on liver regeneration.

Methods: Twelve Wistar rats were divided into two groups: control (n=6) and intervention (n=6). The ones in the control group had their livers partially removed according to the Higgins and Anderson technique, while the rats in the treatment group were submitted to BCH technique. HT and HB levels were measured at day D0, D1 and D7. The rate between the liver and rat weights was calculated in D0 and D7. Liver regeneration was quantitatively and qualitatively evaluated.

Results: The HT and HB levels were lower in the control group as of D1 onwards, reaching an 18% gap at D7 (p=0.01 and p=0.008, respectively); BCH resulted in the preservation of HT and HB levels to the intervention group rats. BCH did not alter liver regeneration in rats.

Conclusion: The BCH led to beneficial effects over the postoperative HT and serum HB levels with no setbacks to liver regeneration. These data are the necessary proof of evidence for translational research into the surgical practice. A) Unresected liver; B) liver appearance after the partial hepatectomy (1=vena cava; 2=portal vein; 3=hepatic vein; 4=biliary drainage; 5=hepatic artery).
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http://dx.doi.org/10.1590/0102-672020190001e1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7099868PMC
April 2020

Tissue expression of retinoic acid receptor alpha and CRABP2 in metastatic nephroblastomas.

Diagn Pathol 2018 Jan 22;13(1). Epub 2018 Jan 22.

Department of Medical Pathology, Federal University of Paraná and School of Health of the Pontifical Catholic University of Paraná, Curitiba, Brazil.

Background: Nephroblastoma or Wilms tumor is the most frequent kidney cancer in children and accounts for 98% of kidney tumors in this age group. Despite favorable prognosis, a subgroup of these patients progresses to recurrence and death. The retinoic acid (RA) pathway plays a role in the chemoprevention and treatment of tumors due to its effects on cell differentiation and its antiproliferative, anti-oxidant, and pro-apoptotic activities. Reports describe abnormal cellular retinoic acid-binding protein 2 (CRABP2) expression in neoplasms and its correlation with prognostic factors and clinical and pathological characteristics. The aim of this study was to evaluate the immunohistochemical expression of retinoic acid receptor alpha (RARA) and CRABP2 in paraffin-embedded samples of nephroblastomas via semiquantitative and quantitative analyses and to correlate this expression with prognostic factors.

Methods: Seventy-seven cases of nephroblastomas were selected from pediatric oncology services. The respective medical records and surgical specimens were reviewed. Three representative tumor samples and one non-tumor renal tissue sample were selected for the preparation of tissue microarrays (TMA). The Allred scoring system was used for semiquantitative immunohistochemical analyses, whereas a morphometric analysis of the stained area was employed for quantitative evaluation. The nonparametric Mann-Whitney test was used for comparisons between two groups, while the nonparametric Kruskal-Wallis test was used to compare three or more groups.

Results: Immunopositivity for RARA and CRABP2 was observed in both the nucleus and cytoplasm. All histological components of the nephroblastoma (blastema, epithelium, and stroma) were positive for both markers. RARA, based on semiquantitative analyses, and CRABP2, bases on quantitative analyses, exhibited increased immunohistochemical expression in patients with metastasis, with p values of 0.0247 and 0.0128, respectively. These findings were similar to the results of the quantitative analysis of RARA expression, showing greater immunopositivity in tumor samples of patients subjected to pre-surgical chemotherapy. No significant correlation was found with the other variables studied, such as disease stage, anaplasia, risk group, histological type, nodal involvement, and clinical evolution.

Conclusions: Semiquantitative and quantitative analyses of the markers RARA and CRABP2 indicate their potential as biomarkers for tumor progression and their participation in nephroblastoma tumorigenesis.
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http://dx.doi.org/10.1186/s13000-018-0686-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6389245PMC
January 2018

Immunohistochemical expression of sulfhydryl oxidase (QSOX1) in pediatric medulloblastomas.

Diagn Pathol 2015 Apr 24;10:37. Epub 2015 Apr 24.

School of Medicine, Pontifical Catholic University of Paraná, Curitiba, Brazil.

Background: Medulloblastoma is a malignant, invasive embryonal tumor of the cerebellum and accounts for 20% of intracranial tumors in children. QSOX1, whose functions include formation of disulphide bridges, which are needed for correct protein folding and stability, formation of the extracellular matrix, regulation of the redox status and cell cycle control, appears to be involved in apoptosis in pathological states such as cancer. Thus, the aim of this study was to investigate the immunohistochemical expression of QSOX1 in medulloblastomas and nonneoplastic cerebellum.

Methods: Histology blocks of pediatric medulloblastomas were separated and two representative areas of the tumors and non-neoplastic cerebellum samples were used to construct tissue microarrays (TMAs) that were stained with an anti-QSOX1 antibody, and the slides were read using image analysis software.

Results: QSOX1 immunoexpression was observed in the non-neoplastic cerebellum samples and the medulloblastoma samples. There was no statistically significant relationship between QSOX1 immunopositivity in the medulloblastoma samples and the clinical and pathological variables.

Conclusions: Although QSOX1 did not prove useful for stratifying patients into risk groups, tumor cells and the fibrillar extracellular matrix were positive for this marker, indicating that this enzyme may be involved in the pathogenesis of medulloblastoma.

Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1822040654139436.
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http://dx.doi.org/10.1186/s13000-015-0268-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414442PMC
April 2015

Adult rhabdomyoma at submandibular gland.

Braz J Otorhinolaryngol 2012 Oct;78(5):138

Hospital Erasto Gaertner, Curitiba, Paraná, Brazil.

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http://dx.doi.org/10.5935/1808-8694.20120024DOI Listing
October 2012
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