LUZ MARINA GOMEZ GOMEZ

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LIM/51 - Laboratório de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina

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  • article 1 Citação(ões) na Scopus
    Biomarker-associated Monocyte Inflammatory Signaling in Myocardial Infarction
    (2023) GUIMARÃES, Raphael Boesche; MARCHINI, Julio; GOMEZ, Luz Marina; LEITE, Rogério Sarmento; DUTRA, Oscar; CASTRO, Iran; MANICA, André Luiz
    Abstract Background: Monocytes are essential components in inflammatory signaling, and their recruitment is crucial in the signaling pathway, which directs and determines cell adhesion to the activated endothelium. A better understanding of the correlation between monocyte subsets and inflammatory signaling in patients with atherosclerotic disease in acute coronary syndrome (ACS) is essential for the development of more effective therapies for the prevention and treatment of cardiovascular diseases. Objective: To analyze differences between biomarkers and monocyte activation in the setting of ischemic heart disease. Methods: This was a case-control study comparing biomarkers and monocyte subsets between patients with ACS with and without ST-segment elevation and individuals without coronary stenosis. The nonparametric Kruskal-Wallis test was used to assess differences between groups, and Dunn's post hoc test was used to identify which groups were different. Cuzick's test for ordered group trends was used to assess falling or rising trends. Participants were classified into 3 groups: control (0); non-ST-elevation myocardial infarction (NSTEMI) (1); ST-elevation myocardial infarction (STEMI) D1 (2). Results: Forty-seven patients with ACS and 19 controls with no obstructive lesions on coronary angiography were recruited. Monocyte profile assessment was statistically different regarding time of symptom onset and the presence or absence of atherosclerotic disease (Kruskal-Wallis, p = 0.0009). Dunn's post hoc test showed a significant difference between the control group and the STEMI D1 (p = 0.0014), STEMI D3 (p = 0.0036), and STEMI D7 (p = 0.0195) groups, corresponding to a 2-fold increase in classical (p = 0.0022) and nonclassical (p = 0.0031) monocytes compared with controls. For classical monocytes, there was a difference between the control group and all STEMI groups and between the NSTEMI group and the STEMI D1, D3, and D7 groups. For nonclassical monocytes, there was a difference between the control group and the STEMI D7 group (p = 0.0056) and between the NSTEMI group and the STEMI D7 group (p = 0.0166). Conclusion: This study found that there was an increase in total and classical monocyte mobilization at the time of acute myocardial infarction in patients with ACS.
  • conferenceObject
    COVID-19 and H1N1 Pneumonia: Reanalysis and Comparison of Two Cohorts
    (2022) SORICE, E.; STERNLICHT, J.; SANTOS, L. B.; BRANDAO, R.; MARINO, L.; MARCHINI, J.; ALENCAR, J.; GOMEZ, L.; SOUZA, H.
  • conferenceObject
    GENETIC EPIDEMIOLOGY OF INSOMNIA IN THE BAEPENDI HEART COHORT STUDY
    (2019) AHMED, S. S.; TAPOROSKI, T. P.; GOMEZ, L. M.; RUIZ, F. S.; BEIJAMINI, F.; HORIMOTO, A. R. V. R.; NEGRAO, A. B.; KNUTSON, K. L.; PEREIRA, A. C.; STERR, A.; SCHANTZ, M. von
  • conferenceObject
    Clinical Prediction Risk Scores Systematically Underestimate the Presence and Extent of Subclinical Atherosclerosis in Brazilian Women: The Brazilian Study of Longitudinal Health (ELSA-Brasil)
    (2014) BITTENCOURT, Marcio S.; PEREIRA, Alexandre C.; STANIAK, Henrique L.; SHAROVSKY, Rodolfo; GOMEZ, Luz Marina; MENDES, Vytor Hugo; BLANKSTEIN, Ron; NASIR, Khurram; BENSENOR, Isabela; LOTUFO, Paulo A.
  • article 21 Citação(ões) na Scopus
    Association between Dietary Intake and Coronary Artery Calcification in Non-Dialysis Chronic Kidney Disease: The PROGREDIR Study
    (2018) MACHADO, Alisson Diego; GOMEZ, Luz Marina; MARCHIONI, Dirce Maria Lobo; ANJOS, Fernanda Silva Nogueira dos; MOLINA, Maria del Carmen Bisi; LOTUFO, Paulo Andrade; BENSENOR, Isabela Judith Martins; TITAN, Silvia Maria de Oliveira
    Coronary artery calcification (CAC) is a widespread condition in chronic kidney disease (CKD). Diet may play an important role in CAC, but this role is not clear. This study evaluated the association between macro-and micronutrient intakes and CAC in non-dialysis CKD patients. We analyzed the baseline data from 454 participants of the PROGREDIR study. Dietary intake was evaluated by a food frequency questionnaire. CAC was measured by computed tomography. After exclusion of participants with a coronary stent, 373 people remained for the analyses. The highest tertile of CAC was directly associated with the intake of phosphorus, calcium and magnesium. There was a higher intake of pantothenic acid and potassium in the second tertile. After adjustments for confounding variables, the intake of pantothenic acid, phosphorus, calcium and potassium remained associated with CAC in the generalized linear mixed models. In order to handle the collinearity between these nutrients, we used the LASSO (least absolute shrinkage and selection operator) regression to evaluate the nutrients associated with CAC variability. In this approach, the nutrients that most explained the variance of CAC were phosphorus, calcium and potassium. Prospective studies are needed to confirmthese findings and assess the role of interventions regarding these micronutrients on CAC prevention and progression.
  • article 2 Citação(ões) na Scopus
    Association of the genetic ancestry with resistant hypertension in the ReHOT (Resistant Hypertension Optimal Treatment) randomized study
    (2020) BUENO, Carolina Tosin; PEREIRA, Alexandre Costa; SANTOS, Hadassa Campos; GOMEZ, Luz Marina Gomez; HORIMOTO, Andrea Roseli Vancan Russo; KRIEGER, Eduardo Moacyr; KRIEGER, Jose Eduardo; SANTOS, Paulo Caleb Junior Lima
    Resistant hypertension (RH) is defined as uncontrolled blood pressure despite treatment with three or more antihypertensive medications, including, if tolerated, a diuretic in adequate doses. It has been widely known that race is associated with blood pressure control. However, intense debate persists as to whether this is solely explained by unadjusted socioeconomical variables or genetic variation. In this scenario, the main aim was to evaluate the association between genetic ancestry and resistant hypertension in a large sample from a multicenter trial of stage II hypertension, the ReHOT study. Samples from 1,358 patients were analyzed, of which 167 were defined as resistant hypertensive. Genetic ancestry was defined using a panel of 192 polymorphic markers. The genetic ancestry was similar in resistant (52.0% European, 36.7% African and 11.3% Amerindian) and nonresistant hypertensive patients (54.0% European, 34.4% African and 11.6% Amerindian) (p>0.05). However, we observed a statistically suggestive association of African ancestry with resistant hypertension in brown patient group. In conclusion, increased African genetic ancestry was not associated with RH in Brazilian patients from a prospective randomized hypertension clinical trial.
  • article 18 Citação(ões) na Scopus
    Mortality and other outcomes of patients with coronavirus disease pneumonia admitted to the emergency department: A prospective observational Brazilian study
    (2021) BRANDAO NETO, Rodrigo A.; MARCHINI, Julio F.; MARINO, Lucas O.; ALENCAR, Julio C. G.; LAZAR NETO, Felippe; RIBEIRO, Sabrina; SALVETTI, Fernando V.; RAHHAL, Hassan; GOMEZ, Luz Marina Gomez; BUENO, Caue G.; FARIA, Carine C.; CUNHA, Victor P. da; PADRAO, Eduardo; VELASCO, Irineu T.; SOUZA, Heraldo Possolo de
    Background The first cases of coronavirus disease (COVID-19) in Brazil were diagnosed in February 2020. Our Emergency Department (ED) was designated as a COVID-19 exclusive service. We report our first 500 confirmed COVID-19 pneumonia patients. Methods From 14 March to 16 May 2020, we enrolled all patients admitted to our ED that had a diagnosis of COVID-19 pneumonia. Infection was confirmed via nasopharyngeal swabs or tracheal aspirate PCR. The outcomes included hospital discharge, invasive mechanical ventilation, and in-hospital death, among others. Results From 2219 patients received in the ED, we included 506 with confirmed COVID-19 pneumonia. We found that 333 patients were discharged home (65.9%), 153 died (30.2%), and 20 (3.9%) remained in the hospital. A total of 300 patients (59.3%) required ICU admission, and 227 (44.9%) needed invasive ventilation. The multivariate analysis found age, number of comorbidities, extension of ground glass opacities on chest CT and troponin with a direct relationship with all-cause mortality, whereas dysgeusia, use of angiotensin converting enzyme inhibitor or angiotensin-ii receptor blocker and number of lymphocytes with an inverse relationship with all-cause mortality Conclusions This was a sample of severe patients with COVID-19, with 59.2% admitted to the ICU and 41.5% requiring mechanical ventilator support. We were able to ascertain the outcome in majority (96%) of patients. While the overall mortality was 30.2%, mortality for intubated patients was 55.9%. Multivariate analysis agreed with data found in other studies although the use of angiotensin converting enzyme inhibitor or angiotensin-ii receptor blocker as a protective factor could be promising but would need further studies.
  • article 3 Citação(ões) na Scopus
    Heritability of semantic verbal fluency task using time-interval analysis
    (2019) TAPOROSKI, T. P.; DUARTE, N. E.; POMPEIA, S.; STERR, A.; GOMEZ, L. M.; ALVIM, R. O.; HORIMOTO, R. V. R.; KRIEGER, J. E.; VALLADA, H.; PEREIRA, A. C.; SCHANTZ, M. von; NEGRAO, A. B.
    Individual variability in word generation is a product of genetic and environmental influences. The genetic effects on semantic verbal fluency were estimated in 1,735 participants from the Brazilian Baependi Heart Study. The numbers of exemplars produced in 60 s were broken down into time quartiles because of the involvement of different cognitive processes-predominantly automatic at the beginning, controlled/executive at the end. Heritability in the unadjusted model for the 60-s measure was 0.32. The best-fit model contained age, sex, years of schooling, and time of day as covariates, giving a heritability of 0.21. Schooling had the highest moderating effect. The highest heritability (0.17) was observed in the first quartile, decreasing to 0.09, 0.12, and 0.0003 in the following ones. Heritability for average production starting point (intercept) was 0.18, indicating genetic influences for automatic cognitive processes. Production decay (slope), indicative of controlled processes, was not significant. The genetic influence on different quartiles of the semantic verbal fluency test could potentially be exploited in clinical practice and genome-wide association studies.
  • article 4 Citação(ões) na Scopus
    Distinct Outcomes in COVID-19 Patients with Positive or Negative RT-PCR Test
    (2022) MENEZES, Maria Clara Saad; PESTANA, Diego Vinicius Santinelli; FERREIRA, Juliana Carvalho; CARVALHO, Carlos Roberto Ribeiro de; FELIX, Marcelo Consorti; MARCILIO, Izabel Oliva; SILVA, Katia Regina da; COBELLO JUNIOR, Vilson Cobello; MARCHINI, Julio Flavio; ALENCAR, Julio Cesar; GOMEZ, Luz Marina Gomez; MAUA, Denis Deratani; SOUZA, Heraldo Possolo
    Identification of the SARS-CoV-2 virus by RT-PCR from a nasopharyngeal swab sample is a common test for diagnosing COVID-19. However, some patients present clinical, laboratorial, and radiological evidence of COVID-19 infection with negative RT-PCR result(s). Thus, we assessed whether positive results were associated with intubation and mortality. This study was conducted in a Brazilian tertiary hospital from March to August of 2020. All patients had clinical, laboratory, and radiological diagnosis of COVID-19. They were divided into two groups: positive (+) RT-PCR group, with 2292 participants, and negative (-) RT-PCR group, with 706 participants. Patients with negative RT-PCR testing and an alternative most probable diagnosis were excluded from the study. The RT-PCR(+) group presented increased risk of intensive care unit (ICU) admission, mechanical ventilation, length of hospital stay, and 28-day mortality, when compared to the RT-PCR(-) group. A positive SARS-CoV-2 RT-PCR result was independently associated with intubation and 28 day in-hospital mortality. Accordingly, we concluded that patients with a COVID-19 diagnosis based on clinical data, despite a negative RT-PCR test from nasopharyngeal samples, presented more favorable outcomes than patients with positive RT-PCR test(s).
  • article 9 Citação(ões) na Scopus
    Performance of NEWS, qSOFA, and SIRS Scores for Assessing Mortality, Early Bacterial Infection, and Admission to ICU in COVID-19 Patients in the Emergency Department
    (2022) ALENCAR, Julio; GOMEZ, Luz Marina Gomez; CORTEZ, Andre Lazzeri; SOUZA, Heraldo Possolo de; LEVIN, Anna Sara; SALOMAO, Matias Chiarastelli
    SARS-CoV-2 infection has a wide spectrum of presentations, from asymptomatic to pneumonia and sepsis. Risk scores have been used as triggers for protocols that combine several interventions for early management of sepsis. This study tested the accuracy of the score SIRS, qSOFA, and NEWS in predicting outcomes, including mortality and bacterial infection, in patients admitted to the emergency department (ED) during the COVID-19 pandemic. We described 2,473 cases of COVID-19 admitted to the ED of the largest referral hospital for severe COVID-19 in Brazil during the pandemic. SIRS, qSOFA and NEWS scores showed a poor performance as prognostic scores. However, NEWS score had a high sensitivity to predict in-hospital death (0.851), early bacterial infection (0.851), and ICU admission (0.868), suggesting that it may be a good screening tool for severe cases of COVID-19, despite its low specificity.