Publications by authors named "Marcia Olandoski"

98 Publications

PREVALENCE OF SELF-MEDICATION FOR DYSPEPTIC SYMPTOMS IN PRIMARY CARE: A BRAZILIAN SURVEY.

Arq Gastroenterol 2021 Jul-Sep;58(3):364-369

Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brasil.

Background: Dyspeptic symptoms are among the eight symptoms that most lead to the use of self-medication globally.

Objective: The aim of the present study was to evaluate the frequency of use and profile of the population doing self-medication to control dyspeptic symptoms in a capital from South Brazil.

Methods: Application of a survey consisting of topics regarding individual's socio-cultural data, self-reported comorbidities, use of self-medication in the 15 days prior to the interview and information on the use of this medication. Statistical analysis was performed on the data collected to determine the prevalence of self-medication for dyspeptic symptoms (SMDS) and to establish correlations with independent factors, such as gender, age, body mass index (BMI), education, family income and self-reported comorbidities.

Results: A total of 719 individuals from the public health system were interviewed. Overall, 67.7% were female, 65.3% had a BMI greater than 25; 28.4% presented with self-reported hypertension, 21.4% with depression and 13.8% with diabetes. The prevalence of self-medication to control digestive symptoms in this population was 28.7% (95%CI: 25.3-32), 91.8% (n=189) due to complaints of dyspeptic origin. Proton pump inhibitors were the most used class of medication (67%), followed by antacids (15%). There was a relationship between SMDS and age >38 years (OR=1.734, 95%CI: 1.177-2.580, P=0.001), BMI >26 (OR=1.660, 95%CI: 1.166-2.362, P<0.001) and self-reported depression (OR=1.471, 95%CI: 0.983-2.201, P=0.04).

Conclusion: There was a higher prevalence of the use of self-medication to control dyspeptic symptoms in relation to previous data from the literature. Age >38 years, BMI >26 and self-reported depression were associated with SMDS.
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http://dx.doi.org/10.1590/S0004-2803.202100000-61DOI Listing
October 2021

Bone-Marrow Stem Cells and Acellular Human Amniotic Membrane in a Rat Model of Heart Failure.

Life (Basel) 2021 Sep 13;11(9). Epub 2021 Sep 13.

Experimental Laboratory of Institute of Biological and Health Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba 80215-901, Brazil.

Myocardial infarction (MI) remains the leading cause of cardiovascular death worldwide and a major cause of heart failure. Recent studies have suggested that cell-based therapies with bone marrow stem cells (BMSC) and human amniotic membrane (hAM) would recover the ventricular function after MI; however, the mechanisms underlying these effects are still controversial. Herein, we aimed to compare the effects of BMSC and hAM in a rat model of heart failure. MI was induced through coronary occlusion, and animals with an ejection fraction (EF) < 50% were included and randomized into three groups: control, BMSC, and hAM. The BMSC and hAM groups were implanted on the anterior ventricular wall seven days after MI, and a new echocardiographic analysis was performed on the 30th day, followed by euthanasia. The echocardiographic results after 30 days showed significant improvements on EF and left-ventricular end-sistolic and end-diastolic volumes in both BMSC and hAM groups, without significant benefits in the control group. New blood vessels, desmine-positive cells and connexin-43 expression were also elevated in both BMSC and hAM groups. These results suggest a recovery of global cardiac function with the therapeutic use of both BMSC and hAM, associated with angiogenesis and cardiomyocyte regeneration after 30 days.
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http://dx.doi.org/10.3390/life11090958DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8471644PMC
September 2021

Association of estrogen receptor alpha 1 and TMJ dysfunction: A pilot study.

Oral Surg Oral Med Oral Pathol Oral Radiol 2021 Apr 28;131(4):e89-e94. Epub 2020 Nov 28.

Full Professor, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba-PR, Brazil. Electronic address:

Objective: Temporomandibular disorder (TMD) is a multifactorial condition and the most common cause of orofacial pain, affecting mostly women, which points to a female hormone predilection. Therefore, the aim of this study was to analyze the association between TMD and estrogen receptor alpha 1 expression in disks of patients with TMD and condyle fracture (CFx).

Study Design: Forty specimens (from 27 patients) included n = 8 CFx, n = 21 anterior disk displacement with reduction (ADDwR), and n = 11 anterior disk displacement without reduction (ADDwoR). Age, area, and intensity of immunostaining were statistically compared between CFx, ADDwR, and ADDwoR groups using analysis of variance and Kruskal-Wallis analysis (P < .05).

Results: No significant difference between CFx, ADDwR, and ADDwoR groups with respect to age and expression of estrogen receptor alpha 1 was observed on immunohistochemical examination.

Conclusion: No association of estrogen receptor alpha 1 expression and age was found in the CFx, ADDwR, and ADDwoR groups.
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http://dx.doi.org/10.1016/j.oooo.2020.11.010DOI Listing
April 2021

High prevalence of biochemical disturbances of chronic kidney disease - mineral and bone disorders (CKD-MBD) in a nation-wide peritoneal dialysis cohort: are guideline goals too hard to achieve?

J Bras Nefrol 2021 Apr-Jun;43(2):173-181

Pontifícia Universidade Católica do Paraná, Escola de Medicina, Curitiba, PR, Brasil.

Introduction: Chronic kidney disease - mineral and bone disorders (CKD-MBD) are common in dialysis patients. Definition of targets for calcium (Ca), phosphorus (P), parathormone (iPTH), and alkaline phosphatase (ALP) and their treatment recommendations, are provided by international guidelines. There are few studies analyzing CKD-MBD in peritoneal dialysis (PD) patients and the impact of guidelines on mineral metabolism control. The aim of our study was to describe the prevalence of biomarkers for CKD-MBD in a large cohort of PD patients in Brazil.

Methods: Data from the nation-wide prospective observational cohort BRAZPD II was used. Incident patients were followed between December 2004 and January 2011. According to KDOQI recommendations, reference ranges for total Ca were 8.4 to 9.5 mg/dL, for P, 3.5 to 5.5 mg/dL, for iPTH, 150-300 pg/mL, and for ALP, 120 U/L.

Results: Mean age was 59.8 ± 16 years, 48% were male, and 43% had diabetes. In the beginning, Ca was 8.9 ± 0.9 mg/dL, and 48.3% were on the KODQI target. After 1 year, Ca increased to 9.1 ± 0.9 mg/dL and 50.4% were in the KDOQI preferred range. P at baseline was 5.2 ± 1.6 mg/dL, with 52.8% on target, declining to 4.9 ± 1.5 mg/dL after one year, when 54.7% were on target. Median iPTH at baseline was 238 (P25% 110 - P75% 426 pg/mL) and it remained stable throughout the first year; patients within target ranged from 26 to 28.5%. At the end of the study, 80% was in 3.5 meq/L Ca dialysate concentration, 66.9% of patients was taking any phosphate binder, and 25% was taking activated vitamin D.

Conclusions: We observed a significant prevalence of biochemical disorders related to CKD-MBD in this dialysis population.
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http://dx.doi.org/10.1590/2175-8239-JBN-2020-0147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8257285PMC
August 2021

Osteoprotegerin is a marker of cardiovascular mortality in patients with chronic kidney disease stages 3-5.

Sci Rep 2021 01 28;11(1):2473. Epub 2021 Jan 28.

Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, General Carneiro, 181, Curitiba, PR, 80060-900, Brazil.

Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). Osteoprotegerin (OPG), known to regulate bone mass by inhibiting osteoclast differentiation and activation, might also play a role in vascular calcification. Increased circulating OPG levels in patients with CKD are associated with aortic calcification and increased mortality. We assessed the predictive role of OPG for all-cause and cardiovascular mortality in patients with CKD stages 3-5 over a 5-year follow-up period. We evaluated the relationship between OPG and all-cause and cardiovascular mortality in 145 CKD patients (stages 3-5) in a prospective observational follow-up study. Inflammation markers, including high-sensitivity C-reactive protein, standard echocardiography, and estimation of intima-media thickness in the common carotid artery, were assessed at baseline, and correlations with OPG levels were determined. The cutoff values for OPG were defined using ROC curves for cardiovascular mortality. Survival was assessed during follow up lasting for up to 5.5 years using Fine and Gray model. A total of 145 (89 men; age 58.9 ± 15.0 years) were followed up. The cutoff value for OPG determined using ROC was 10 pmol/L for general causes mortality and 10.08 pmol/L for CV causes mortality. Patients with higher serum OPG levels presented with higher mortality rates compared to patients with lower levels. Aalen-Johansen cumulative incidence curve analysis demonstrated significantly worse survival rates in individuals with higher baseline OPG levels for all-cause and cardiovascular mortality (p < 0.001). In multivariate analysis, OPG was a marker of general and cardiovascular mortality independent of sex, age, CVD, diabetes, and CRP levels. When CKD stages were included in the multivariate analysis, OPG was an independent marker of all-cause mortality but not cardiovascular mortality. Elevated serum OPG levels were associated with higher all-cause and cardiovascular mortality risk, independent of age, CVD, diabetes, and inflammatory markers, in patients with CKD.
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http://dx.doi.org/10.1038/s41598-021-82072-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844415PMC
January 2021

Association Between Abdominal Waist Circumference and Blood Pressure In Brazilian Adolescents With Normal Body Mass Index: Waist circumference and blood pressure in Adolescents.

Glob Heart 2020 04 3;15(1):27. Epub 2020 Apr 3.

Center for Clinical and Epidemiological Research (EpiCenter), School of Medicine, Pontifícia Universidade Católica do Paraná, Rua Rockfeller, Curitiba/PR, BR.

Obesity is the most common chronic disease in adolescents. In adults, waist circumference (WC) is associated with the presence of cardiovascular risk factors and is also a better predictor of cardiovascular (CV) risk than body mass index (BMI). The association between WC and CV risk factors in adolescents has been poorly explored so far, mainly in those within the normal BMI range.

Objective: To evaluate the association between WC and elevated blood pressure (BP) in adolescents with a normal BMI.

Methods: Cross-sectional analysis of 73,399 scholars between 12 and 17 years old from the ERICA study, a school-based, national representative study with Brazilian adolescents. Only those within the normal range of BMI were included. The WC was categorized into quartiles for sex and age (Q1 to Q4). For the analysis, BP values ≥ 90th percentile were considered to indicate elevated BP, what includes hypertension and pre-hypertension. The Poisson Regression model was used and the prevalence ratio was estimated.

Results: A total of 53,308 adolescents with normal BMI were included. Prevalence of elevated BP in the overall group was 18.0%. In female adolescents with WC in the lowest quartile for their age, the prevalence of elevated BP was 7.3% (12-14 years) and 6.9% (15-17 years), increasing in the upper quartile to 15.2% and 19.5% respectively, with a prevalence ratio (PR) indicating chance at least two times higher for elevated BP in Q4 (p < 0.001). Similarly, this was observed in boys, with a prevalence of elevated BP of 10.0% and 18.9% in Q1, increasing to 21.4% and 49.6% in Q4 (p < 0.001).

Conclusion: In adolescents, there is a strong association of increased WC with BP elevation, even when the BMI is adequate.
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http://dx.doi.org/10.5334/gh.779DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218763PMC
April 2020

Prevalence of Combined Lipid Abnormalities in Brazilian Adolescents and Its Association with Nutritional Status: Data from the Erica Study.

Glob Heart 2020 03 18;15(1):23. Epub 2020 Mar 18.

Pontificial Catholic University of Parana (PUCPR), Curitiba, BR.

Background: Cardiovascular diseases are the leading cause of death in Brazil and worldwide. The growing incidence of obesity in children and adolescents and its association with lipid abnormalities may worsen this scenario, mainly in developing countries where obesity has reached epidemic levels. Dyslipidemias have several patterns, and the combination of some lipid abnormalities may have higher atherogenic potential.

Objectives: To evaluate the prevalence of single or multiple combined lipid abnormalities in adolescents and its association with nutritional status assessed by body mass index.

Methods: Data were obtained from the Study of Cardiovascular Risks in Adolescents (ERICA), a school-based, national representative study with Brazilian adolescents between 12 and 17 years of age. Adolescents whose lipid profiles were available were included, and lipid abnormalities were defined as LDL-C ≥ 100 mg/dL, HDL-C < 45 mg/dL, and tryglicerides (TG) ≥ 100 mg/dL. We assessed the prevalence of single or combined lipid abnormalities and correlated this nutritional status with body mass index of low weight, normal, overweight, and obesity.

Results: A total of 38,069 adolescents were included, with more than 24,000 of them presenting at least one lipid abnormality (64.7%), and 3.7% showing alterations in all of them. The most prevalent combination was high TG with low HDL-C levels. The higher the BMI, the more lipid abnormalities were found.

Conclusions: In this large and representative sample of Brazilian adolescents, the majority had at least one lipid abnormality. Higher BMI was associated with a higher prevalence of combined lipid abnormalities.

Highlights: - There is a high prevalence of Brazilian adolescents with dyslipidemias.- BMI was associated with a higher prevalence of combined lipid abnormalities.- BMI can be considered as an indicator of the diagnosis of dyslipidemia in adolescents.
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http://dx.doi.org/10.5334/gh.769DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218779PMC
March 2020

Nonalcoholic Fatty Liver Disease and Coronary Artery Disease: Big Brothers in Patients with Acute Coronary Syndrome.

ScientificWorldJournal 2020 13;2020:8489238. Epub 2020 Apr 13.

Department of Internal Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.

Background: The prevalence of nonalcoholic fatty liver disease (NAFLD) has been increasing. This study aimed to evaluate the prevalence of NAFLD, as diagnosed by ultrasound, in patients with acute coronary syndrome (ACS) and to assess whether NAFLD is associated with the severity of coronary obstruction as diagnosed by coronary angiography.

Methods: We performed a prospective single-center study in patients hospitalized due to acute coronary syndrome who underwent diagnostic coronary angiography. Consecutive patients who presented to the emergency room were diagnosed with acute coronary syndrome and were included. All patients underwent ultrasonography of the upper abdomen to determine the presence or absence of NAFLD; NAFLD severity was graded from 0 to 3 based on a previously validated scale. All patients underwent diagnostic coronary angiography in the same hospital, with the same team of interventional cardiologists, who were blinded to the patients' clinical and ultrasonographic data. CAD was then angiographically graded from none to severe based on well-established angiographic criteria.

Results: This study included 139 patients, of whom 83 (59.7%) were male, with a mean age of 59.7 years. Of the included patients, 107 (77%) patients had CAD, 63 (45%) with serious injury. Regarding the presence of NAFLD, 76 (55.2%) had NAFLD including 18 (23.6%) with grade III disease. In severe CAD, 47 (60.5%) are associated with NAFLD, and 15 (83.3%) of the patients had severe CAD and NAFLD grade III.

Conclusions: NAFLD is common in patients with ACS. The intensity of NAFLD detected by ultrasonography is strongly associated with the severity of coronary artery obstruction on angiography.
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http://dx.doi.org/10.1155/2020/8489238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7174950PMC
November 2020

Stem Cells and Platelet-Rich Plasma Enhance the Healing Process of Tendinitis in Mice.

Stem Cells Int 2019 2;2019:1497898. Epub 2019 Jun 2.

Experimental Laboratory of Institute of Biological and Health Sciences of Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição 1155, 80215-901 Curitiba, PR, Brazil.

Objective: Achilles tendon pathologies occur frequently and have a significant socioeconomic impact. Currently, there is no evidence on the best treatment for these pathologies. Cell therapy has been studied in several animal models, and encouraging results have been observed with respect to tissue regeneration. This study is aimed at evaluating the functional and histological effects of bone marrow stem cell or platelet-rich plasma implantation compared to eccentric training in the treatment of Achilles tendinopathy in rats.

Methods: Fourty-one male Wistar rats received collagenase injections into their bilateral Achilles tendons (collagenase-induced tendinopathy model). The rats were randomly divided into four groups: stem cells (SC), platelet-rich plasma (PRP), stem cells+platelet-rich plasma (SC+PRP), and control (eccentric training (ET)). After 4 weeks, the Achilles tendons were excised and subjected to biomechanical and histological analyses (Sirius red and hematoxylin-eosin staining).

Results: Biomechanical assessments revealed no differences among the groups in ultimate tensile strength or yield strength of the tendons ( = 0.157), but there were significant differences in the elastic modulus (MPa; = 0.044) and maximum tensile deformation ( = 0.005). The PRP group showed the greatest maximum deformation, and the SC group showed the highest Young's modulus (elasticity) measurement. In histological analysis (hematoxylin-eosin and Sirius red staining), there were no differences among the groups.

Conclusion: PRP and SC+PRP yielded better biomechanical results than eccentric training, showing that these treatments offer better tend function outcomes. This theoretical rationale for the belief that cell therapies can serve as viable alternatives to current treatments chronic fibrotic opens the door for opportunities to continue this research.
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http://dx.doi.org/10.1155/2019/1497898DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6778922PMC
June 2019

Ramipril significantly attenuates the development of non-alcoholic steatohepatitis in hyperlipidaemic rabbits.

Am J Cardiovasc Dis 2019 15;9(2):8-17. Epub 2019 Apr 15.

Department of Medicine, Pontificia Universidade Católica do Parana Curitiba, Brazil.

Background: Non-alcoholic fatty liver disease (NAFLD) is considered as the most frequent cause of chronic hepatic disease in adults. It is strictly correlated with insulin resistance, frequently associated with components of metabolic syndrome, and, similarly to the latter, it has been correlated with high risk of developing type 2 diabetes and cardiovascular diseases. Systemic arterial hypertension has been suggested to be associated with NAFLD in approximately 40% of the cases, and NAFLD has been independently associated with an increased risk of arterial hypertension in observational studies. Therefore, we can infer that treating arterial hypertension in NAFLD carriers will be often necessary and that the potential beneficial effects of the antihypertensive might, in this context, influence the choice of the respective drug. The renin-angiotensin system has been correlated to the whole basic physiopathogenic mechanism of NAFLD in experimental models. Based on these findings, we conducted this study to evaluate the effects of the ACE-inhibitor ramipril, used preventively, in NAFLD induced in rabbits fed hyperlipidaemic diet.

Methods: Twenty-nine rabbits were divided into three groups (normal, placebo, and ramipril). The placebo and ramipril groups were fed a ration containing 0.925% cholesterol. The groups were orally administered 0.35 mg/kg/day of ramipril, and an equivalent volume of vehicle was administered to the placebo group. At the end of the 8th week, all rabbits underwent segmental hepatic resection and were euthanized. Blood samples were collected to determine glucose, insulin, creatinine, total cholesterol, triglycerides, HDL-C, and aminotransferase levels at baseline and euthanasia. Haematoxylin and eosin and Gomori trichrome-stained slides were analysed based on the histological scoring system for NAFLD. Sudan III-stained slides were analysed by morphometry and immunostained based on the Allred scoring system.

Results: When compared with placebo, ramipril significantly diminished the development of steatosis (P=0.032), lobular inflammation (P=0.006), hepatocellular ballooning (P=0.023), and fibrosis (P=0.02). Based on the NAFLD activity score (NAS), ramipril significantly reduced the development of non-alcoholic steatohepatitis (NASH) (P=0.003).

Conclusions: The preventive use of ramipril in rabbits fed hyperlipidaemic diet, attenuates the development of the whole NAFLD histopathological spectrum and based on NAS, ramipril significantly reduced the development of NASH.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526354PMC
April 2019

The Impact of Uremic Toxicity Induced Inflammatory Response on the Cardiovascular Burden in Chronic Kidney Disease.

Toxins (Basel) 2018 09 23;10(10). Epub 2018 Sep 23.

Graduate Program in Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR 80215-901, Brazil.

Uremic toxin (UT) retention in chronic kidney disease (CKD) affects biological systems. We aimed to identify the associations between UT, inflammatory biomarkers and biomarkers of the uremic cardiovascular response (BUCVR) and their impact on cardiovascular status as well as their roles as predictors of outcome in CKD patients. CKD patients stages 3, 4 and 5 ( = 67) were recruited and UT (indoxyl sulfate/IS, p-cresil sulfate/pCS and indole-3-acetic acid/IAA); inflammatory biomarkers [Interleukin-6 (IL-6), high sensitivity C reactive protein (hsCRP), monocyte chemoattractant protein-1 (MCP-1), soluble vascular adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (sICAM-1) and soluble Fas (sFas)] and BUCVRs [soluble CD36 (sCD36), soluble receptor for advanced glycation end products (sRAGE), fractalkine] was measured. Patients were followed for 5.2 years and all causes of death was used as the primary outcome. Artery segments collected at the moment of transplantation were used for the immunohistochemistry analysis in a separate cohort. Estimated glomerular filtration rate (eGFR), circulating UT, plasma biomarkers of systemic and vascular inflammation and BUCVR were strongly interrelated. Patients with plaque presented higher signs of UT-induced inflammation and arteries from CKD patients presented higher fractalkine receptor (CX3CR1) tissue expression. Circulating IS ( = 0.03), pCS ( = 0.007), IL-6 ( = 0.026), sFas ( = 0.001), sCD36 ( = 0.01) and fractalkine ( = 0.02) were independent predictors of total mortality risk in CKD patients. Our results reinforce the important role of uremic toxicity in the pathogenesis of cardiovascular disease (CVD) in CKD patients through an inflammatory pathway.
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http://dx.doi.org/10.3390/toxins10100384DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6215310PMC
September 2018

Vitamin D Receptor Gene Polymorphisms and Environment Influencing the Impact on Survival in Hemodialysis Patients.

Iran J Kidney Dis 2018 07;12(4):223-231

School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.

Introduction: The vitamin D-receptor axis is involved in multiple physiological functions and altered states such as hypertension, mineral metabolism disorders, and inflammation. These disturbances are major risk factors for progression to end-stage kidney disease and cardiovascular disease. In addition, changes in internal systemic environment could be influencing the impact of survival in patients with kidney disease. This study aimed to evaluate the impact of vitamin D receptor (VDR) polymorphisms on hemodialysis patients' survival.

Material And Methods: A total of 122 hemodialysis patients and 120 healthy controls were compared for VDR gene polymorphism. Markers for full coverage in the VDR gene were selected and genotyped. The hemodialysis patients were followed until death event, which was considered the primary endpoint for the survival analysis.

Results: Two tag SNPs (rs10875695 and rs11168293) showed significant differences between the hemodialysis and healthy patients. In survival analysis, the CC genotype for rs2248098, compared to the TT genotype, was associated with a worse mortality rate. After adjustments for age, sex, diabetes mellitus, and cardiovascular disease, the genotype CC (rs2248098) was associated with a higher risk of mortality in a multivariable analysis.

Conclusions: Polymorphisms specific to patients with kidney disease could be influencing different conditions associated with mortality. Thus, these genetic markers, rs2248098 for example, would act in a specific time in the history of kidney disease and would bring different results of patient survival outcomes.
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July 2018

Expanded CD133 Cells from Human Umbilical Cord Blood Improved Heart Function in Rats after Severe Myocardial Infarction.

Stem Cells Int 2018 11;2018:5412478. Epub 2018 Apr 11.

Core for Cell Technology, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.

Pharmacological approaches are partially effective in limiting infarct size. Cell therapies using a cell population enriched with endothelial progenitor cells (EPCs) CD133 have opened new perspectives for the treatment of ischemic areas after infarction. This preclinical study evaluated the effect of intramyocardial transplantation of purified or expanded human umbilical cord blood-derived CD133 cells on the recovery of rats following acute myocardial infarction (AMI). Histology studies, electrocardiogram, and fluorescence in situ hybridization (FISH) were used to evaluate heart recovery. Purified CD133 cells, enriched in endothelial progenitor cells, when expanded acquired an endothelial-like cell phenotype expressing CD31 and von Willebrand factor (vWF). The group of infarcted rats that received expanded CD133 cells had a more significant recovery of contraction performance and less heart remodeling than the group that received purified CD133 cells. Either purified or expanded CD133 cells were able to induce neovascularization in the infarcted myocardium in an equivalent manner. Few human cells were detected in the infarcted myocardium of the rats 28 days after transplantation suggesting that the effects observed might be related primarily to paracrine activity. Although both cell populations ameliorated the infarcted heart and are suitable for regeneration of the vascular system, expanded CD133 cells are more beneficial and promising candidates for vascular regeneration.
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http://dx.doi.org/10.1155/2018/5412478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5925035PMC
April 2018

Regeneration of Tracheal Tissue in Partial Defects Using Porcine Small Intestinal Submucosa.

Stem Cells Int 2018 26;2018:5102630. Epub 2018 Feb 26.

Experimental Laboratory of Institute of Biological and Health Sciences of Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição 1155, 80215-901 Curitiba, PR, Brazil.

Background: Surgical correction of tracheal defects is a complex procedure when the gold standard treatment with primary end-to-end anastomosis is not possible. An alternative treatment may be the use of porcine small intestinal submucosa (SIS). It has been used as graft material for bioengineering applications and to promote tissue regeneration. The aim of this study was to evaluate whether SIS grafts improved tracheal tissue regeneration in a rabbit model of experimental tracheostomy.

Methods: Sixteen rabbits were randomized into two groups. Animals in the control group underwent only surgical tracheostomy, while animals in the SIS group underwent surgical tracheostomy with an SIS graft covering the defect. We examined tissues at the site of tracheostomy 60 days after surgery using histological analysis with hematoxylin and eosin (H&E) staining and analyzed the perimeter and area of the defect with Image-Pro® PLUS 4.5 (Media Cybernetics).

Results: The average perimeter and area of the defects were smaller by 15.3% ( = 0.034) and 21.8% ( = 0.151), respectively, in the SIS group than in the control group. Histological analysis revealed immature cartilage, pseudostratified ciliated epithelium, and connective tissue in 54.5% ( = 0.018) of the SIS group, while no cartilaginous regeneration was observed in the control group.

Conclusions: Although tracheal SIS engraftment could not prevent stenosis in a rabbit model of tracheal injury, it produced some remarkable changes, efficiently facilitating neovascularization, reepithelialization, and neoformation of immature cartilage.
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http://dx.doi.org/10.1155/2018/5102630DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846444PMC
February 2018

Investigation of the Relationship Between Electrical Stimulation Frequency and Muscle Frequency Response Under Submaximal Contractions.

Artif Organs 2018 Jun 25;42(6):655-663. Epub 2018 Mar 25.

Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.

Neuromuscular electrical stimulation (NMES) is a common tool that is used in clinical and laboratory experiments and can be combined with mechanomyography (MMG) for biofeedback in neuroprostheses. However, it is not clear if the electrical current applied to neuromuscular tissues influences the MMG signal in submaximal contractions. The objective of this study is to investigate whether the electrical stimulation frequency influences the mechanomyographic frequency response of the rectus femoris muscle during submaximal contractions. Thirteen male participants performed three maximal voluntary isometric contractions (MVIC) recorded in isometric conditions to determine the maximal force of knee extensors. This was followed by the application of nine modulated NMES frequencies (20, 25, 30, 35, 40, 45, 50, 75, and 100 Hz) to evoke 5% MVIC. Muscle behavior was monitored by the analysis of MMG signals, which were decomposed into frequency bands by using a Cauchy wavelet transform. For each applied electrical stimulus frequency, the mean MMG spectral/frequency response was estimated for each axis (X, Y, and Z axes) of the MMG sensor with the values of the frequency bands used as weights (weighted mean). Only with respect to the Z (perpendicular) axis of the MMG signal, the stimulus frequency of 20 Hz did not exhibit any difference with the weighted mean (P = 0.666). For the frequencies of 20 and 25 Hz, the MMG signal displayed the bands between 12 and 16 Hz in the three axes (P < 0.050). In the frequencies from 30 to 100 Hz, the muscle presented a higher concentration of the MMG signal between the 22 and 29 Hz bands for the X and Z axes, and between 16 and 34 Hz bands for the Y axis (P < 0.050 for all cases). We observed that MMG signals are not dependent on the applied NMES frequency, because their frequency contents tend to mainly remain between the 20- and 25-Hz bands. Hence, NMES does not interfere with the use of MMG in neuroprosthesis.
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http://dx.doi.org/10.1111/aor.13083DOI Listing
June 2018

Prevalence of high cholesterol levels suggestive of familial hypercholesterolemia in Brazilian adolescents: Data from the study of cardiovascular risk in adolescents.

J Clin Lipidol 2018 Mar - Apr;12(2):403-408. Epub 2017 Dec 28.

Pontificia Universidade Catolica do Parana (PUCPR), Curitiba, Brazil. Electronic address:

Background: Familial hypercholesterolemia (FH) is an autosomal dominant genetic disorder with an estimated worldwide prevalence ranging from 1 in 200 individuals to 1 in 500 individuals in its heterozygous form. Individuals with FH exhibit high low-density lipoprotein cholesterol (LDLc) levels from birth, which leads to premature cardiovascular events. In Brazil, like in most countries around the world, FH is considered a public health problem but remains underdiagnosed and undertreated.

Objective: The aim of this study was to evaluate the prevalence of LDLc or non-high-density lipoprotein cholesterol (non-HDLc) levels suggestive of FH among Brazilian adolescents.

Methods: The Study of Cardiovascular Risk in Adolescents (ERICA) was a nationwide, school-based, cross-sectional study that assessed the prevalence of cardiovascular risk factors in approximately 75,000 adolescents between 12 and 17 years old. Data were analyzed according to sex, age, type of school (public or private), and geographic regions of Brazil. Adolescents with untreated fasting LDLc levels of 160 mg/dL or higher or non-HDLc levels of 190 mg/dL or higher were suspected to have FH. We also evaluated the prevalence of LDLc levels of 190 mg/dL or higher, which is highly suggestive of a diagnosis of FH in this age group.

Results: A total of 38,069 adolescents were evaluated; more than half (59.9%) were female and most (74%) attended public schools. The prevalence of LDLc levels of 160 mg/dL or higher or non-HDLc levels of 190 mg/dL or higher among the adolescents was 0.49% (95% confidence interval: 0.34-0.71; n = 209). Moreover, 0.12% of the adolescents (95% confidence interval: 0.04-0.34; n = 44) had LDLc levels of 190 mg/dL or higher. We estimate that approximately 100,000 (1 in 200) Brazilian adolescents aged 12 to 17 years are suspected to have FH on the basis of LDLc and non-HDLc levels.

Conclusion: We identified a significant prevalence of cholesterol levels suggestive of FH among Brazilian adolescents. Further evaluation is needed to confirm the diagnoses among the students. Our results reinforce the importance of universal screening as a critical tool for early diagnosis and treatment of FH.
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http://dx.doi.org/10.1016/j.jacl.2017.12.009DOI Listing
September 2019

Comparison of time until elective intestinal resection regarding previous anti-tumor necrosis factor exposure: a Brazilian study on patients with Crohn's disease.

Intest Res 2018 Jan 18;16(1):62-68. Epub 2018 Jan 18.

Colorectal Surgery Unit, Department of Surgery, Campinas State University (UNICAMP), Campinas, Brazil.

Background/aims: The use of anti-tumor necrosis factor (anti-TNF) agents seems to reduce surgical rates and delay surgical procedures in prospective trials and population-based studies in the management of Crohn's disease (CD). This study aimed to identify whether preoperative anti-TNF agents influence the time from diagnosis to surgery.

Methods: An observational retrospective cohort study was conducted on patients with CD submitted to intestinal resections due to complications or medical therapy failure in a period of 7 years. The patients were allocated into 2 groups according to their previous exposure to anti-TNF agents in the preoperative period. Epidemiological aspects regarding age at diagnosis, smoking, perianal disease, and preoperative conventional therapy were considered. A Kaplan-Meier survival analysis was used to outline possible differences between the groups regarding the time to surgery.

Results: A total of 123 patients were included (71 and 52 with and without previous exposure to biologics, respectively). The overall time to surgery was 108±6.9 months (maximum, 276 months). The survival estimation revealed no difference in the mean time to intestinal resection between the groups (99.78±10.62 months in the patients without and 114.01±9.07 months in those with previous anti-TNF use) (log-rank =0.35). There was no significant difference in the time to surgery regarding perianal CD (=0.49), smoking (=0.63), preoperative azathioprine (=0.073) and steroid use (=0.58).

Conclusions: The time from diagnosis to surgery was not influenced by the preoperative use of anti-TNF therapy in this cohort of patients.
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http://dx.doi.org/10.5217/ir.2018.16.1.62DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797273PMC
January 2018

Waist Circumference is Associated with Blood Pressure in Children with Normal Body Mass Index: A Cross-Sectional Analysis of 3,417 School Children.

Arq Bras Cardiol 2017 Dec 27;109(6):509-515. Epub 2017 Nov 27.

Pontifícia Universidade Católica do Paraná, Curitiba, PR- Brazil.

Background: The prevalence of childhood obesity and associated conditions, such as hypertension, has become a major problem of public health. Although waist circumference (WC) is a marker of cardiovascular risk in adults, it is unclear whether this index is associated with cardiovascular risk factors in children.

Objective: Our aim was to evaluate the association between increased WC and elevated blood pressure (BP) in children with normal body mass index (BMI) ranges.

Methods: Cross-sectional evaluation of students between 6 and 11 years with normal BMI. WC was categorized by quartile for each age group. Normal BP was defined as values < 90th percentile, and levels above this range were considered elevated. Values of p < 0.05 were considered statistically significant.

Results: Of the 5,037 children initially assessed, 404 (8%) were excluded for being underweight and 1,216 (24.1%) were excluded for being overweight or obese. A final sample of 3,417 children was evaluated. The prevalence of elevated BP was 10.7%. In children with WC in the lowest quartile, the prevalence of elevated BP was 8.1%. This prevalence increased in upper quartiles: 10.6% in the second, 12.4% in third and 12.1% in the upper quartile. So, in this group, being in the highest WC quartile was associated with a 57% higher likelihood to present elevated BP when compared to those in the lowest quartile (Q4 vs Q1; OR 1.57 - 95%CI 1.14 - 2.17).

Conclusion: In children aged 6 to 11 years, increased waist circumference is associated with elevated BP even when BMI is normal.
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http://dx.doi.org/10.5935/abc.20170162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5783431PMC
December 2017

Adalimumab and postoperative complications of elective intestinal resections in Crohn's disease: a propensity score case-matched study.

Colorectal Dis 2017 Oct 20. Epub 2017 Oct 20.

Colorectal Surgery Unit, Campinas State University (UNICAMP), Campinas, Brazil.

Background: data are scarce regarding the effect of preoperative Adalimumab (ADA) in postoperative complications in Crohn's disease (CD) patients.

Aim: to compare the rates of postoperative complications after intestinal resections in CD, with and without previous exposure to ADA.

Method: case-matched retrospective observational study of patients submitted to intestinal resections for CD. The patients were allocated to 2 groups, according to their previous exposure to ADA before surgery. The patients under ADA therapy were matched with controls (patients without previous biologics) with the propensity score method (PSM), according to age at surgery, CD location (Montreal L) and phenotype (Montreal B). Medical and surgical complications were compared.

Results: 123 patients were initially considered, 71 with previous biologics (32 under ADA therapy) and 52 without. The PSM selected 25 ADA patients to be matched with 25 controls from the non-biologics group. There was no difference regarding overall surgical complications (40% in the control vs 36% in the ADA group; p = 1.0000) or medical complications (36% vs 12% in the control and ADA groups, respectively; p = 0.095). In univariate analysis, previous ADA was not considered a risk factor for higher postoperative complication rates. Stomas were considered a risk factor for surgical complications, and previous steroids were associated to higher medical complication rates.

Conclusions: preoperative ADA did not influence the rates of medical and surgical complications after elective intestinal resections for CD. This was the first study to include exclusively patients under ADA therapy. This article is protected by copyright. All rights reserved.
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http://dx.doi.org/10.1111/codi.13929DOI Listing
October 2017

ADALIMUMAB FOR ULCERATIVE COLITIS: RESULTS OF A BRAZILIAN MULTICENTER OBSERVATIONAL STUDY.

Arq Gastroenterol 2017 Dec 2;54(4):321-327. Epub 2017 Oct 2.

Unidade de Cirurgia Colorretal, Hospital Universitário Cajuru, PUCPR, Curitiba, PR, Brazil.

Background: Adalimumab is a monoclonal antibody, tumor necrosis factor-alpha (TNFα) inhibitor that has efficacy for inducing and maintaining remission in moderate-to-severe ulcerative colitis. Real world studies with adalimumab in Latin American ulcerative colitis patients are scarce.

Objective: To assess the clinical remission rates in induction and maintenance with adalimumab therapy in ulcerative colitis.

Methods: Observational, multicenter and retrospective study on a case series of patients with moderate-to-severe ulcerative colitis under adalimumab therapy. The variables analyzed were: demographic data, previous infliximab status, concomitant drugs, the Montreal Classification, disease activity (Mayo score) at weeks 0, 8, 26 and 52, or until the last follow-up. Clinical remission was defined as a partial Mayo score ≤2 and Last observation carried forward (LOCF) and Non responder imputation (NRI) analysis were used.

Results: Thirty-six patients were included in the study. With LOCF analysis, remission rates at weeks 8, 26 e 52 were of 41.7%, 47.2% and 47.2%, respectively. With NRI analysis, remission rates at weeks 8, 26 and 52 were of 41.7%, 41.7% and 27.8%, respectively.

Conclusion: Adalimumab was effective in the treatment of moderate-to-severe ulcerative colitis. Clinical remission was observed in approximately 40% of the patients at weeks 8 and 26, and in almost a quarter of the patients after 1 year of follow up.
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http://dx.doi.org/10.1590/S0004-2803.201700000-51DOI Listing
December 2017

Chromoblastomycosis: tissue modifications during itraconazole treatment.

An Bras Dermatol 2017 Jul-Aug;92(4):478-483

Discipline of Biostatistics of the Medical School - Pontifícia Universidade Católica do Paraná (PUC-PR) - Curitiba (PR), Brazil.

Background:: Histological and mycological changes during itraconazole use have not been totally established in chromoblastomycosis.

Objectives:: To evaluate tissue modifications in chromoblastomycosis carriers under itraconazole treatment.

Methods:: A histological retrospective study of 20 cases of chromoblastomycosis seen at the university hospital at the south of Brazil, during itraconazole 400 mg daily treatment. Patients were classified into two groups: plaque or tumor lesions, and underwent periodic evaluations every four months during three years. Hematoxylin-eosin stain was used to analyze epidermal modifications, inflammatory infiltrate and fibrosis, and Fontana-Masson stain for parasite evaluation.

Results:: Fontana-Masson stain was superior to hematoxylin-eosin stain in fungal count in the epidermis (mean difference=0.14; p<0.05). The most distinct mycosis tissue responses were registered in the dermis. Epidermal thinning, granulomatous infiltrate decrease or disappearance, fibrosis increase and quantitative/morphological changes occurred during treatment.

Study Limitations:: Patients could not be located to have their current skin condition examined.

Conclusion:: Parasitic and tissue changes verified in this study can reflect the parasite-host dynamics under itraconazole action.
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http://dx.doi.org/10.1590/abd1806-4841.20175466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5595593PMC
October 2017

Impact of the Karnofsky Performance Status on Survival and its Dynamics During the Terminal Year of Peritoneal Dialysis Patients.

Perit Dial Int 2018 Jan-Feb;38(1):24-29. Epub 2017 Aug 1.

Pontifícia Universidade Católica do Paraná (PUCPR), School of Medicine, Curitiba, Brazil

Background: Simple and low-cost tools to monitor the risk profile of patients on peritoneal dialysis (PD) at high risk of complications and mortality are scarce. One of the tools available to monitor the variation in vitality and dependence levels is the Karnofsky performance status (KPS). This study analyzed the average trends and variation of KPS during the 12 months before death and its independent value in predicting patients' survival.

Methods: The data were compiled from the BRAZPD II multicenter study, performed in Brazil between 2004 and 2011. For the analysis of KPS dynamics, we included patients with at least 12 months of follow-up on PD and who had a fatal event during the follow-up. The following covariables were evaluated: age, gender, ethnicity, educational level, and presence of diabetes. We used the linear regression model to present the results: the log (time) before death was represented by the regression variable and KPS was the response. We also analyzed the independent impact of baseline KPS on patients' survival.

Results: From the population of 9,905 patients enrolled in the BRAZPD study, 4,133 survived 12 months on PD and were included in the analysis. There was a gradual decline in the KPS scores, which accelerated in the last 2 months before death. These changes were similar irrespective of age, race, family income, gender, diabetes, PD modality, and education level. We observed 989 fatal events in this population during the observation period, and the KPS score was identified as an independent predictor for mortality in this cohort.

Conclusions: This study demonstrates for the first time the dynamics of KPS before death in PD patients, indicating a progressive and accelerated decline of KPS in the 12 months before patients died. In addition, KPS was an independent predictor of mortality in this population.
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http://dx.doi.org/10.3747/pdi.2015.00241DOI Listing
November 2018

Expression of MMP-13 in human temporomandibular joint disc derangement and osteoarthritis.

Cranio 2018 May 26;36(3):161-166. Epub 2017 Apr 26.

a School of Health and Biosciences , Pontifícia Universidade Católica do Paraná (PUCPR) , Curitiba , Brazil.

Objective: MMP-13 performs digestion of collagen, which is a primary component of the temporomandibular joint (TMJ) articular disc. This study evaluated the expression of MMP-13 in patients with anterior disc displacement with (ADDwR) and without reduction (ADDwoR), and in the presence of TMJ osteoarthrosis.

Methods: Thirty-nine human temporomandibular joint disc samples were collected and divided in two ways: ADDwR (21 samples), ADDwoR (10 samples), and a control group (8 samples); and with osteoarthrosis (10 samples) and without osteoarthrosis (29 samples). Immunostaining of the TMJ discs was statistically compared between the groups.

Results: There was no statistically significant difference for the area of MMP-13 immunostaining between the control group, ADDwR, and ADDwoR, nor between groups with and without osteoarthrosis.

Conclusion: This study suggests MMP-13 is not significantly involved in collagen degradation in human TMJ disc displacement or osteoarthrosis.
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http://dx.doi.org/10.1080/08869634.2017.1315511DOI Listing
May 2018

Interleukin-6 expression in disc derangement of human temporomandibular joint and association with osteoarthrosis.

J Craniomaxillofac Surg 2017 May 24;45(5):768-774. Epub 2017 Feb 24.

School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil. Electronic address:

The inflammatory process is a coordinated response that protects host after infection or trauma, involving several molecular reactions. Once the inflammation is closely linked to the process of destruction of the temporomandibular joint, this study aims to examine, by immunohistochemistry, the expression of interleukin-6 (IL-6), an important inflammatory marker, in temporomandibular articular discs of patients with anterior disc displacement with (ADDwR) and without reduction (ADDwoR) and its association with osteoarthrosis (OA). Thirty-eight (n = 38) articular discs were divided into two cutoffs: 1) analysis 1: 4 control (acute pathology), 17 ADDwR, 17 ADDwoR; and 2) analysis 2: without OA (n = 21) and with OA (n = 17). The area of immunostaining was compared statistically between groups (p < 0.05). In the disc samples, no significant differences were observed between the groups ADDwR and ADDwoR, and with and without OA, in respect to the expression of IL-6 by immunohistochemical examination. Future studies should be conducted with a larger sample size, which could clarify the association of the inflammatory mediator IL-6 with temporomandibular joint dysfunction.
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http://dx.doi.org/10.1016/j.jcms.2017.02.019DOI Listing
May 2017

Comparison between types of dressing following catheter insertion and early exit-site infection in peritoneal dialysis.

J Clin Nurs 2017 Nov 22;26(21-22):3658-3663. Epub 2017 Mar 22.

School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil.

Aims And Objectives: To investigate whether the type of dressing used (occlusive vs. semi-occlusive) impacts on exit-site infection.

Background: The exit-site infections are a major predisposing factor for peritoneal dialysis-related peritonitis, the main cause of technique failure and an important cause of mortality. The care taken in exit-site dressing is considered an important procedure for the prevention of trauma and contamination of this area. Nevertheless, to our knowledge, no study has yet analysed the impact of different dressing types on early exit-site infection (up to two months after catheter insertion).

Design: A prospective observational study involving the BRAZPD II (Brazilian Peritoneal Dialysis Multicenter Study) cohort.

Methods: All incident patients with data available for dressing type applied following peritoneal dialysis catheter insertion were included in the study. A multilevel logistic regression model was used to compare the log-odds of exit-site infections between groups.

Results: A total of 2460 incident patients were included. Occlusive and semi-occlusive dressings were applied in 82·6% (n = 2031) and 17·4% (n = 427) of patients, respectively. Exit-site infection incidence was not affected by the type of dressing used, with a logit for occlusive dressing of 2·15 (95% CI 0·81-5·70). The combined outcome of exit-site infection and tunnel infection also showed no significance between the groups (logit 1·46, 95% CI 0·72-2·97).

Conclusion: Our results indicate that the type of exit-site dressing used during the healing phase following peritoneal dialysis catheter insertion has no impact on early exit-site infection rates.

Relevance To Clinical Practice: Provides evidence to support the similarity between occlusive and semi-occlusive dressing regarding infection rates in exit site of peritoneal dialysis catheter, therefore allowing the choice to be made accordingly to routine or availability.
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http://dx.doi.org/10.1111/jocn.13738DOI Listing
November 2017

A Randomized Open-Label Trial to Assess the Effect of Plant Sterols Associated with Ezetimibe in Low-Density Lipoprotein Levels in Patients with Coronary Artery Disease on Statin Therapy.

J Med Food 2017 Jan;20(1):30-36

School of Medicine, Pontificia Universidade Catolica do Parana , Curitiba, Brazil .

Consumption of food products enriched with plant sterols and the use of ezetimibe reduce cholesterol absorption in the intestine and effectively reduce low-density lipoprotein (LDL) plasma levels. We evaluated the therapeutic effect of the ezetimibe+plant sterol association in patients with coronary artery disease still not reaching recommended lipid levels despite the use of statins. We performed a prospective open-label study with 41 patients with stable coronary disease and LDL >70 mg/dL. Patients were randomized into four groups for a 6-week treatment: the control (CT) group remained on the same statin therapy, the ezetimibe (EZ) group received 10 mg/day of ezetimibe, the plant sterol (PS) group received spread enriched with 2 g of plant sterols, and the ezetimibe+PS (EZ+PS) group received 10 mg/day EZ +2 g PS. Initial mean LDL level was 97.4 ± 31.1 mg/dL in control group, 105.1 ± 23.1 mg/dL in EZ group, 95.4 ± 27.7 mg/dL in PS group, and 97.0 ± 8.3 mg/dL in EZ+PS group (P > .05). After 6 weeks of treatment, LDL of patients slightly increased in the control group (+8.9%; P > .05) and dropped in EZ group (-19.1%; P = .06), PS group (-16.6%; P = .01), and EZ+PS group (-27.3%; P < .01). Mean LDL levels after treatment were 70.5 ± 17.9 mg/dL in EZ+PS group, lower than the other groups (control was 106.1 ± 34.9 mg/dL, EZ group was 85.0 ± 35.6 mg/dL, and PS was 79.6 ± 29.7 mg/dL) (P = .05 variance analysis factor [ANOVA]). Body weight, body-mass index, and glucose plasma levels did not change significantly after intervention. The combination of PS+ezetimibe was associated with lower LDL levels and suggests beneficial therapeutic effect against major cardiovascular events.
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http://dx.doi.org/10.1089/jmf.2016.0042DOI Listing
January 2017

Peritonitis as a risk factor for long-term cardiovascular mortality in peritoneal dialysis patients: The case of a friendly fire?

Nephrology (Carlton) 2018 Mar;23(3):253-258

UNESP, Botucatu, Brazil Sao Paulo State University, Botucatu, Brazil.

Aim: Since the impact of peritonitis on long-term non-infectious mortality has not been investigated until the present, the aim of this study was to analyze the impact of peritonitis on long-term cardiovascular (CV) mortality in a large peritoneal dialysis (PD) cohort.

Methods: The analysis was based on BRAZPD II, a national prospective cohort study that recruited patients in Brazilian centres from December 2004 to January 2011. Incident adult PD patients with at least 90 days on treatment were included in the analysis. Cardiovascular death occurring after a minimum of 30 days after a peritonitis episode was considered the primary endpoint. Cox regression analysis for time-dependent variables was used for the adjustments.

Results: There were 2405 episodes of peritonitis in 5707 patients (48% males, 44% diabetes, 73% hypertensive). Patients with one episode of peritonitis presented a 22% increase in the hazard ratio of late CV mortality compared to those who never experienced peritonitis (HR1.22; CI95%1.01-1.47). Adjusted hazard for CV mortality showed a stepwise negative effect on survival for each additional peritonitis episode of infection: two episodes (HR1.78; CI95%1.31-2.42), three episodes (HR2.81; CI95%1.83-4.32) and four episodes (HR3.84; CI95%2.01-7.32).

Conclusion: Peritonitis was an independent predictor of CV mortality and the frequency of peritonitis was strongly associated with an increase in this risk. This is the first study to demonstrate the impact of peritonitis on late cardiovascular mortality of PD patients, suggesting a link between acute inflammation and cardiovascular outcomes.
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http://dx.doi.org/10.1111/nep.12986DOI Listing
March 2018

Tumor Necrosis Factor Alpha Inhibitors Did Not Influence Postoperative Morbidity After Elective Surgical Resections in Crohn's Disease.

Dig Dis Sci 2017 02 8;62(2):456-464. Epub 2016 Dec 8.

Colorectal Surgery Unit, Campinas State University (UNICAMP), Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, SP, CEP 13083-887, Brazil.

Background: The real impact of anti-tumor necrosis alpha (TNF) therapy in postoperative complications after intestinal resections in Crohn's disease (CD) still needs to be determined.

Aims: To compare the postoperative complication rates after elective intestinal resections in CD patients, with or without previous exposure to anti-TNF therapy.

Methods: This was a retrospective and observational study, with elective intestinal resections for CD (emergency procedures were excluded). Patients were allocated in two groups according to preoperative anti-TNF status. Surgical and medical complications were analyzed and subsequently compared between the groups.

Results: A total of 123 patients were included (71 with and 52 without preoperative anti-TNF). The groups were considered homogeneous, except for perianal CD, previous azathioprine, and stomas. There was no significant difference between the groups regarding overall surgical complications (32.69% in anti-TNF- vs. 39.44% in anti-TNF+ patients, p = 0.457) or overall medical complications (21.15 vs. 21.13%, respectively, p = 1.000). In univariate analysis, previous steroids, perianal CD, and stomas were considered risk factors for surgical complications, and previous steroids and hypoalbuminemia for medical complications. In multivariate analysis, previous steroids were associated with higher rates of surgical and medical complications, while hypoalbuminemia was associated with higher medical complication rates.

Conclusions: There was no influence of the previous use of anti-TNF agents in postoperative surgical and medical complication rates in elective intestinal resections for CD. Previous steroids and hypoalbuminemia were associated with higher complication rates. This was the first case series of the literature describing outcomes in exclusively elective operations.
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http://dx.doi.org/10.1007/s10620-016-4400-2DOI Listing
February 2017

Host and clinical aspects in patients with benign migratory glossitis.

Arch Oral Biol 2017 Jan 26;73:259-268. Epub 2016 Oct 26.

Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.

Objective: Investigate the association of clinical, cytological and genetic characteristics with benign migratory glossitis (BMG).

Study Design: Sample consisted of 175 patients, 44 with BMG and 131 control patients. Clinical examination and DMFT index were assessed. Cytological evaluation determined cell morphology and morphometry. Genetic evaluation was performed by analysing IL6 polymorphisms by real-time PCR. Univariate and multivariate analyses were performed (p<0.05).

Results: There was a higher level of anxiety, DMFT score and a prevalence of fissured tongue in BMG group. A high mean nuclear/cytoplasmic area ratio was observed in patients with BMG. There was predominance of Papanicolaou class II I BMG group. IL6 allele G rs2069843 polymorphism was associated with BMG in the dominant model. In multivariate analysis, DMFT and anxiety scale remained associated with BMG.
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http://dx.doi.org/10.1016/j.archoralbio.2016.10.027DOI Listing
January 2017

Immunohistochemical analysis of IL-1 beta in the discs of patients with temporomandibular joint dysfunction.

Cranio 2017 Jul 13;35(4):233-237. Epub 2016 Jul 13.

f Department of Surgical Sciences , University of Catania , Catania , Italy.

Purpose: Interleukin-1 beta (IL-1β) is a cytokine that participates in the regulation of immune responses and inflammatory reactions. It is hypothesized that IL-1 levels may be elevated in patients suffering from temporomandibular joint dysfunction. The purpose of this study was to determine the association of IL-1β expression with TMD using an immunohistochemical approach to evaluate the joint disc.

Materials And Methods: A total of 39 human temporomandibular joint disc samples were collected, with 31 samples in the test group. Nineteen of the test group samples were from discs of patients with anterior disc displacement with reduction, and 12 of the samples were from patients with anterior disc displacement without reduction. Eight control samples were used in the control group. The samples were immunostained and evaluated on both quantity and intensity of staining.

Results: There was a statistically significant difference (p < 0.05) between the control and test groups for both quantity and intensity of staining.

Conclusion: IL-1β plays a role in the inflammatory process and degradation of TMJ discs in patients with TMJ dysfunctions.
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http://dx.doi.org/10.1080/08869634.2016.1207911DOI Listing
July 2017
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