ANA BEATRIZ AYROZA GALVAO RIBEIRO GOMES
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4
Projetos de Pesquisa
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Instituto Central, Hospital das Clínicas, Faculdade de Medicina
16 resultados
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- Differential diagnosis of demyelinating diseases: what's new?(2022) GOMES, Ana Beatriz Ayroza Galvao Ribeiro; ADONI, TarsoBackground: Acquired demyelinating disorders lead to overlapping visual, pyramidal, sensory, autonomic, and cerebellar deficits and may lead to severe disability. Early diagnosis and start of treatment are fundamental towards preventing further attacks and halting disability. Objective: In this paper we provide an updated overview of the differential diagnoses of acquired demyelinating disorders. Methods: We performed a critical targeted review of the diagnoses of the most prevalent demyelinating disorders: multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD). Results: We discuss the workup, diagnostic criteria and new biomarkers currently being used for the diagnosis of these disease entities taking into account the particularities of the Brazilian population and healthcare system. Conclusion: A comprehensive analysis of medical history, physical examination, biomedical and imaging data should be performed to obtain differential diagnosis. Diagnostic criteria should be mindfully employed considering ethnic and environmental particularities of each patient.
- Reducing infection risk in multiple sclerosis and neuromyelitis optica spectrum disorders: a Brazilian reference center's approach(2022) GOMES, Ana Beatriz Ayroza Galvao Ribeiro; FEO, Lucas Bueno; SILVA, Guilherme Diogo; DISSEROL, Caio Cesar Diniz; PAOLILO, Renata Barbosa; LARA, Amanda Nazareth; TONACIO, Adriana Coracini; MENDES, Maria Fernanda; PEREIRA, Samira Luisa Apostolos; CALLEGARO, DagobertoBackground Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) are the most common autoimmune diseases of the central nervous system (CNS). They present chronic relapsing courses that demand treatment with disease-modifying drugs (DMDs) to prevent inflammatory activity. Disease-modifying drugs lead to immunomodulation or immunosuppression through diverse mechanisms (e.g., shifting lymphocyte and cytokine profile, suppressing specific lymphocyte subpopulations). Thus, patients are more prone to infectious complications and associated worsening of disease. Objective To present feasible strategies for mitigating the infection risk of MS and NMOSD treated patients. Methods Targeted literature review concerning the management of infection risk with an emphasis on vaccination, therapy-specific measures, and particularities of the Brazilian endemic infectious diseases' scenario. Conclusion We propose a vaccination schedule, infectious screening routine, and prophylactic measures based on the current scientific evidence. Awareness of emergent tropical diseases is necessary due to evidence of demyelinating events and possible parainfectious cases of MS and NMOSD.
conferenceObject Neuroimaging profile in pediatric Neuromyelitis Optica Spectrum Disorders (NMOSD)(2017) PAOLILO, R.; RIMKUS, C. D. M.; PAZ, J. A.; APOSTOLOS-PEREIRA, S. L.; ARAUJO, A. L. P. C.; GOMES, A. B.; VENTURA, L. M. Gomes De Brito; PITOMBEIRA, M. S.; MATOS, A. D. M. B.; REED, U. C.; CALLEGARO, D.; SATO, D. K.conferenceObject Brainstem syndrome and longitudinally extensive transverse myelitis (LETM) as first manifestation of Adult T-Cell Leukemia/Lymphoma (ATLL)(2017) GOMES, A. B. Ayroza Galvao Ribeiro; SOARES NETO, H.; LEMOS, M. Delboni; CALLEGARO, D.; PEREIRA, S. L. Apostolos- Recommendations by the Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology (DCNI/ABN) and the Brazilian Committee for Treatment and Research in Multiple Sclerosis and Neuroimmunological Diseases (BCTRIMS) on vaccination in general and specifically against SARS-CoV-2 for patients with demyelinating diseases of the central nervous system(2021) BECKER, Jefferson; FERREIRA, Lis Campos; DAMASCENO, Alfredo; BICHUETTI, Denis Bernardi; CHRISTO, Paulo Pereira; CALLEGARO, Dagoberto; PEIXOTO, Marco Aurelio Lana; SOUSA, Nise Alessandra de Carvalho; ALMEIDA, Sergio Monteiro de; ADONI, Tarso; SANTIAGO-AMARAL, Juliana; JUNQUEIRA, Thiago; PEREIRA, Samira Luisa Apostolos; GOMES, Ana Beatriz Ayroza Galvao Ribeiro; PITOMBEIRA, Milena; PAOLILO, Renata Barbosa; GRZESIUK, Anderson Kuntz; PICCOLO, Ana Claudia; ALMEIDA, Jose Arthur Costa D.; GOMES NETO, Antonio Pereira; OLIVEIRA, Augusto Cesar Penalva de; OLIVEIRA, Bianca Santos de; TAUIL, Carlos Bernardo; VASCONCELOS, Claudia Ferreira; KAIMEN-MACIEL, Damacio; VARELA, Daniel; DINIZ, Denise Sisterolli; OLIVEIRA, Enedina Maria Lobato De; MALFETANO, Fabiola Rachid; BORGES, Fernando Elias; FIGUEIRA, Fernando Faria Andrade; GONDIM, Francisco de Assis Aquino; PASSOS, Giordani Rodrigues dos; SILVA, Guilherme Diogo; OLIVAL, Guilherme Sciascia Do; SANTOS, Gutemberg Augusto Cruz dos; RUOCCO, Heloisa Helena; SATO, Henry Koiti; SOARES NETO, Herval Ribeiro; CALIA, Leandro Cortoni; GONCALVES, Marcus Vinicius Magno; VECINO, Maria Cecilia Aragon De; PIMENTEL, Maria Lucia Vellutini; RIBEIRO, Marlise de Castro; BOAVENTURA, Mateus; PAROLIN, Monica Koncke Fiuza; MELO, Renata Brant de Souza; LAZARO, Robson; THOMAZ, Rodrigo Barbosa; KLEINPAUL, Rodrigo; DIAS, Ronaldo Maciel; GOMES, Sidney; LUCATTO, Simone Abrante; ALVES-LEON, Soniza Vieira; FUKUDA, Thiago; RIBEIRO, Taysa Alexandrino Gonsalves Jube; WINCKLER, Thereza Cristina D'avila; FRAGOSO, Yara Dadalti; NASCIMENTO, Osvaldo Jose Moreira do; FERREIRA, Maria Lucia Brito; MENDES, Maria Fernanda; BRUM, Doralina Guimaraes; GLEHN, Felipe VonThe Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology (DCNI/ABN) and Brazilian Committee for Treatment and Research in Multiple Sclerosis and Neuroimmunological Diseases (BCTRIMS) provide recommendations in this document for vaccination of the population with demyelinating diseases of the central nervous system (CNS) against infections in general and against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. We emphasize the seriousness of the current situation in view of the spread of COVID-19 in our country. Therefore, reference guides on vaccination for clinicians, patients, and public health authorities are particularly important to prevent some infectious diseases.The DCNI/ABN and BCTRIMS recommend that patients with CNS demyelinating diseases (e.g., MS and NMOSD) be continually monitored for updates to their vaccination schedule, especially at the beginning or before a change in treatment with a disease modifying drug (DMD). It is also important to note that vaccines are safe, and physicians should encourage their use in all patients. Clearly, special care should be taken when live attenuated viruses are involved. Finally, it is important for physicians to verify which DMD the patient is receiving and when the last dose was taken, as each drug may affect the induction of immune response differently.
conferenceObject MOG-IgA characterizes a subgroup of patients with central nervous system demyelination(2023) GOMES, Ana Beatriz Ayroza Galvao Ribeiro; KULSVEHAGEN, Laila; LIPPS, Patrick; CAGOL, Alessandro; FUERTES, Nuria Cerda; NEZIRAJ, Tradite; FLAMMER, Julia; LERNER, Jasmine; LECOURT, Anne-Catherine; SIEBENBORN, Nina de Oliveira S.; CORTESE, Rosa; SCHADELIN, Sabine; SCHOEPS, Vinicius; MATOS, Aline; MENDES, Natalia; PEREIRA, Clarissa dos Reis; MONTEIRO, Mario Luiz; PEREIRA, Samira Luisa Dos Apostolos; SCHINDLER, Patrick; CHIEN, Claudia; SCHWAKE, Carolin; SCHNEIDER, Ruth; PAKEERATHAN, Thivya; KIM, Ki Hoon; AKTAS, Orhan; FISCHER, Urs; MEHLING, Matthias; DERFUSS, Tobias; KAPPOS, Ludwig; AYZENBERG, Ilya; RINGELSTEIN, Marius; PAUL, Friedemann; CALLEGARO, Dagoberto; KIM, Ho Jin; KUHLE, Jens; PAPADOPOULOU, Athina; GRANZIERA, Cristina; PROBSTEL, Anne-KatrinbookPart Mielopatias no pronto-socorro(2021) GOMES, Ana Beatriz Ayroza Galvão Ribeiro; SOARES NETO, Herval Ribeiro- Immunoglobulin A Antibodies Against Myelin Oligodendrocyte Glycoprotein in a Subgroup of Patients With Central Nervous System Demyelination(2023) GOMES, Ana Beatriz Ayroza Galvao Ribeiro; KULSVEHAGEN, Laila; LIPPS, Patrick; CAGOL, Alessandro; CERDA-FUERTES, Nuria; NEZIRAJ, Tradite; FLAMMER, Julia; LERNER, Jasmine; LECOURT, Anne-Catherine; SIEBENBORN, Nina De Oliveira S.; CORTESE, Rosa; SCHAEDELIN, Sabine; SCHOEPS, Vinicius Andreoli; MATOS, Aline de Moura Brasil; MENDES, Natalia Trombini; PEREIRA, Clarissa dos Reis; MONTEIRO, Mario Luiz Ribeiro; APOSTOLOS-PEREIRA, Samira Luisa dos; SCHINDLER, Patrick; CHIEN, Claudia; SCHWAKE, Carolin; SCHNEIDER, Ruth; PAKEERATHAN, Thivya; AKTAS, Orhan; FISCHER, Urs; MEHLING, Matthias; DERFUSS, Tobias; KAPPOS, Ludwig; AYZENBERG, Ilya; RINGELSTEIN, Marius; PAUL, Friedemann; CALLEGARO, Dagoberto; KUHLE, Jens; PAPADOPOULOU, Athina; GRANZIERA, Cristina; PROBSTEL, Anne-KatrinIMPORTANCE Differential diagnosis of patients with seronegative demyelinating central nervous system (CNS) disease is challenging. In this regard, evidence suggests that immunoglobulin (Ig) A plays a role in the pathogenesis of different autoimmune diseases. Yet little is known about the presence and clinical relevance of IgA antibodies against myelin oligodendrocyte glycoprotein (MOG) in CNS demyelination. OBJECTIVE To investigate the frequency of MOG-IgA and associated clinical features in patients with demyelinating CNS disease and healthy controls. DESIGN, SETTING, AND PARTICIPANTS This longitudinal study comprised 1 discovery and 1 confirmation cohort derived from 5 centers. Participants included patients with suspected or confirmed demyelinating diseases and healthy controls. MOG-IgA, MOG-IgG, and MOG-IgM were measured in serum samples and cerebrospinal fluid (CSF) of patients, who were assessed from September 2012 to April 2022. MAIN OUTCOMES AND MEASURES Frequency and clinical features of patients who were seropositive for MOG-IgA and double-seronegative for aquaporin 4 (AQP4) IgG and MOG-IgG. RESULTS After the exclusion of 5 participants with coexisting AQP4-IgG and MOG-IgA, MOG-IgG, and/or MOG-IgM, 1339 patients and 110 healthy controls were included; the median follow-up time was 39 months (range, 0-227 months). Of included patients with isolated MOG-IgA, 11 of 18 were female (61%), and the median age was 31.5 years (range, 3-76 years). Among patients double-seronegative for AQP4-IgG and MOG-IgG (1126/1339; 84%), isolated MOG-IgA was identified in 3 of 50 patients (6%) with neuromyelitis optica spectrum disorder, 5 of 228 patients (2%) with other CNS demyelinating diseases, and 10 of 848 patients (1%) with multiple sclerosis but in none of the healthy controls (0/110). The most common disease manifestation in patients seropositive for isolated MOG-IgA was myelitis (11/17 [65%]), followed by more frequent brainstem syndrome (7/16 [44%] vs 14/75 [19%], respectively; P =.048), and infrequent manifestation of optic neuritis (4/15 [27%] vs 46/73 [63%], respectively; P =.02) vs patients with MOG-IgG. Among patients fulfilling 2017 McDonald criteria for multiple sclerosis, MOG-IgA was associated with less frequent CSF-specific oligoclonal bands (4/9 [44%] vs 325/351 [93%], respectively; P <.001) vs patients with multiple sclerosis who were MOG-IgG/IgA seronegative. Further, most patients with isolated MOG-IgA presented clinical attacks after recent infection or vaccination (7/11 [64%]). CONCLUSION AND RELEVANCE In this study, MOG-specific IgA was identified in a subgroup of patients who were double-seronegative for AQP4-/MOG-IgG, suggesting that MOG-IgA may be a novel diagnostic biomarker for patients with CNS demyelination.
conferenceObject Five-year follow-up of pediatric onset Neuromyelitis Optica Spectrum Disorders (NMOSD)(2017) PAOLILO, R. B.; PAZ, J. A.; APOSTOLOS-PEREIRA, S. L.; RIMKUS, C. D. M.; ARAUJO, A. L. P. C.; VENTURA, L. M. G. D. B.; PITOMBEIRA, M. S.; GOMES, A. B.; MATOS, A. D. M. B.; TORRETTA, P. H. B.; REED, U. C.; CALLEGARO, D.; SATO, D. K.- Long-term safety of azathioprine for treatment of neuromyelitis optica spectrum disorders(2021) GOMES, Ana Beatriz Ayroza Galvao Ribeiro; PITOMBEIRA, Milena Sales; SATO, Douglas Kazutoshi; CALLEGARO, Dagoberto; APOSTOLOS-PEREIRA, Samira LuisaBackground: Azathioprine is a common first-line therapy for neuromyelitis optica spectrum disorder (NMOSD). Objective: The aim of this study was to determine whether long-term treatment (>10 years) with azathioprine is safe in NMOSD. Methods: We conducted a retrospective medical record review of all patients at the School of Medicine of the University of Sao Paulo (Sao Paulo, Brazil) who fulfilled the 2015 international consensus diagnostic criteria for NMOSD and were treated with azathioprine for at least 10 years. Results: Out of 375 patients assessed for eligibility, 19 were included in this analysis. These patients' median age was 44 years (range=28-61); they were mostly female (17/19) and AQP4-IgG seropositive (18/19). The median disease duration was 15 years (range=10-39) and most patients presented a relapsing clinical course (84.2%). The median duration of treatment was 11.9 years (range=10.0-23.8). The median annualized relapse rates (ARR) pre- and post-treatment with azathioprine were 1 (range=0.1 2) and 0.1 (range=0-0.35); p=0.09. Three patients (15.7%) had records of adverse events during the follow-up, which consisted of chronic B12 vitamin deficiency, pulmonary tuberculosis and breast cancer. Conclusion: Azathioprine may be considered a safe agent for long-term treatment (>10 years) of NMOSD, but continuous vigilance for infections and malignancies is required.