Publications by authors named "Mariana Vasconcelos"

47 Publications

Evaluation of Urinary Tract Dilation Classification System for Prediction of Long-Term Outcomes in Isolated Antenatal Hydronephrosis: A Cohort Study.

J Urol 2021 Jun 8:101097JU0000000000001899. Epub 2021 Jun 8.

Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology of Molecular Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.

Purpose: The aim of this study was to evaluate the performance of the new classification of urinary tract dilatation (UTD) to predict long-term clinical outcomes in infants with isolated antenatal hydronephrosis (ANH).

Materials And Methods: Between 1989 and 2019, 447 infants diagnosed with isolated severe ANH and were prospectively followed. The main predictive variable for the analysis was the new UTD classification system. The events of interest were surgical interventions, urinary tract infections, chronic kidney disease stage II or higher, hypertension and proteinuria. The primary end-point was time until the occurrence of a composite event of renal injury, including proteinuria, hypertension and chronic kidney disease.

Results: Among 447 infants with ANH included in the analysis, 255 (57%) had UTD P1, 93 (20.8%) UTD P2 and 99 (22.2%) UTD P3. Median followup time was 9 years (IQR 7-12 years). Of 447 patients included in the analysis, 11 (2.5%) had hypertension, 13 (2.9%) exhibited persistent mild proteinuria, 14 (3%) developed chronic kidney disease Stage 2 and 26 (5.8%) had the composite outcome of renal injury. By survival analysis, the UTD system predicted accurately all events of interest. According to the Kaplan-Meier survival analysis, the probability of renal injury at 20 years of age was estimated at about 0%, 14% and 56% for patients assigned to UTD P1, UTD P2 and UTD P3, respectively (p <0.001).

Conclusions: Our findings provide insights that the new UTD classification has a good performance for discriminating not only mid-term, but also long-term clinical outcomes, including renal injury.
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http://dx.doi.org/10.1097/JU.0000000000001899DOI Listing
June 2021

Consensus document on chronic coronary syndrome assessment and risk stratification in Portugal: A position paper statement from the [Portuguese Society of Cardiology's] Working Groups on Nuclear Cardiology, Magnetic Resonance and Cardiac Computed Tomography, Echocardiography, and Exercise Physiology and Cardiac Rehabilitation.

Rev Port Cardiol (Engl Ed) 2020 Dec 18. Epub 2020 Dec 18.

Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.

Despite constant medical evolution, the reimbursement policy of Portuguese National Health Service (NHS) for the study and risk stratification of coronary heart disease has remained unchanged for several decades. Lack of adjustment to contemporary clinical practice has long been evident. However, the recent publication of the European Guidelines for diagnosis and treatment of chronic coronary syndromes further highlighted this gap and the urgent need for a change. Prompted by these Guidelines, the Working Group on Nuclear Cardiology, Cardiac Magnetic Resonance and Cardiac CT, the Working Group on Echocardiography and the Working Group on Stress Pathophysiology and Cardiac Rehabilitation of the Portuguese Society of Cardiology, began a process of joint reflection on the current limitations and how these recommendations could be applied in Portugal. To this end, the authors suggest that the new imaging methods (stress echocardiogram, cardiac computed tomography and cardiac magnetic resonance), should be added to exercise treadmill stress test and myocardial perfusion scintigraphy in the available exam portfolio within the Portuguese NHS. This change would allow full adoption of European guidelines and a better use of tests, according to clinical context, availability and local specificities. The adoption of clinical guidance standards, based on these assumptions, would translate into a qualitative improvement in the management of these patients and would promote an effective use of the available resources, with potential health and financial gains.
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http://dx.doi.org/10.1016/j.repc.2020.10.009DOI Listing
December 2020

A Case of Acute Myocardial Infarction and Pericarditis Unmasking Metastatic Involvement of the Heart.

Arq Bras Cardiol 2020 04;115(1 suppl 1):22-24

Centro Hospitalar Universitário de São João, Porto - Portugal.

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http://dx.doi.org/10.36660/abc.20190534DOI Listing
April 2020

Caseous calcification of the mitral annulus in a cardiac arrest survivor.

Rev Port Cardiol (Engl Ed) 2020 May 10;39(5):295-297. Epub 2020 Jun 10.

Serviço de Cardiologia, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal.

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http://dx.doi.org/10.1016/j.repc.2019.09.012DOI Listing
May 2020

Surgical Treatment of Aggressive Intraosseous Cavernous Hemangioma in Maxilla Through Surgical Resection.

J Craniofac Surg 2020 Jul-Aug;31(5):e445-e448

São Leopoldo Mandic Dental School, Santa Casa de Misericórdia Hospital of São Miguel dos Campos, São Miguel dos Campos, Brazil.

Hemangiomas are benign vascular lesions characterized by endothelial vascular proliferation and may demonstrate aggressive clinical features. Intraosseous hemangiomas are uncommon and the maxillary location rare, with few cases described in the literature. The treatment of these lesions varies, however they have a better prognosis when a surgical treatment through resection is performed. The aim of this study is to report a case of right maxillary cavernous intraosseous hemangioma treated by surgical resection with previous embolization. The diagnosis was made through incisional biopsy and immunohistochemical examination. An aggressive lesion profile was observed through the Ki67 marker. During surgery, a temporary ipsilateral external carotid artery ligation was performed to minimize possible bleeding. Weber-Fergson surgical access was performed and total surgical resection through hemi-maxillectomy. The patient is stable after 30 months of follow-up without relapses. In suspected cases of intraosseous hemangiomas, accurate diagnosis and total surgical resection of the lesion is essential. The use of therapeutic mammoths that minimize sagging during and after the procedure such as embolization and arteriography should always be performed.
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http://dx.doi.org/10.1097/SCS.0000000000006382DOI Listing
November 2020

Two hearts: A complex case of heart failure.

Rev Port Cardiol (Engl Ed) 2019 Jul 11;38(7):515-517. Epub 2019 Sep 11.

Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal.

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http://dx.doi.org/10.1016/j.repc.2018.09.012DOI Listing
July 2019

A clinical predictive model of renal injury in children with isolated antenatal hydronephrosis.

Clin Kidney J 2020 Oct 19;13(5):834-841. Epub 2019 Aug 19.

Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology of Molecular Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.

Background: Antenatal hydronephrosis (ANH) affects ∼1-5% of pregnancies. The aim of this study was to develop a clinical prediction model of renal injury in a large cohort of infants with isolated ANH.

Methods: This is a longitudinal cohort study of 447 infants with ANH admitted since birth between 1989 and 2015 at a tertiary care center. The primary endpoint was time until the occurrence of a composite event of renal injury, which includes proteinuria, hypertension and chronic kidney disease (CKD). A predictive model was developed using a Cox proportional hazards model and evaluated by -statistics.

Results: Renal pelvic dilatation (RPD) was classified into two groups [Grades 1-2 ( = 255) versus Grades 3-4 ( = 192)]. The median follow-up time was 6.4 years (interquartile range 2.8-12.5). Thirteen patients (2.9%) developed proteinuria, 6 (1.3%) hypertension and 14 (3.1%) CKD Stage 2. All events occurred in patients with RPD Grades 3-4. After adjustment, three covariables remained as predictors of the composite event: creatinine {hazard ratio [HR] 1.27, [95% confidence interval (CI) 1.05-1.56]}, renal parenchyma thickness at birth [HR 0.78(95% CI 0.625-0.991)] and recurrent urinary tract infections [HR 4.52 (95% CI 1.49-13.6)]. The probability of renal injury at 15 years of age was estimated as 0, 15 and 24% for patients assigned to the low-risk, medium-risk and high-risk groups, respectively (P < 0.001).

Conclusion: Our findings indicate an uneventful clinical course for patients with Society for Fetal Urology (SFU) Grades 1-2 ANH. Conversely, for infants with SFU Grades 3-4 ANH, our prediction model enabled the identification of a subgroup of patients with increased risk of renal injury over time.
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http://dx.doi.org/10.1093/ckj/sfz102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577777PMC
October 2020

Collaborative Brazilian pediatric renal transplant registry (CoBrazPed-RTx): A report from 2004 to 2018.

Pediatr Transplant 2019 09 22;23(6):e13463. Epub 2019 Jul 22.

Hospital Ana Nery, Salvador, Brazil.

The Brazilian collaborative registry for pediatric renal transplantation began in 2004 as a multicenter initiative aimed at analyzing, reporting, and disseminating the results of pediatric renal transplantation in Brazil. Data from all pediatric renal transplants performed from January 2004 to May 2018 at the 13 participating centers were analyzed. A total of 2744 pediatric renal transplants were performed in the thirteen participating centers. The median age at transplantation was 12.2 years, with the majority being male recipients (56%). The main underlying diseases were CAKUT (40.5%) and glomerulopathy (28%). 1981 (72%) of the grafts were from deceased donors (DD). Graft survival at one year (censored by death) was 94% in the live donor group (LD) and 91% in the DD group (log-rank test P < 0.01). The patient's survival at one and 5 years was 97% and 95% for the LD group and 96% and 93% for the DD group (log-rank test P = 0.02). The graft loss rate was 19% (n = 517), more frequently caused by vascular thrombosis (n = 102) and chronic graft nephropathy (n = 90). DD recipients had 1.6 (1.0-2.2) times greater chance of death and 1.5 (1.2-1.8) times greater chance of graft loss compared to LD recipients. The mortality rate was 5.4% (n = 148), mainly due to infection (n = 69) and cardiovascular disease (n = 28). The results of this collaborative pediatric renal transplant record are comparable to other international registries, although we still have a high infection rate as a cause of death.
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http://dx.doi.org/10.1111/petr.13463DOI Listing
September 2019

Myocardial dysfunction in Takotsubo syndrome: More than meets the eye?

Rev Port Cardiol (Engl Ed) 2019 Apr 16;38(4):261-266. Epub 2019 May 16.

Serviço de Cardiologia, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.

Introduction: Takotsubo syndrome (TTS) is characterized by transient left ventricular (LV) dysfunction, typically mimicking an anterior wall myocardial infarction (MI), without obstructive coronary artery disease. In the few published reports assessing myocardial deformation in TTS and MI, no consistent differences have been described between the two entities. We sought to characterize global and regional function in TTS and to compare it with a population with MI.

Methods: Clinical data, including echocardiography, were gathered from 17 TTS patients and 20 anterior wall ST-segment elevation myocardial infarction (STEMI) controls. Peak systolic longitudinal strain was determined for each LV segment using speckle tracking imaging, and global and mean apical, midventricular and basal longitudinal strain were calculated from these.

Results: Both TTS and STEMI patients presented significant LV systolic dysfunction, and there were no significant differences in ejection fraction or global longitudinal strain. Regional longitudinal strain was more severely impaired in basal inferolateral and mid anterolateral segments in the TTS group and in apical anteroseptal segments in the STEMI group. Mean longitudinal strain was worse in the basal segments of TTS patients (-9.8±2.9 vs. -12.4±4.1%, p=0.010), with no significant differences in mid and apical segments. The basal/apical ratio was significantly lower in this group as well (1.51±0.86 vs. 2.94±1.88, p=0.006).

Conclusions: While both TTS and STEMI feature significantly impaired global systolic function, we found a regional pattern of worse basal longitudinal strain and a lower basal/apical ratio in the former. These suggest generalized myocardial impairment in TTS, providing new clues about its pathophysiology and possible specific echocardiographic changes.
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http://dx.doi.org/10.1016/j.repc.2018.07.008DOI Listing
April 2019

Incidence, predictive factors and clinical significance of development of portal vein thrombosis in cirrhosis: A prospective study.

Liver Int 2019 08 15;39(8):1459-1467. Epub 2019 May 15.

Serviço De Gastrenterologia e Hepatologia, Hospital De Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal.

Background And Aims: The role of portal vein thrombosis (PVT) in the natural history of cirrhosis is controversial. There are few prospective studies validating risk factors for development of PVT. We analysed the incidence, factors associated with PVT development and its influence on cirrhosis decompensations and orthotopic liver transplant (OLT)-free survival.

Methods: In this prospective observational study between January 2014 and March 2019, 445 consecutive patients with chronic liver disease were screened and finally 241 with cirrhosis included. Factors associated with PVT development and its influence on cirrhosis decompensations and OLT-free survival by time dependent covariate coding were analysed.

Results: Majority of patients belonged to Child-Pugh class A 184 (76.3%) and the average MELD score was 10 ± 5. Previous cirrhosis decompensations occurred in 125 (52.1%), 63 (26.1%) were on NSBB and 59 (27.2%) had undergone banding for bleeding prophylaxis. Median follow-up was 29 (1-58) months. Cumulative incidence of PVT was 3.7% and 7.6% at 1 and 3 years. Previous decompensation of cirrhosis and low platelet counts but not NSBB independently predicted the development of PVT. During follow-up, 82/236 (34.7%) patients developed cirrhosis decompensations. OLT-free survival was 100% and 82.8% at 3 years, with and without PVT respectively. MELD score, but not PVT, independently predicted cirrhosis decompensations (HR 1.14; 95%CI:1.09-1.19) and OLT-free survival (HR 1.16;95%CI:1.11-1.21).

Conclusion: Previous decompensations of cirrhosis and thrombocytopenia predict PVT development in cirrhosis suggesting a pathophysiologic role for severity of portal hypertension. PVT development did not independently predict cirrhosis decompensations or lower OLT-free survival.
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http://dx.doi.org/10.1111/liv.14121DOI Listing
August 2019

A Predictive Model of Postnatal Surgical Intervention in Children With Prenatally Detected Congenital Anomalies of the Kidney and Urinary Tract.

Front Pediatr 2019 2;7:120. Epub 2019 Apr 2.

Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands.

The aim of this study was to identify predictive factors and develop a model to assess individualized risk of postnatal surgical intervention in patients with antenatal hydronephrosis. This is a retrospective cohort study of 694 infants with prenatally detected congenital anomalies of kidney and urinary tract with a median follow-up time of 37 months. The main event of interest was postnatal surgical intervention. A predictive model was developed using Cox model with internal validation by bootstrap technique. Of 694 patients, 164 (24%) infants underwent surgical intervention in a median age of 7.8 months. Predictors of the surgical intervention in the model were: baseline glomerular filtration rate, associated hydronephrosis, presence of renal damage and the severity of renal pelvic dilatation. The optimism corrected c statistic for the model was 0.84 (95%CI, 0.82-0.87). The predictive model may contribute to identify infants at high risk for surgical intervention. Further studies are necessary to validate the model in patients from other settings.
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http://dx.doi.org/10.3389/fped.2019.00120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454042PMC
April 2019

Anticoagulation in Cirrhosis and Portal Vein Thrombosis Is Safe and Improves Prognosis in Advanced Cirrhosis.

Dig Dis Sci 2019 09 9;64(9):2671-2683. Epub 2019 Mar 9.

Serviço De Gastrenterologia e Hepatologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Avenida Egas Moniz, 1649-035, Lisbon, Portugal.

Background: The role of portal vein thrombosis (PVT) in the natural history of cirrhosis is controversial.

Aims: We analyzed the safety and effect of anticoagulant therapy (AT) on PVT recanalization and orthotopic liver transplant (OLT)-free survival.

Methods: Eighty consecutive patients from a prospective registry of cirrhosis and non-tumoral PVT at a tertiary center were analyzed. AT effect on PVT recanalization and OLT-free survival was determined by time-dependent Cox regression analysis.

Results: Average MELD score was 15 ± 7. Portal hypertension-related complications at PVT diagnosis were present in 65 (81.3%) patients. Isolated portal vein trunk/branch thrombosis was present in 53 (66.3%) patients. AT was started in 37 patients. AT was stopped in 17 (45.9%) patients, in 4 (10.8%) due to bleeding events. No variceal bleeding occurred while on AT. Anticoagulation was restarted in 6/17 (35.2%) patients due to rethrombosis. In 67 patients with adequate follow-up imaging, AT significantly increased the rate of PVT recanalization compared with those who did not receive anticoagulation [51.4% (18/35) vs 6/32 (18.8%), p = 0.005]. OLT-free survival after a median follow-up of 25 (1-146) months was 32 (40%). Although there was no significant effect of AT on overall OLT-free survival, OLT-free survival was higher among patients with MELD ≥ 15 receiving AT compared to those who did not (p = 0.011). Baseline MELD at PVT detection independently predicted PVT recanalization (HR 1.11, 95% CI 1.01-1.21, p = 0.027) and mortality/OLT (HR 1.12, 95% CI 1.05-1.19, p < 0.001).

Conclusions: Although AT did not improve overall OLT-free survival, it was associated with higher survival in advanced cirrhosis. Anticoagulation increased PVT recanalization and should be maintained after PVT recanalization to avoid rethrombosis.
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http://dx.doi.org/10.1007/s10620-019-05572-zDOI Listing
September 2019

A clinical predictive model of renal injury in children with congenital solitary functioning kidney.

Pediatr Nephrol 2019 03 15;34(3):465-474. Epub 2018 Oct 15.

Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil.

Background: Solitary functioning kidney (SFK) is an important condition in the spectrum of congenital anomalies of the kidney and urinary tract. The aim of this study was to describe the risk factors for renal injury in a cohort of patients with congenital SFK.

Methods: In this retrospective cohort study, 162 patients with SFK were systematically followed up (median, 8.5 years). The primary endpoint was time until the occurrence of a composite event of renal injury, which includes proteinuria, hypertension, and chronic kidney disease (CKD). A predictive model was developed using Cox proportional hazards model and evaluated by c statistics.

Results: Among 162 children with SFK included in the analysis, 132 (81.5%) presented multicystic dysplastic kidney, 20 (12.3%) renal hypodysplasia, and 10 (6.2%) unilateral renal agenesis. Of 162 patients included in the analysis, 10 (6.2%) presented persistent proteinuria, 11 (6.8%) had hypertension, 9 (5.6%) developed CKD stage ≥ 3, and 18 (11%) developed the composite outcome. After adjustment by the Cox model, three variables remained as independent predictors of the composite event: creatinine (HR, 3.93; P < 0.001), recurrent urinary tract infection (UTI) (HR, 5.05; P = 0.002), and contralateral renal length at admission (HR, 0.974; P = 0.002). The probability of the composite event at 10 years of age was estimated as 3%, 11%, and 56% for patients assigned to the low-risk, medium-risk, and high-risk groups, respectively (P < 0.001).

Conclusion: Our findings have shown an overall low risk of renal injury for most of infants with congenital SFK. Nevertheless, our prediction model enabled the identification of a subgroup of patients with an increased risk of renal injury over time.
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http://dx.doi.org/10.1007/s00467-018-4111-3DOI Listing
March 2019

A clinical predictive model of chronic kidney disease in children with posterior urethral valves.

Pediatr Nephrol 2019 02 8;34(2):283-294. Epub 2018 Sep 8.

Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), R. Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil.

Background: Posterior urethral valves (PUVs) are associated with severe consequences to the urinary tract and are a common cause of chronic kidney disease (CKD). The aim of this study was to develop clinical predictive model of CKD in a cohort of patients with PUVs.

Methods: In this retrospective cohort study, 173 patients with PUVs were systematically followed up at a single tertiary unit. The primary endpoint was CKD ≥ stage 3. Survival analyses were performed by Cox regression proportional hazard models with time-fixed and time-dependent covariables.

Results: Mean follow-up time was 83 months (SD, 70 months). Sixty-five children (37.6%) developed CKD stage ≥ 3. After adjustment by the time-dependent Cox model, baseline creatinine, nadir creatinine, hypertension, and proteinuria remained as predictors of the endpoint. After adjustment by time-fixed model, three variables were predictors of CKD ≥ stage 3: baseline creatinine, nadir creatinine, and proteinuria. The prognostic risk score was divided into three categories: low-risk (69 children, 39.9%), medium-risk (45, 26%), and high-risk (59, 34.1%). The probability of CKD ≥ stage 3 at 10 years age was estimated as 6%, 40%, and 70% for patients assigned to the low-risk, medium-risk, and high-risk groups, respectively (P < 0.001). The main limitation was the preclusion of some relevant variables, especially bladder dysfunction, that might contribute to a more accurate prediction of renal outcome.

Conclusion: The model accurately predicts the risk of CKD in PUVs patients. This model could be clinically useful in applying timely intervention and in preventing the impairment of renal function.
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http://dx.doi.org/10.1007/s00467-018-4078-0DOI Listing
February 2019

Evaluating seroprevalence to circumsporozoite protein to estimate exposure to three species of Plasmodium in the Brazilian Amazon.

Infect Dis Poverty 2018 May 14;7(1):46. Epub 2018 May 14.

Laboratory of Immunoparasitology, Oswaldo Cruz Institute/Fiocruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, Brazil.

Background: Brazil has seen a great decline in malaria and the country is moving towards elimination. However, for eventual elimination, the control program needs efficient tools in order to monitor malaria exposure and transmission. In this study, we aimed to evaluate whether seroprevalence to the circumsporozoite protein (CSP) is a good tool for monitoring the exposure to and/or evaluating the burden and distribution of Plasmodium species in the Brazilian Amazon.

Methods: Cross-sectional surveys were conducted in a rural area of Porto Velho, Rondônia state. Parasite infection was detected by microscopy and polymerase chain reaction. Antibodies to the sporozoite CSP repeats of Plasmodium vivax, P. falciparum, and P. malariae (PvCS, PfCS, and PmCS) were detected using the enzyme-linked immunosorbent assay technique. Human leukocyte antigen (HLA)-DRB1 and DQB1 genes were typed using Luminex® xMAP® technology.

Results: The prevalence of immunoglobulin G against P. vivax CSP peptide (62%) was higher than P. falciparum (49%) and P. malariae (46%) CSP peptide. Most of the studied individuals had antibodies to at least one of the three peptides (72%), 34% had antibodies to all three peptides and 28% were non-responders. Although the majority of the population was not infected at the time of the survey, 74.3% of parasite-negative individuals had antibodies to at least one of the CSPs. Importantly, among individuals carrying the haplotypes DRB1*04~DQB1*03, there was a significantly higher frequency of PfCS responders, and DRB1*16~DQB1*03 haplotype for PvCS and PfCS responders. In contrast, HLA-DRB1*01 and HLA-DQB1*05 allelic groups were associated with a lack of antibodies to P. vivax and P. falciparum CSP repeats, and the haplotype DRB1*01~DQB1*05 was also associated with non-responders, including non-responders to P. malariae.

Conclusions: Our results show that in low transmission settings, naturally acquired antibody responses against the CSP repeats of P. vivax, P. falciparum, and P. malariae in a single cross-sectional study may not represent a valuable marker for monitoring recent malaria exposure, especially in an area with a high prevalence of P. vivax. Furthermore, HLA class II molecules play an important role in antibody response and require further study with a larger sample size. It will be of interest to consider HLA analysis when using serosurveillance to monitor malaria exposure among genetically diverse populations.
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http://dx.doi.org/10.1186/s40249-018-0428-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5950184PMC
May 2018

Percutaneous Closure of a Fistulous Giant Coronary Aneurysm.

Can J Cardiol 2018 06 3;34(6):812.e13-812.e15. Epub 2018 Feb 3.

Cardiology Department, Centro Hospitalar São João, Porto, Portugal; Faculty of Medicine, Porto University, Porto, Portugal.

Giant coronary artery aneurysms larger than 50 mm are rare and associated with important complications: namely, rupture. Its workup requires comprehensive imaging and standard treatment is surgical exclusion. We present a 60-year-old patient with previous ostium secundum atrial septal defect surgical closure diagnosed with a giant proximal right coronary artery aneurysm (70 x 62 mm) fistulizing into the right atrium. Percutaneous closure of its aortic origin with an atrial septal occluder was successfully performed, and thrombosis of the aneurysm confirmed on angiography and echocardiogram. This case depicts an innovative, minimally invasive approach to this worrisome entity.
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http://dx.doi.org/10.1016/j.cjca.2018.01.088DOI Listing
June 2018

Identifying palliative care needs in a Portuguese liver unit.

Liver Int 2018 11 14;38(11):1982-1987. Epub 2018 May 14.

Department of Gastroenterology and Hepatology, North Lisbon Hospital Centre, University of Lisbon, Lisbon, Portugal.

Background & Aims: Chronic liver disease is a major worldwide cause of morbidity and mortality. Palliative care policies are not clearly established in chronic liver disease. The NECPAL CCOMS-ICO© (NECesidades PALiativas/Palliative Needs) is a tool to identify palliative care needs, including a section for liver disease.

Aim: The aim of this study was to identify palliative care needs in liver patients hospitalised in a tertiary referral Liver Unit.

Methods: Single-centre prospective observational study. One hundred and twenty patients with cirrhosis were included and NECPAL questionnaire was applied to all patients in a 7-month period.

Results: 84.2% of patients were considered as requiring palliative intervention; however, clinicians identified those needs only in 65.8% of the cases and caregivers in 6.7% of the cases; less than 8% of the patients were referred for palliative care consultation. An excessive use of healthcare resources (positive answer to question 3) was strongly associated with a positive need for palliative care (positive NECPAL): OR 7.305, CI 95% 2.54-20.995, P < .001). An excessive use of healthcare facilities has a sensitivity of 84.2% and a specificity of 42.1% for prediction of a positive NECPAL result (AUC 0.710, 95% CI 0.570-0.850, P = .004).

Conclusions: The NECPAL CCOMS-ICO© represents a feasible and easy-to-use tool to identify palliative care needs in patients with chronic liver disease.
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http://dx.doi.org/10.1111/liv.13865DOI Listing
November 2018

Hepatitis delta: virological and clinical aspects.

Virol J 2017 09 13;14(1):177. Epub 2017 Sep 13.

Laboratório de Virologia Molecular - FIOCRUZ - RONDÔNIA, Rua da Beira, 7671 - BR 364, Km 3,5 Bairro Lagoa, CEP: 76812, Porto Velho, RO, CEP: 76812-329, Brazil.

There are an estimated 400 million chronic carriers of HBV worldwide; between 15 and 20 million have serological evidence of exposure to HDV. Traditionally, regions with high rates of endemicity are central and northern Africa, the Amazon Basin, eastern Europe and the Mediterranean, the Middle East and parts of Asia. There are two types of HDV/HBV infection which are differentiated by the previous status infection by HBV for the individual. Individuals with acute HBV infection contaminated by HDV is an HDV/HBV co-infection, while individuals with chronic HBV infection contaminated by HDV represent an HDV/HBV super-infection. The appropriate treatment for chronic hepatitis delta is still widely discussed since it does not have an effective drug. Alpha interferon is currently the only licensed therapy for the treatment of chronic hepatitis D. The most widely used drug is pegylated interferon but only approximately 25% of patients maintain a sustained viral response after 1 year of treatment. The best marker of therapeutic success would be the clearance of HBsAg, but this data is rare in clinical practice. Therefore, the best way to predict a sustained virologic response is the maintenance of undetectable HDV RNA levels.
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http://dx.doi.org/10.1186/s12985-017-0845-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597996PMC
September 2017

Pericardial mesothelioma presenting as a suspected ST-elevation myocardial infarction.

Rev Port Cardiol 2017 Apr 23;36(4):307.e1-307.e5. Epub 2017 Mar 23.

Unidade de Cuidados Intermédios de Medicina, Centro Hospitalar São João, Porto, Portugal.

Primary cardiac and pericardial tumors are rare entities with an autopsy frequency of 0.001-0.03%. Metastases to the heart and pericardium are much more common than primary tumors. Malignant pericardial mesotheliomas account for up to 50% of primary pericardial tumors. We report the case of a 75-year-old woman with hypertension, dyslipidemia and atrial fibrillation who went to the emergency department due to nonspecific thoracic discomfort of over six hours duration associated with syncope. Physical examination revealed a low-amplitude arrhythmic pulse, no heart murmurs and no signs of pulmonary congestion. The ECG revealed atrial fibrillation with ST-segment elevation in V2-V6, I and aVL. The patient was transferred for emergent coronary angiography, which revealed a long stenosis in the mid-distal portion of the left anterior descending artery. The echocardiogram showed a large pericardial effusion with diffuse thickening of the myocardium. Due to worsening hemodynamics, cardiac rupture was suspected and the patient underwent urgent sternotomy and pericardiotomy with drainage of a large quantity of hematic fluid. The surgeons then identified a large, unresectable tumor occupying the distal half of the anterior portion of the heart. This is, to our knowledge, the first case report of primary pericardial mesothelioma presenting with suspected ST-elevation myocardial infarction. In this case, direct observation of the tumor led to biopsy and the final diagnosis. These are highly malignant tumors and when diagnosed are usually already at an advanced stage.
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http://dx.doi.org/10.1016/j.repc.2016.03.014DOI Listing
April 2017

Arrhythmic storm: Short-coupled variant torsade de pointes.

Rev Port Cardiol 2016 May 25;35(5):307.e1-5. Epub 2016 Apr 25.

Serviço de Cardiologia, Hospital de São João, Porto, Portugal.

A 49-year-old woman, with no relevant family history, was admitted in 1996 for arrhythmic storm with polymorphic ventricular tachycardia (torsade de pointes) which degenerated into ventricular fibrillation. Iatrogenic causes were excluded, the electrocardiogram (ECG) was normal and there was no structural heart disease. She refused cardioverter-defibrillator implantation. Treatment was begun with amiodarone, which she took irregularly. She remained asymptomatic until 2014 when she was admitted for a new arrhythmic storm with torsade de pointes, refractory to antiarrhythmic therapy and aggravated by ventricular pacing (65 defibrillations). She had frequent ventricular extrasystoles (with short-coupled period <300 ms) preceding the tachycardia. After administration of isoprenaline infusion electric stability was maintained. In this setting and in the absence of structural heart disease or iatrogenic cause, a diagnosis of short-coupled variant torsade de pointes was established. A cardioverter-defibrillator was implanted and she was treated with verapamil, without recurrence of arrhythmias.
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http://dx.doi.org/10.1016/j.repc.2016.01.007DOI Listing
May 2016

The influence of intestinal parasites on Plasmodium vivax-specific antibody responses to MSP-119 and AMA-1 in rural populations of the Brazilian Amazon.

Malar J 2015 Nov 6;14:442. Epub 2015 Nov 6.

Laboratorio de Imunoparasitologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, Brazil.

Background: Polyparasitism is a common condition in humans but its impact on the host immune system and clinical diseases is still poorly understood. There are few studies of the prevalence and the effect of malaria-intestinal parasite co-infections in the immune response to malaria vaccine candidates. The present study determines whether the presence of malaria and intestinal parasites co-infection is associated with impaired IgG responses to Plasmodium vivax AMA-1 and MSP-119 in a rural population of the Brazilian Amazon.

Methods: A cross-sectional survey was performed in a rural area of Rondonia State and 279 individuals were included in the present study. At recruitment, whole blood was collected and Plasmodium and intestinal parasites were detected by microscopy and molecular tests. Blood cell count and haemoglobin were also tested and antibody response specific to P. vivax AMA-1 and MSP-119 was measured in plasma by ELISA. The participants were grouped according to their infection status: singly infected with Plasmodium (M); co-infected with Plasmodium and intestinal parasites (CI); singly infected with intestinal parasites (IP) and negative (N) for both malaria and intestinal parasites.

Results: The prevalence of intestinal parasites was significantly higher in individuals with malaria and protozoan infections were more prevalent. IgG antibodies to PvAMA-1 and/or PvMSP-119 were detected in 74 % of the population. The prevalence of specific IgG was similar for both proteins in all four groups and among the groups the lowest prevalence was in IP group. The cytophilic sub-classes IgG1 and IgG3 were predominant in all groups for PvAMA-1 and IgG1, IgG3 and IgG4 for PvMSP-119. In the case of non-cytophilic antibodies to PvAMA-1, IgG2 was significantly higher in IP and N group when compared to M and CI while IgG4 was higher in IP group.

Conclusions: The presence of intestinal parasites, mainly protozoans, in malaria co-infected individuals does not seem to alter the antibody immune responses to P. vivax AMA-1 and MSP-119. However, IgG response to both AMA1 and MSP1 were lower in individuals with intestinal parasites.
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http://dx.doi.org/10.1186/s12936-015-0978-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636833PMC
November 2015

Hunger, food and drink in Brazilian popular music: a brief overview.

Hist Cienc Saude Manguinhos 2015 Jul-Sep;22(3):723-41

Unidade Acadêmica de Letras, Centro de Formação de Professores, Universidade Federal de Campina Grande, Cajazeiras, PB, BR,

The article reflects on how the themes of hunger, consumption of soft drinks and consumption of beans and rice are addressed in Brazilian popular music. We investigate the years of military dictatorship (1964-1985). The focus of the analysis is on the so-called protest song, a musical genre characterized by aesthetic, cultural, political, ideological and social criticism to military rule. The study of the ideology and philosophy of language of Mikhail Bakhtin is the theoretical reference; especially his concepts of "ideological sign" and "word." Analysis reveals that the protest song portrayed elements of the economic, political and social contexts and led to the diffusion of healthy or unhealthy eating habits or ideologies, contributing to the construction of the Brazilian dietary identity.
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http://dx.doi.org/10.1590/S0104-59702015000300004DOI Listing
May 2017

Resveratrol Regulates the Quiescence-Like Induction of Activated Stellate Cells by Modulating the PPARγ/SIRT1 Ratio.

J Cell Biochem 2015 Oct;116(10):2304-12

Departamento de Bioquímica, ICBS, Universidade Federal do Rio Grande do Sul (UFRGS), rua Ramiro Barcelos, 2600-Anexo I, CEP 90035-003, Porto Alegre, RS, Brazil.

The activation of hepatic stellate cell (HSC), from a quiescent cell featuring cytoplasmic lipid droplets to a proliferative myofibroblast, plays an important role in liver fibrosis development. The GRX line is an activated HSC model that can be induced by all-trans-retinol to accumulate lipid droplets. Resveratrol is known for activating Sirtuin1 (SIRT1), a NAD(+)-dependent deacetylase that suppresses the activity of peroxisome proliferator-activated receptor gamma (PPARγ), an important adipogenic transcription factor involved in the quiescence maintenance of HSC. We evaluated the effects of 0.1 μM of resveratrol in retinol-induced GRX quiescence by investigating the interference of SIRT1 and PPARγ on cell lipogenesis. GRX lipid accumulation was evaluated through Oil-red O staining, triacylglycerides quantification, and [(14)C] acetate incorporation into lipids. mRNA expression and protein content of SIRT1 and PPARγ were measured by RT-PCR and immunoblotting, respectively. Resveratrol-mediated SIRT1 stimuli did not induce lipogenesis and reduced the retinol-mediated fat-storing capacity in GRX. In order to support our results, we established a cell culture model of transgenic super expression of PPARγ in GRX cells (GRXPγ). Resveratrol reduced lipid droplets accumulation in GRXPγ cells. These results suggest that the PPARγ/SIRT1 ratio plays an important role in the fate of HSC. Thus, whenever the PPARγ activity is greater than SIRT1 activity the lipogenesis is enabled.
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http://dx.doi.org/10.1002/jcb.25181DOI Listing
October 2015

IL10A genotypic association with decreased IL-10 circulating levels in malaria infected individuals from endemic area of the Brazilian Amazon.

Malar J 2015 Jan 28;14:30. Epub 2015 Jan 28.

Laboratório de Imunoparasitologia, Instituto Oswaldo Cruz/Fiocruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, Brazil.

Background: Cytokines play an important role in human immune responses to malaria and variation in their production may influence the course of infection and determine the outcome of the disease. The differential production of cytokines has been linked to single nucleotide polymorphisms in gene promoter regions, signal sequences, and gene introns. Although some polymorphisms play significant roles in susceptibility to malaria, gene polymorphism studies in Brazil are scarce.

Methods: A population of 267 individuals from Brazilian Amazon exposed to malaria was genotyped for five single nucleotide polymorphisms (SNPs), IFNG + 874 T/A, IL10A-1082G/A, IL10A-592A/C, IL10A-819 T/C and NOS2A-954G/C. Specific DNA fragments were amplified by polymerase chain reaction, allowing the detection of the polymorphism genotypes. The polymorphisms IL10A-592A/C and IL10A-819 T/C were estimated by a single analysis due to the complete linkage disequilibrium between the two SNPs with D' = 0.99. Plasma was used to measure the levels of IFN-γ and IL-10 cytokines by Luminex and nitrogen radicals by Griess reaction.

Results: No differences were observed in genotype and allelic frequency of IFNG + 874 T/A and NOS2A-954G/C between positive and negative subjects for malaria infection. Interesting, the genotype NOS2A-954C/C was not identified in the study population. Significant differences were found in IL10A-592A/C and IL10A-819 T/C genotypes distribution, carriers of IL10A -592A/-819 T alleles (genotypes AA/TT + AC/TC) were more frequent among subjects with malaria than in negative subjects that presented a higher frequency of the variant C allele (p < 0.0001). The presence of the allele C was associated with low producer of IL-10 and low parasitaemia. In addition, the GTA haplotypes formed from combinations of investigated polymorphisms in IL10A were significantly associated with malaria (+) and the CCA haplotype with malaria (-) groups. The IL10A-1082G/A polymorphism showed high frequency of heterozygous AG genotype in the population, but it was not possible to infer any association of the polymorphism because their distribution was not in Hardy Weinberg equilibrium.

Conclusion: This study shows that the IL10A-592A/C and IL10A-819 T/C polymorphisms were associated with malaria and decreased IL-10 levels and low parasite density suggesting that this polymorphism influence IL-10 levels and may influence in the susceptibility to clinical malaria.
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http://dx.doi.org/10.1186/s12936-015-0548-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334410PMC
January 2015

Intestinal parasites coinfection does not alter plasma cytokines profile elicited in acute malaria in subjects from endemic area of Brazil.

Mediators Inflamm 2014 16;2014:857245. Epub 2014 Sep 16.

Laboratório de Imunoparasitologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, 21040-900 Rio de Janeiro, RJ, Brazil.

In Brazil, malaria is prevalent in the Amazon region and these regions coincide with high prevalence of intestinal parasites but few studies explore the interaction between malaria and other parasites. Therefore, the present study evaluates changes in cytokine, chemokine, C-reactive protein, and nitric oxide (NO) concentrations in 264 individuals, comparing plasma from infected individuals with concurrent malaria and intestinal parasites to individuals with either malaria infection alone and uninfected. In the studied population 24% of the individuals were infected with Plasmodium and 18% coinfected with intestinal parasites. Protozoan parasites comprised the bulk of the intestinal parasites infections and subjects infected with intestinal parasites were more likely to have malaria. The use of principal component analysis and cluster analysis associated increased levels of IL-6, TNF-α, IL-10, and CRP and low levels of IL-17A predominantly with individuals with malaria alone and coinfected individuals. In contrast, low levels of almost all inflammatory mediators were associated predominantly with individuals uninfected while increased levels of IL-17A were associated predominantly with individuals with intestinal parasites only. In conclusion, our data suggest that, in our population, the infection with intestinal parasites (mainly protozoan) does not modify the pattern of cytokine production in individuals infected with P. falciparum and P. vivax.
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http://dx.doi.org/10.1155/2014/857245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4182071PMC
June 2015

The interplay between apoptosis, mitophagy and mitochondrial biogenesis induced by resveratrol can determine activated hepatic stellate cells death or survival.

Cell Biochem Biophys 2015 Mar;71(2):657-72

Department of Biochemistry, ICBS, Federal University of Rio Grande do Sul (UFRGS), rua Ramiro Barcelos, 2600-Anexo I, Porto Alegre, RS, CEP 90035-003, Brazil,

Resveratrol has been the focus of numerous studies reporting opposite effects that depend on its concentration. The GRX is an activated hepatic stellate cells model used to study liver fibrosis development and resolution. We recently showed that GRX treatment with RSV (0.1-50 µM) for 24 h triggered dose-dependent pro-oxidant effects, resulting in cytotoxicity and cell damage only at the highest concentration. Here, we evaluated whether the pro-oxidant effect of resveratrol treatment is accompanied by alterations on the GRX mitochondrial metabolism, and whether the concomitantly autophagy/mitophagy induction can influence on cell death or survival. We demonstrated that all concentrations of resveratrol promoted an increase of GRX cell death signals, altering the mitochondrial dynamics and function. Cells treated with all resveratrol concentrations presented higher autophagy/mitophagy features, but only treatments with 1 and 10 µM of resveratrol-induced mitochondrial biogenesis. Since cell damage was higher and there was no mitochondrial biogenesis in GRX treated with 50 µM of resveratrol, we suggest that these cells failed to remove and replace all damaged mitochondria. In conclusion, the cytotoxic effect of resveratrol that effectively promotes cell death could be related to the interrelation between the concomitant induction of apoptosis, autophagy/mitophagy and mitochondrial biogenesis in GRX.
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http://dx.doi.org/10.1007/s12013-014-0245-5DOI Listing
March 2015

The lost needle of a seamstress.

Rev Port Cardiol 2014 Sep 2;33(9):573-4. Epub 2014 Aug 2.

Serviço de Cardiologia, Hospital de São João, Porto, Portugal.

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http://dx.doi.org/10.1016/j.repc.2014.03.004DOI Listing
September 2014

A predictive model of chronic kidney disease in patients with congenital anomalies of the kidney and urinary tract.

Pediatr Nephrol 2014 Dec 19;29(12):2357-64. Epub 2014 Jun 19.

Pediatric Nephrology Unit, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, Faculty of Medicine, Federal University of Minas Gerais, Av Alfredo Balena, 190, Belo Horizonte, MG, 30130-100, Brazil.

Background: The antenatal detection of congenital anomalies of the kidney and urinary tract (CAKUT) has permitted early management of these conditions. The aim of this study was to identify predictive factors associated with chronic kidney disease (CKD) in CAKUT. We also propose a risk score of CKD.

Methods: In this cohort study, 822 patients with prenatally detected CAKUT were followed up for a median time of 43 months. The primary outcome was CKD stage III or higher. A predictive model was developed using the Cox proportional hazards model and evaluated by using c statistics.

Results: Chronic kidney disease occurred in 49 of the 822 (6 %) children with prenatally detected CAKUT. The most accurate model included bilateral hydronephrosis, oligohydramnios, estimated glomerular filtration rate and postnatal diagnosis. The accuracy of the score was 0.95 [95 % confidence interval (CI) 0.89-0.99] and 0.92 (95 % CI 0.86-0.95) after a follow-up of 2 and 10 years, respectively. Based on survival curves, we estimated that at 10 years of age, the probability of survival without CKD stage III was approximately 98 and 58 % for the patients assigned to the low-risk and high-risk groups, respectively (p < 0.001).

Conclusions: Our predictive model of CKD may contribute to an early identification of a subgroup of patients at high risk for renal impairment. It should be pointed out, however, that this model requires external validation in a different cohort.
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http://dx.doi.org/10.1007/s00467-014-2870-zDOI Listing
December 2014

Stress-induced cardiomyopathy associated with ipratropium bromide therapy in a patient with chronic obstructive pulmonary disease.

Rev Port Cardiol 2014 Mar 27;33(3):175.e1-4. Epub 2014 Mar 27.

Serviço de Cardiologia, Centro Hospitalar São João, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Portugal.

Stress-induced cardiomyopathy, also known as 'broken heart syndrome' or Takotsubo cardiomyopathy, is characterized by transient systolic dysfunction of the apical and/or mid segments of the left ventricle, in the absence of significant coronary artery disease. We report the case of a 56-year-old male patient with chronic obstructive pulmonary disease (COPD), with stress-induced cardiomyopathy associated with the use of ipratropium bromide, administered in the context of an acute exacerbation of COPD.
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http://dx.doi.org/10.1016/j.repc.2013.10.012DOI Listing
March 2014