AYTAN MIRANDA SIPAHI
Projetos de Pesquisa
Unidades Organizacionais
LIM/07 - Laboratório de Gastroenterologia Clínica e Experimental, Hospital das Clínicas, Faculdade de Medicina - Líder
39 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 39
- The role of titanium dioxide in the gut(2017) ACHTSCHIN, Cassiana Ganem; SIPAHI, Aytan MirandaPurpose -Titanium is a naturally occurring mineral in the form of titanium dioxide (TiO2) and is one of the most widely used food additives. The purpose of this review article is to show the importance of the accumulation of this mineral in the gut and its relation with inflammatory processes. Methodology - This is a literature review study from 2002 to 2016, focusing on studies with TiO2 and its relation with inflammatory bowel diseases. Findings -Articles describe that TiO2 is resistant to gastrointestinal degradation, as it has high stability, and that its particles, ingested daily, may bind to biomolecules in the lumen or be absorbed by the intestinal mucosa, accumulating in the macrophages of lymphoid tissue in the gut, thus causing or aggravating the inflammatory response in the inflamed bowel. Limitations/implications -There is a limited number of studies on the long-term impact of dietary microparticles in animal models, in healthy subjects and in patients with inflammatory bowel diseases. Practical implications -It is necessary to regulate the amount of TiO2 used in industrialized products. Social implications - The high consumption of processed foods, as opposed to a healthy diet based on the balanced consumption of nutrients, is relevant, as it may lead to or exacerbate intestinal inflammation. Originality/value - This review indicates that titanium particles may mediate toxicological processes leading to an abnormal increase in intestinal permeability, which may be particularly aggravating in patients with inflammatory bowel diseases.
article 16 Citação(ões) na Scopus Ophthalmologic manifestations of celiac disease(2016) MARTINS, Thiago Goncalves dos Santos; COSTA, Ana Luiza Fontes de Azevedo; OYAMADA, Maria Kiyoko; SCHOR, Paulo; SIPAHI, Aytan MirandaCeliac disease is an autoimmune disorder that affects the small intestine of genetically predisposed individuals. Ophthalmic manifestations are within the extra-intestinal manifestations, and can be divided into those of autoimmune disorders or those due to absorptive disabilities. This article reviewed the ophthalmologic manifestation of celiac disease. Ophthalmic symptoms are rare, but should be investigated in patients with celiac disease and taken into consideration as the first systemic manifestation.- Cytomegalovirus Infection in Inflammatory Bowel Disease Is Not Associated with Worsening of Intestinal Inflammatory Activity (vol 9, e111574, 2014)(2015) CARMO, Alexandre Medeiros do; SANTOS, Fabiana Maria; ORTIZ-AGOSTINHO, Carmen Lucia; NISHITOKUKADO, Ieda; FROTA, Cintia S.; GOMES, Flavia Ubeda; LEITE, Andre Zonetti de Arruda; PANNUTI, Claudio Sergio; BOAS, Lucy Santos Vilas; TEIXEIRA, Magaly Gemio; SIPAHI, Aytan Miranda
conferenceObject Clinical features of thrombosis in patients with Crohn's disease followed at the Clinical Hospital of the University of Sao Paulo, Brazil(2016) ANDRADE, A. Ribas; BARROS, L. Leite; AZEVEDO, M.; SIPAHI, A.; LEITE, A. Zonetti de Arruda- Prevalence of dysplasia and colorectal cancer in Ulcerative Colitis patients from a referral center in Latin America(2021) JUNIOR, R. S. F.; CARVALHO, M. F.; SILVA, J. C.; BARROS, L. L.; AZEVEDO, M. F. C.; CARLOS, A. D. S.; OBA, J.; HASHIMOTO, C. L.; CANCADO, E. L. R.; DAMIAO, A. O. M. C.; SIPAHI, A. M.
- Efficacy of Early Optimization of Infliximab Guided by Therapeutic Drug Monitoring during Induction-A Prospective Trial(2023) GARCIA, Karoline Soares; AZEVEDO, Matheus Freitas Cardoso de; CARLOS, Alexandre de Sousa; BARROS, Luisa Leite; OBA, Jane; SOBRADO JUNIOR, Carlos Walter; SIPAHI, Aytan Miranda; ALVES, Olivia Duarte de Castro; NAVARRO-RODRIGUEZ, Tomas; PARRA, Rogerio Serafim; CHEBLI, Julio Maria Fonseca; CHEBLI, Liliana Andrade; FLORES, Cristina; VIEIRA, Andrea; CEARA, Christianne Damasceno Arcelino do; QUEIROZ, Natalia Sousa Freitas; DAMIAO, Aderson Omar Mourao CintraTherapeutic drug monitoring (TDM) during induction therapy with anti-tumor necrosis factor drugs has emerged as a strategy to optimize response to these biologics and avoid undesired outcomes related to inadequate drug exposure. This study aimed to describe clinical, biological, and endoscopic remission rates at six months in Brazilian inflammatory bowel disease (IBD) patients following a proactive TDM algorithm guided by IFX trough levels (ITL) and antibodies to IFX (ATI) levels during induction, at week six. A total of 111 IBD patients were prospectively enrolled, excluding those previously exposed to the drug. ITL & GE; 10 & mu;g/mL was considered optimal. Patients with suboptimal ITL (<10 & mu;g/mL) were guided according to ATI levels. Those who presented ATI & LE; 200 ng/mL underwent dose intensification in the maintenance phase, and patients with ATI > 200 ng/mL discontinued IFX. In our study, proactive TDM was associated with persistence in the IFX rate at six months of 82.9%. At that time, rates of clinical, biological, and endoscopic remission in patients under IFX treatment were 80.2%, 73.9%, and 48.1%, respectively. Applying a simplified TDM-guided algorithm during induction seems feasible and can help improve patients' outcomes in clinical practice.
- Safety of anti-TNF introduction following tuberculosis treatment in Inflammatory Bowel Disease patients in an endemic area(2021) AZEVEDO, M. F. C. D.; JUSTUS, F. F.; LIMA, C. C. G.; GARCIA, K. S.; BARROS, L. L.; OBA, J.; CARLOS, A. D. S.; MILANI, L. R.; SIPAHI, A. M.; DAMIAO, A. O. M. C.; QUEIROZ, N. S. F.
- Active tuberculosis in inflammatory bowel disease patients: a case-control study(2023) AZEVEDO, Matheus Freitas Cardoso de; BARROS, Luisa Leite; JUSTUS, Filipe Fernandes; OBA, Jane; GARCIA, Karoline Soares; MARTINS, Camilla de Almeida; CARLOS, Alexandre de Sousa; LEITE, Andre Zonetti Arruda; SIPAHI, Aytan Miranda; QUEIROZ, Natalia Sousa Freitas; DAMIAO, Aderson Omar Mourao CintraBackground/Aims:Anti-tumor necrosis factor (anti-TNF) drugs have been the mainstay therapy for moderate to severe inflammatory bowel disease (IBD) over the past 25 years. Nevertheless, these drugs are associated with serious opportunistic infections like tuberculosis (TB). Brazil is ranked among the 30 countries with the highest incidence of TB in the world. This study aimed at identifying risk factors for the development of active TB and describing clinical characteristics and outcomes in IBD patients followed at a tertiary referral center in Brazil. Methods:We conducted a retrospective, case-control study between January 2010 and December 2021. Active TB cases in IBD patients were randomly matched 1:3 to controls (IBD patients with no previous history of active TB) according to gender, age, and type of IBD. Design:This was a retrospective, case-control study. Results:A total of 38 (2.2%) cases of TB were identified from 1760 patients under regular follow-up at our outpatient clinics. Of the 152 patients included in the analysis (cases and controls), 96 (63.2%) were male, and 124 (81.6%) had Crohn's disease. Median age at TB diagnosis was 39.5 [interquartile range (IQR) 30.8-56.3]. Half of the active TB cases were disseminated (50%). Overall, 36 patients with TB (94.7%) were being treated with immunosuppressive medications. Of those, 31 (86.1%) were under anti-TNF drugs. Diagnosis of TB occurred at a median of 32 months after the first dose of anti-TNF (IQR 7-84). In multivariate analysis, IBD diagnosis older than 17 years and anti-TNF therapy were significantly associated with the development of TB (p < 0.05). After the TB treatment, 20 (52.7%) patients received anti-TNF therapy, and only one developed 'de novo' TB 10 years after the first infection. Conclusions:TB remains a significant health problem in IBD patients from endemic regions, especially those treated with anti-TNFs. In addition, age at IBD diagnosis (>17 years old) was also a risk factor for active TB. Most cases occur after long-term therapy, suggesting a new infection. The reintroduction of anti-TNFs agents after the anti-TB treatment seems safe. These data highlight the importance of TB screening and monitoring in IBD patients living in endemic areas.
- Cytomegalovirus Infection in Inflammatory Bowel Disease Is Not Associated with Worsening of Intestinal Inflammatory Activity(2014) CARMO, Alexandre Medeiros do; SANTOS, Fabiana Maria; ORTIZ-AGOSTINHO, Carmen Lucia; NISHITOKUKADO, Ieda; FROTA, Cintia S.; GOMES, Flavia Ubeda; LEITE, Andre Zonetti de Arruda; PANNUTI, Claudio Sergio; BOAS, Lucy Santos Vilas; TEIXEIRA, Magaly Gemio; SIPAHI, Aytan MirandaBackground: Cytomegalovirus is highly prevalent virus and usually occurs in immunocompromised patients. The pathophysiology and treatment of inflammatory bowel disease often induce a state of immunosuppression. Because this, there are still doubts and controversies about the relationship between inflammatory bowel disease and cytomegalovirus. Aim: Evaluate the frequency of cytomegalovirus in patients with inflammatory bowel disease and identify correlations. Methods: Patients with inflammatory bowel disease underwent an interview, review of records and collection of blood and fecal samples. The search for cytomegalovirus was performed by IgG and IgM blood serology, by real-time PCR in the blood and by qualitative PCR in feces. Results were correlated with red blood cell levels, C-reactive protein levels, erythrocyte sedimentation rates and fecal calprotectin levels for each patient. Results: Among the 400 eligible patients, 249 had Crohn's disease, and 151 had ulcerative colitis. In the group of Crohn's disease, 67 of the patients had moderate or severe disease, but 126 patients presented with active disease, based on the evaluation of the fecal calprotectin. In patients with ulcerative colitis, only 21 patients had moderate disease, but 76 patients presented with active disease, based on the evaluation of the fecal calprotectin. A large majority of patients had positive CMV IgG. Overall, 10 patients had positive CMV IgM, and 9 patients had a positive qualitative detection of CMV DNA by PCR in the feces. All 400 patients returned negative results after the quantitative detection of CMV DNA in blood by real-time PCR. Analyzing the 19 patients with active infections, we only found that such an association occurred with the use of combined therapy (anti-TNF-alpha + azathioprine) Conclusion: The findings show that latent cytomegalovirus infections are frequent and active cytomegalovirus infection is rare. We did not find any association between an active infection of CMV and inflammatory bowel disease activity.
- Inter-and intraobserver agreement in computed tomography enterography in inflammatory bowel disease(2016) HORVAT, Natally; TAVARES, Camila Carlos; ANDRADE, Adriana Ribas; CABRAL, Julia Campos Simoes; LEAO-FILHO, Hilton Muniz; CAIADO, Angela Hissae Motoyama; UEDA, Serli Kiyomi Nakao; LEITE, Andre Zonetti Arruda; SIPAHI, Aytan Miranda; ROCHA, Manoel SouzaAIM To evaluate intra-and interobserver agreement in imaging features in inflammatory bowel disease and comparison with fecal calprotectin (FC) levels. METHODS Our institutional computed tomography enterography (CTE) database was retrospectively queried to identify patients who underwent CTE from January 2014 to June 2015. Patient inclusion criteria were confirmed inflammatory bowel disease (IBD) and FC collected < 4 mo after CTE without any change in clinical treatment or surgical treatment during this interval. The exclusion criterion was poor image quality. Two blinded abdominal radiologists, with 12 and 3 years of experience analyzed the CTE regarding localization (small bowel, colonic, both, or no disease detected); type of IBD (inflammatory, stenosing, fistulizing, > 1 pattern, or normal); and signs of active disease (present or absent). In 42 of 44 patients evaluated, routine CTE reports were made by one of the readers who reevaluated the CTEs >= 6 mo later, to determine the intraobserver agreement. FC was considered a sign of disease activity when it was higher than 250 mu g/g. RESULTS Forty-four patients with IBD (38 with Crohn's disease and 6 with ulcerative colitis) were included. There was a moderate interobserver agreement regarding localization of IBD (kappa = 0.540), type of disease (kappa = 0.410) and the presence of active signs in CTE (kappa = 0.419). There was almost perfect intraobserver agreement regarding localization, type and signs of active disease in IBD. The kappa values were 0.902, 0.937 and 0.830, respectively. After a consensus between both radiologists regarding inflammatory activity in CTE, we found that 24 (85.7%) of 28 patients who were classified with active disease had elevated FC, and six (37.5%) of 16 patients without inflammatory activity in CTE had elevated FC (P = 0.003). The correlation between elevated FC and the presence of active disease in CTE was significant (kappa = 0.495, P = 0.001). CONCLUSION We found almost perfect intraobserver and moderate interobserver agreement in the signs of active disease in CTE with concurrence of high FC levels.