LUCIANA PARENTE COSTA SEGURO

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina

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  • conferenceObject
    Induction of Lupus Nephritisin in Real Situation: Cyclophosphamide or Mycophenolate Mofetil?
    (2017) MUNHOZ, Gabriela; LACERDA, Maira; LOPES, Michelle; BORBA, Eduardo Ferreira; SEGURO, Luciana; BONFA, Eloisa
  • article 73 Citação(ões) na Scopus
    Early proteinuria response: a valid real-life situation predictor of long-term lupus renal outcome in an ethnically diverse group with severe biopsy-proven nephritis?
    (2017) UGOLINI-LOPES, Michelle R.; SEGURO, Luciana Parente C.; CASTRO, Maite Xavier F.; DAFFRE, Danielle; LOPES, Alex C.; BORBA, Eduardo F.; BONFA, Eloisa
    Objective Two recent important lupus nephritis trials reported that proteinuria was a good predictor of renal outcome in Caucasians, but data on real-life situation, other races and severe nephritis are lacking to substantiate this finding as a simple test to guide clinical practice. The aim of this study was to validate proteinuria as a predictor of long-term renal outcome in real-life situation in a racially diverse group of patients with severe nephritis. Methods Proteinuria, serum creatinine (SCr) and urine red blood cells were assessed at baseline and after 3, 6 and 12 months, as early predictors of long-term renal outcome (SCr <1.5 mg/dL at 7 years), in 94 patients with biopsy-proven lupus nephritis. The parameter performance and cut-off values were computed by receiver operating characteristic curves. Kaplan-Meier curves were used to validate the parameter. Results A proteinuria <0.8 g/24 hours at 12 months was the best single predictor of long-term renal outcome (sensitivity 90%, specificity 78%, positive predictive value 67%, negative predictive value (NPV) 94% and area under the curve 0.86; p<0.001). Addition of other variables to proteinuria such as SCr and haematuria at 12 months did not improve its performance. The proteinuria cut-aft value of <0.8 g/24 hours at 12 months was a good predictor of 7-year renal survival (years free of dialysis) for patients with pure membranous (p=0.005) and proliferative nephritis (p=0.043), as well as black (p=0.002) and white race (p=0.001), anti-dsDNA positive (p=0.001) and anti-dsDNA negative (p=0.04) and male (p=0.028) and female (p=0.003) patients. Conclusion We provided novel evidence that, in a real-life situation, proteinuria at 12 months of follow-up was the single best predictor of renal outcome at 7 years for an ethnically diverse group of patients with severe nephritis and a valid parameter for distinct histological classes, races, genders and anti-dsDNA profiles. The remarkably high NPV obtained reinforces its recommendation as the ideal predictor for clinical practice, since it is of low cost, easy to interpret, non-invasive and widely available.
  • conferenceObject
    BASELINE CHARACTERISTICS OFA LONGITUDINAL, MULTINATIONAL, MULTIETHNIC STUDYOF LUPUS PATIENTS, WITH ORWITHOUT LUPUS NEPHRITIS
    (2023) NIETO, Romina; QUINTANA, Rosana; BORBA, Eduardo; HERNANDEZ, Lucia; FERNANDEZ, Diana; MAURELLI, Laura; ALBA, Paula; BORDON, Florencia; ARIZPE, Fernando; BERBOTTO, Guillermo; SERRANO, Rosa; BERTOLACCINI, Maria; KERSBERG, Eduardo; GARGIULO, Maria; RODRIGUEZ, Anabella; BARBOSA, Vitalina; GASPARIN, Andrese; CAVALCANTI, Fernando; ALVES, Laissa; PARENTE, Luciana; OLIVEIRA, Lucas de; NEIRA, Oscar; MASSARDO, Loreto; AROCA, Gustavo; NIETO, Ivana; MENDEZ, Paul; IGLESIAS, Antonio; ZUNIGA, Andres; VERA, Olga; PEREZ, Mario; NARES, Eduardo; AMEZCUA, Luis; GONZALEZ, Yelitza; GONZALEZ, Octavio; GALARZA, Dionicio; VAZQUEZ, Carolina; BARRIOS, Marcelo; LINARES, Magaly; REATEGUI, Cristina; QUIROS, Ana; POLANCO, Teresandris; PIZZAROSSA, Carina; REBELLA, Martin; CRESPO, Maria; DANZA, Alvaro; BONFA, Eloisa; ALARCON, Graciela; ZAZZETTI, Federico; ORILLION, Ashley; SBARIGIA, Urbano; ESTEL, Guillermo Pons
  • conferenceObject
  • article 2 Citação(ões) na Scopus
    Intramastoid Phosphaturic Mesenchymal Tumor Causing Hypophosphatemic Osteomalacia Detected on Ga-68-DOTATATE PET/CT But Not on Tc-99m-Sestamibi and F-18-FDG Scans
    (2019) ARAUJO, Carlo Scognamiglio Renner; SEGURO, Luciana Parente Costa; DUARTE, Paulo Schiavom; BUCHPIGUEL, Carlos Alberto; PEREIRA, Rosa Maria Rodrigues
    Ga-68-DOTATATE uptake in mesenchymal tumors causing hypophosphatemic osteomalacia has been recently described. Herein, we present a case of Ga-68-DOTATATE uptake in an intramastoid phosphaturic mesenchymal tumor that had not been depicted in previous Tc-99m-Sestamibi and F-18-FDG scans. The lesion was surgically removed and the phosphorus level increased to the normal range.
  • conferenceObject
    CLINICAL AND SEROLOGICAL COMPARATIVE ANALYSIS OF SYSTEMIC SCLEROSIS WITH OR WITHOUT OVERLAP SYNDROMES IN A LARGE BRAZILIAN COHORT
    (2014) SILVA, C. M.; PASOTO, S. G.; VIANA, V. S.; SEGURO, L. P. C.; ANDRADE, D. C. O.; BONFA, E.; SAMPAIO-BARROS, P. D.
  • conferenceObject
    Bone Metabolism Impairment in Heart Transplant: Results from a Prospective Cohort Study
    (2019) SEGURO, Luis; PEREIRA, Rosa; SEGURO, Luciana; CAPARBO, Valeria; AVILA, Monica; MANGINI, Sandrigo; CAMPOS, Iascara; GAIOTTO, Fabio; MARCONDES-BRAGA, Fabiana; BACAL, Fernando
  • article 24 Citação(ões) na Scopus
    Chronic arthritis in systemic lupus erythematosus: distinct features in 336 paediatric and 1830 adult patients
    (2016) GORMEZANO, Natali W. S.; SILVA, Clovis A.; AIKAWA, Nadia E.; BARROS, Diego L.; SILVA, Mariana A. da; OTSUZI, Carini I.; KOZU, Katia; SEGURO, Luciana Parente; PEREIRA, Rosa M. R.; BONFA, Eloisa
    The objectives of this study are to assess the frequency of chronic arthritis and compare the clinical and laboratory features in a large population of childhood-onset systemic lupus erythematosus (cSLE) and adult-onset (aSLE) patients. This historical study evaluated 336 cSLE and 1830 aSLE patients. Chronic arthritis was defined as synovitis of at least 6 weeks of duration. Rhupus was characterised as the association of SLE and chronic inflammatory arthritis with erosion and positive rheumatoid factor. Jaccoud's arthropathy is a non-erosive subluxation leading to severe deformity of the hands and feet. Data were compared using Student's t test or the Mann-Whitney test for continuous variables. For categorical variables, differences were assessed by Fisher's exact test and Pearson chi-square. Frequencies of chronic arthritis were similar in cSLE and aSLE (2.4 vs. 3.8 %, p=0.261). The median time from disease onset to appearance of chronic arthritis was shorter in cSLE (0 vs. 10 years, p<0.001), and the median of age at chronic arthritis diagnosis was [10.8 (4.2-14.6) vs. 40 (21-67), p<0.001]. The children presented with more chronic polyarthritis than the adults (75 vs. 32 %, p=0.024), a higher median number of joints with arthritis [8.5 (118) vs. 3 (1-9), p=0.017] and a higher number of joints with limitation [1.5(0-24) vs. 0(0-4), p=0.004]. The chronic arthritis diagnosis frequencies of hepatomegaly (25 vs. 0 %, p=0.009), splenomegaly (25 vs. 0 %, p=0.009), pericarditis (25 vs. 0 %, p=0.009), nephritis (37 vs. 3 %, p=0.006), haematuria (37 vs. 1.4 %, p=0.002), lupus anticoagulant (40 vs. 1.6 %, p=0.012), anticardiolipin IgM (40 vs. 1.5 %, p=0.012) and median Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) [10.5(1-20) vs. 6(4-16), p=0.029] were higher in cSLE. Frequency of rhupus, (12 vs. 17 %, p=1.0), Jaccoud's arthropathy (0 vs. 17 %, p=0.343) and treatments were similar in cSLE and aSLE. We determined that chronic arthritis in SLE has distinct features in children, with very early onset, polyarticular involvement and association with active disease. We further demonstrated in this series that a proportion of chronic arthritis involvement in SLE is manifested as rhupus and Jaccoud's arthropathy.
  • article
    Profiles of criteria and non-criteria anti-phospholipid autoantibodies are associated with clinical phenotypes of the antiphospholipid syndrome
    (2020) VOLKOV, Ilan; SEGURO, Luciana; LEON, Elaine P.; KOVACS, Laszlo; ROGGENBUCK, Dirk; SCHIERACK, Peter; GILBURD, Boris; DORIA, Andrea; TEKTONIDOU, Maria G.; AGMON-LEVIN, Nancy
    Background Specific anti-phospholipids antibodies (aPLs) are used as classification criteria of the antiphospholipid syndrome (APS). These aPLs, although essential for diagnosis, do not predict disease phenotypes, which may require specific therapies. Non-criteria aPLs are rarely evaluated and their role is yet to be defined. In the current study, we aimed to examine the association between criteria and non-criteria aPLs and APS phenotypes. Methods Serum samples from 188 subjects, 130 APS patients and 58 controls were analyzed for the presence of 20 aPLs (IgG and IgM isotypes to cardiolipin (CL), beta2-glycoprotein1 (beta 2GP1), phosphatidic acid (P-acid), phosphatidylcholine (PC), phosphatidylethanolamine (PE), phosphatidylglycerol (PG), phosphatidylinositol (PI), phosphatidylserine (PS), annexin-5 (AN) and prothrombin (PT) using a line immunoassay (GA Generic Assays, Germany). Sero-positivity to the different aPLs/aPLs profiles was correlated to APS phenotypes (i.e. arterial thrombosis, CNS manifestations, venous thrombosis, relapsing disease, obstetric morbidity). Results In this cohort, arterial thrombosis was associated with accumulative number of >= 7/20 aPLs evaluated (OR 4.1; CI 95% 1.9-96, p = 0.001) as well as the sole presence of aPT (IgG) (OR 2.3;CI 95% 1.1-5.1, p = 0.03). CNS manifestations were linked with a profile of 4 aPLs (IgG): aPT, aPG, aPI and aAN (OR 2.6;CI 95% 1.1-6.3, p = 0.03). Symptom-free period of >= 3 years was linked with lower number of aPLs and the presence of aPI (IgG) (OR 3.0;CI 95% 1.08-8.1, p < 0.05) or aAN (IgG) (OR 3.4;CI 95% 1.08-10.9, p < 0.05). APS related pregnancy morbidity correlated with a profile of 2 aPLs (IgG): aCL and aPS (OR 2.9; CI 95% 1.3-6.5, p < 0.05) or the sole presence of aAN (IgG) (OR 2.8; CI 95% 1.02-8, p = 0.05). Conclusion In this study, we observed an association between specific criteria/non-criteria aPLs or aPLs profiles and clinical phenotypes of APS. Our data suggest that examination of a wider variety of aPLs may allow better characterization of APS.
  • article 15 Citação(ões) na Scopus
    Increased visceral adipose tissue and altered adiposity distribution in premenopausal lupus patients: correlation with cardiovascular risk factors
    (2018) SEGURO, L. P. C.; PAUPITZ, J. A.; CAPARBO, V. F.; BONFA, E.; PEREIRA, R. M. R.
    Objective: Visceral adipose tissue (VAT) correlates with cardiovascular risk factors and has never been assessed in systemic lupus erythematosus (SLE). Our aim was to evaluate VAT in premenopausal SLE patients. Methods: Sixty-three premenopausal SLE patients and 186 age-matched healthy women were included. Demographic, anthropometric, disease and treatment parameters were evaluated. VAT was measured by dual X-ray absorptiometry (DXA) with APEX 4.0 software. Results: SLE patients had a disease duration of 5.25 +/- 3.80 years, SLEDAI activity score of 4.35 +/- 5.13, SLICC/ACR-DI of 0.70 +/- 0.80, current prednisone dose of 11.60 +/- 12.10 mg/day and cumulative glucocorticoid dose of 22.34 +/- 12.94 g. Overweight/obese SLE patients and controls had similar VAT parameters (p>0.05). Among individuals with BMI <25 kg/m(2), SLE patients and controls had similar weight, fat mass and fat percentage (p>0.05) but patients had higher values of VAT parameters (VAT mass: 260.60 +/- 117.23 vs. 194.77 +/- 71.42 g, p=0.001; VAT area: 54.05 +/- 24.30 vs. 40.40 +/- 14.82 cm(2), p=0.001; VAT volume: 281.75 +/- 126.81 vs. 210.61 +/- 77.29 cm(3), p=0.001) and trunk/limb fat mass ratio (0.78 +/- 0.21 vs. 0.67 +/- 0.12, p=0.002) compared to controls. In SLE, VAT area correlated with weight (r=0.66, p<0.001), non-HDL cholesterol (r=0.53, p<0.001), LDL cholesterol (r=0.48, p<0.001) and triglycerides (r=0.33, p=0.008), but not with disease duration, SLEDAI, SLICC/ACR-DI or current glucocorticoid use (p>0.05). Conclusion: This study provides original evidence that SLE is associated with increased VAT and altered adiposity distribution. The correlation with traditional risk factors for cardiovascular disease, independent of current glucocorticoid dose and disease activity, suggests the role of visceral fat as an additional tool for risk assessment in these young patients.