NAIRO MASSAKAZU SUMITA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/03 - Laboratório de Medicina Laboratorial, Hospital das Clínicas, Faculdade de Medicina
LIM/03 - Laboratório de Medicina Laboratorial, Hospital das Clínicas, Faculdade de Medicina
16 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 16
- Point-of-Care Testing: General Aspects(2018) FERREIRA, Carlos E. S.; GUERRA, Joao C. C.; SLHESSARENKO, Natasha; SCARTEZINI, Marileia; FRANCA, Carolina N.; COLOMBINI, Marjorie P.; BERLITZ, Fernando; MACHADO, Antonia M. O.; CAMPANA, Gustavo A.; FAULHABER, Adriana C. L.; GALORO, Cesar A.; DIAS, Claudia M.; SHCOLNIK, Wilson; MARTINO, Marines D. V.; CESAR, Katia R.; SUMITA, Nairo M.; MENDES, Maria E.; FAULHABER, Marcelo H. W.; PINHO, Joao R. R.; BARBOSA, Ismar V.; BATISTA, Marcelo C.; KHAWALI, Cristina; PARIZ, Vitor M.; ANDRIOLO, AdagmarPoint-of-Care Testing (POCT) has been highlighted in the health care sector in recent decades. On the other hand, due to its low demand, POCT is at a disadvantage compared to conventional equipment, since its cost is inversely proportional to the volume of use. In addition, for the implementation of POCT to succeed, it is essential to rely on the work of a multidisciplinary team. The awareness of health professionals of the importance of each step is perhaps the critical success factor. The trend towards the continuous advancement of the use of POCT and the great potential of its contributions reinforce the need to implement quality management tools, including performance indicators, to ensure their results. This review presents some advantages and disadvantages concerning POCT and the real need to use it. A worldwide call for the availability of easy-to-use health technologies that are increasingly closer to the final user is one of the main reasons for this focus.
- Diminished Mycophenolic Acid Exposure Caused by Omeprazole May Be Clinically Relevant in the First Week Posttransplantation(2012) DAVID-NETO, Elias; TAKAKI, Kelly M.; AGENA, Fabiana; ROMANO, Paschoalina; SUMITA, Nairo M.; MENDES, Maria E.; NERI, Leticia Aparecida Lopes; NAHAS, William C.Background: Some studies have reported a decreased absorption of mycophenolic acid (MPA) from mycophenolate mofetil (MMF) in renal transplanted (RTx) patients under proton-pump inhibitors (PPIs). There is still a lack of information regarding (1) whether this effect occurs when MMF is administered with either tacrolimus or cyclosporine A [calcineurin inhibitors (CNIs)], (2) whether the effect has the same amplitude during the first year after RTx, and finally (3) whether this decrease in exposure is clinically relevant. Methods: We retrospectively analyzed the omeprazole effect in 348 12-hour pharmacokinetic samplings [area under the curve (AUC) 0-12h] performed on days 7, 14, 30, 60, 180, and 360 after RTx in 77 patients who participated in previous trials. Results: For all periods, the groups with and without PPI did not differ in all variables. By mixed-model analysis of variance, PPI reduced the MPA AUC(0-12h) (P < 0.0008) in the patients under both CNIs mainly due to decreased absorption (P = 0.049). In the tacrolimus group, a lower exposure seemed also due to a decreased MPA reabsorption at 10-12 hours. The PPI effect remains throughout the first year but was clinically more important on day 7. By Cox analysis, the use of PPI was associated with a 25% less chance of being adequately exposed to MPA (95% confidence interval 0.58-0.99, P = 0.04). Similarly, the number of patients underexposed to MPA (AUC < 30 ng.h/mL) was higher at most periods in the PPI group but again not statistically significant. Conclusions: These data indicate that PPI decreases the MPA exposure when associated with both CNIs but particularly in the first week after RTx. In this period, the MMF dose should be increased. This effect lasts throughout the first year but does not seem to be clinically relevant after the first week.
article Pharmacokinetics of 6-thioguanine nucleotide and 6-methyl-mercaptopurine in a case of inadvertent combination therapy of azathioprine with allopurinol(2012) PACHECO-NETO, Maurílio; ALVES, Atecla N. L; FORTINI, Alexandre S.; SUMITA, Nairo M.; MENDES, Maria E.; TORRES, Larissa H. L.; DULEY, John A.; NAHAS, William C.; CHOCAIR, Pedro R.Background: Allopurinol was invented originally to improve response to thiopurine drugs, such as azathioprine (AZA) and mercaptopurine, but if they are given in combination then the thiopurine dose must be drastically reduced to about one third of a normal dose. Failure to reduce the thiopurine dose can cause severe toxicity, and has resulted in allopurinol usually being contraindicated for patients taking thiopurines. Case report: We present a case of a 44 year old female patient who received a renal transplant in 2001, with mycophenylate/tacrolimus/prednisolone immunosuppression. In 2004 the patient experienced gout symptoms and was prescribed 100 mg allopurinol per day. In 2008, her mycophenylate was replaced with 150 mg AZA. Within four weeks the patient was hospitalized suffering from severe myelotoxicity, with high blood levels of the AZA metabolite thioguanine nucleotide (6-TGN). AZA was stopped, with recovery of hematological parameters and elimination of AZA metabolites requiring a further two weeks. Discussion: This case demonstrates the risk of rapid-onset myelotoxicity due to AZA/ allopurinol co-therapy without correct dose adjustment of these drugs. The availability of routine analysis of AZA metabolites was useful for rapidly diagnosing the cause of the toxicity and monitoring recovery. Interestingly, the half-life of AZA metabolites after cessation of therapy (5.5 days for 6-TGN, 4 days for 6-MMP) was comparable to values in the absence of allopurinol: this excluded the elevation of 6-TGN being caused by an increased half-life.- Validation protocol for multiple blood gas analyzers in accordance with laboratory accreditation programs(2015) EBNER, Pérsio A. R.; ROMANO, Paschoalina; SANT’ANNA, Alexandre; MENDES, Maria Elizabete; OLIVEIRA, Magna; SUMITA, Nairo M.Introduction: The results of blood gas analysis using different instrumentation can vary widely due to the methodological differences, the calibration procedures and the use of different configurations for each type of instrument. Objective: The objective of this study was to evaluate multiple analytical systems for measurement of blood gases, electrolytes and metabolites in accordance with the accreditation program (PALC) of Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial (SBPC/ML). Materials and methods:20 samples were evaluated in three ABL800 Flex (Radiometer Medical ApS, Denmark) blood gas analyzers, and the results were compared with those of the device in use, which was considered the reference. The analysis of variance (Anova) was applied for statistical purposes, as well as the calculation of mean, standard deviation and coefficient of variation.Results:The p values obtained in the statistical analysis were: pH = 0.983, pO2 = 0.991, pCO2 = 0.353, lactate = 0.584, glucose = 0.995, ionized calcium = 0.983, sodium = 0.991, potassium = 0.926, chlorine = 0.029. Conclusion: The evaluation of multiple analytical systems is an essential procedure in the clinical laboratory for quality assurance and accuracy of the results.
- Proteína C reativa: aplicações clínicas e propostas para utilização racional(2013) AGUIAR, Francisco J. B.; FERREIRA-JUNIOR, Mario; SALES, Maria M.; CRUZ-NETO, Luiz M.; FONSECA, Luiz A. M.; SUMITA, Nairo M.; DUARTE, Nilo J. C.; LICHTENSTEIN, Arnaldo; DUARTE, Alberto J. S.C-reactive protein (CRP) is an acute-phase protein whose requests have been growing exponentially in several countries, including Brazil. In this study, the use of CRP in several clinical situations was reviewed by a group of physicians comprised by specialists in internal medicine, medical emergencies, intensive care, screening, and laboratory medicine, aiming to analyze the applicable literature and to propose guidelines for a more rational use of this laboratory test. The result was the creation of flowcharts guiding CRP request, adjusted to four different healthcare environments, namely, intensive care units, emergency room, wards; and outpatient clinics. These flowcharts, as well as a more detailed discussion on several clinical recommendations for the test, are presented in this study.
- The critical value concept in clinical laboratory(2016) ROCHA, Bruna Cláudia B.; ALVES, José Adilson R.; PINTO, Félix Pedro D.; MENDES, Maria Elizabete; SUMITA, Nairo M.ABSTRACT The critical value is a laboratory result representing a pathophysiological state that offers risk to a patient's life. The communication of these results is a laboratory responsibility and, according to the literature, 95% of physicians consider it useful in decision-making and patient management. Two-thirds of critical results lead to some change in therapeutic approach. The communication of critical results is a requirement for laboratory accreditation programs. Thus laboratories should establish a list of tests, their critical values, and the procedure describing the communication flow. The performance indicator for this activity should consider the time between results release and their effective communication, and the percentage of successful communication. There is no standardization of laboratory parameters that need to have critical values established, not even the ranges to be considered for notification purposes. The frequent update of test lists and critical value ranges based on literature reviews and on experience exchange among clinical laboratories ensure the continuous improvement process for this procedure and patient safety.
- As interferências e as limitações metodológicas na dosagem da hemoglobina glicada (A1C)(2012) SUMITA, Nairo M.
- Analytical Performance of COVID-19 Detection Methods (RT-PCR): Scientific and Societal Concerns(2021) VERNA, Roberto; ALALLON, Walter; MURAKAMI, Masami; HAYWARD, Catherine P. M.; HARRATH, Abdel Halim; ALWASEL, Saleh H.; SUMITA, Nairo M.; ALATAS, Ozkan; FEDELI, Valeria; SHARMA, Praveen; FUSO, Andrea; CAPUANO, Daniela Maria; CAPALBO, Maria; ANGELONI, Antonio; BIZZARRI, MarianoBackground. Health and social management of the SARS-CoV-2 epidemic, responsible for the COVID-19 disease, requires both screening tools and diagnostic procedures. Reliable screening tests aim at identifying (truely) infectious individuals that can spread the viral infection and therefore are essential for tracing and harnessing the epidemic diffusion. Instead, diagnostic tests should supplement clinical and radiological findings, thus helping in establishing the diagnosis. Several analytical assays, mostly using RT-PCR-based technologies, have become commercially available for healthcare workers and clinical laboratories. However, such tests showed some critical limitations, given that a relevant number of both false-positive and false-negative cases have been so far reported. Moreover, those analytical techniques demonstrated to be significantly influenced by pre-analytical biases, while the sensitivity showed a dramatic time dependency. Aim. Herein, we critically investigate limits and perspectives of currently available RT-PCR techniques, especially when referring to the required performances in providing reliable epidemiological and clinical information. Key Concepts. Current data cast doubt on the use of RT-PCR swabs as a screening procedure for tracing the evolution of the current SARS-COV-2 pandemic. Indeed, the huge number of both false-positive and false-negative results deprives the trustworthiness of decision making based on those data. Therefore, we should refine current available analytical tests to quickly identify individuals able to really transmit the virus, with the aim to control and prevent large outbreaks.
- Clinical Applications of Point-of-Care Testing in Different Conditions(2018) SUMITA, Nairo M.; FERREIRA, Carlos E. S.; MARTINO, Marines D. V.; FRANCA, Carolina N.; FAULHABER, Adriana C. L.; SCARTEZINI, Marileia; PINHO, Joao R. R.; DIAS, Claudia M.; CESAR, Katia R.; PARIZ, Vitor M.; GUERRA, Joao C. C.; BARBOSA, Ismar V.; FAULHABER, Marcelo H. W.; BATISTA, Marcelo C.; ANDRIOLO, Adagmar; MENDES, Maria E.; MACHADO, Antonia M. O.; COLOMBINI, Marjorie P.; SLHESSARENKO, Natasha; SHCOLNIK, Wilson; KHAWALI, Cristina; CAMPANA, Gustavo A.; BERLITZ, Fernando; GALORO, Cesar A.Background: The use of point-of-care testing (POCT) in different clinical applications is justified by the fact that the time to release the result is shortened, allowing the physician to define the diagnosis and most appropriate therapy in a shorter time. However, the negative aspects must also be highlighted and studied so that we can move forward with the use of these devices. These negative aspects include greater analytical imprecision compared to laboratory automation, the variability between different equipment from different manufacturers, the risk of inappropriate use, a low level of global regulation, higher costs compared with laboratory testing and cost ineffectiveness in terms of health care. Methods and Results: This review presents some clinical applications of POCT in different scenarios, such as for diabetes mellitus, infectious diseases, pediatrics, and chronic kidney disease, among others. Conclusions: We hope to see a global consensus on an acceptable quality standard for performing POCT that is adaptable, practical, and cost effective in primary care settings, ensuring patient safety, and minimizing the risk of harm.
article A case report of azathioprine-induced recurrent acute pancreatitis associated with high levels of 6-thioguanine nucleotides in a renal transplant recipient(2012) PACHECO-NETO, Maurílio; ALVES, Atecla N. L; FORTINI, Alexandre S.; SUMITA, Nairo M.; MENDES, Maria E.; TORRES, Larissa H. L.; DULEY, John A.; NAHAS, William C.; CHOCAIR, Pedro R.Background: Myelotoxicity is the most common side effect associated with the use of azathioprine (AZA) in transplant recipients, while other side effects – rash, nausea, flu-like symptoms, diarrhea, hepatitis, and pancreatitis – are relatively rare. This is the first report of the evolution in a kidney transplant recipient of recurrent acute pancreatitis related to the use of AZA and high levels of 6-thioguanine nucleotide (6-TGN). Case report: A 57-year-old Brazilian male renal transplant patient remained stable for 30 years on a maintenance immunosuppressive regimen of AZA and prednisone. The patient experienced three episodes of mild acute pancreatitis in 2004, 2007 and 2008, and despite intensive investigation, AZA was not suspected as the causal agent of pancreatitis. In October 2008 the patient was found to have raised levels of erythrocyte 6-TGN, which resolved rapidly when AZA was interrupted. His maintenance immunosuppression regimen was subsequently changed to mycophenolate mofetil/ tacrolimus/ prednisone. Discussion: Despite the classic pharmacogenetic model for thiopurines afforded by thiopurine methyltransferase (TPMT) and highly variable pharmacokinetics, AZA continues to be used empirically, i.e. mg/kg. In transplant recipients, AZA is usually employed as part of polytherapy, which complicates the elucidation of the cause of drug-related side effects. We propose that therapeutic drug monitoring of AZA metabolites is useful for differential diagnosis of the causes of drug-related side effects, such as acute pancreatitis.