WILSON JACOB FILHO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/66, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/66, Hospital das Clínicas, Faculdade de Medicina - Líder
17 resultados
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- Trace element concentration differences in regions of human brain by INAA(2013) SAIKI, M.; LEITE, R. E. P.; GENEZINI, F. A.; GRINBERG, L. T.; FERRETTI, R. E. L.; FARFEL, J. M.; SUEMOTO, C.; PASQUALUCCI, C. A.; JACOB-FILHO, W.Studies have shown that there is a potential relationship between the levels of trace elements in cerebral tissues and neurological disorders. However, there are few publications available on the elemental composition of these tissues as well as for different regions of the brain. The aim of this study was to investigate trace element differences in various regions of the human brain from an elderly population of normal individuals. Brain samples from 31 individuals of both genders, aged 51-95 years were provided by the Brain Bank of the Brazilian Aging Study Group of the So Paulo University, Medical School. The tissues from the regions of the hippocampus, cerebellum and frontal, parietal, temporal, occipital cortex were dissected using a titanium knife, ground, freeze-dried and then analyzed by instrumental neutron activation analysis (INAA). Samples and element standards were irradiated with a neutron flux at the IEA-R1 nuclear research reactor for Br, Fe, K, Na, Rb, Se and Zn determinations. One-way ANOVA test (p < 0.05) was used to compare the results which showed significant differences for several elements among the brain regions. Most of our brain analysis results agreed with the literature data. The results were also submitted for brain region classification by cluster analysis.
- Effects of resistance training and aerobic exercise in elderly people concerning physical fitness and ability: a prospective clinical trial(2013) ROMA, Maria Fernanda Bottino; BUSSE, Alexandre Leopold; BETONI, Rosana Aparecida; MELO, Antonio Cesar de; KONG, Juwando; SANTAREM, Jose Maria; JACOB FILHO, WilsonOBJECTIVE: To compare the effects of physical fitness and function on older adults in two programs of supervised exercise activity: resistance training and aerobic exercise. METHODS: This study is a randomized, prospective clinical trial composed of sedentary elderly people who did not have contraindications to exercise. Participants were divided into two groups: group one performed 6 exercises of resistance training twice a week, and group two participated in walking activity for 30 minutes twice a week. Functional assessment (time 0,6 and 12 months) was measured by the Short Physical Performance Battery (time to sit or stand, gait speed, and balance), flexibility test, and the six-minute walking test. We randomly selected 96 patients: 46 in the Resistance Training Group and 50 in the Aerobic Exercise Group. In the Resistance Training Group, 46 attended the first assessment and 20 attended until the third section. In the Aerobic Exercise Group, 50 attended the first assessment and 12 attended until the third assessment. RESULTS: Mean age was 68.8 years in the Resistance Training Group and 69.1 years in the Aerobic Exercise Group. The Resistance Training Group showed improvement in the sit/stand (p=0.022), balance with feet in a row (p=0.039) and queued (p=0.001). The second showed a statistical difference in speed and balance with the feet lined up and the feet together (p=0.008; p=0.02; and p=0.043, respectively). Concerning flexibility, the Resistance Training Group had improvement (p=0.001), whereas in the Aerobic Exercise Group, no significant difference was seen (p=0.359). Both groups had improvement in the six-minute walking test, but no significant improvement was seen in the Aerobic Exercise Group (p=0.033). CONCLUSION: Both groups showed improvement in physical fitness. No statistical difference was seen when groups was compared in the short physical performance battery, flexibility, and six-minute walking test.
- Aging, Diabetes, and Hypertension Are Associated With Decreased Nasal Mucociliary Clearance(2013) OLIVEIRA-MAUL, Janaina Proenca de; CARVALHO, Heraclito Barbosa de; GOTO, Danielle Miyuki; MAIA, Raphaela Mendonca; FLO, Claudia; BARNABE, Viviane; FRANCO, Denise Reis; BENABOU, Simon; PERRACINI, Monica Rodrigues; JACOB-FILHO, Wilson; SALDIVA, Paulo Hilario Nascimento; LORENZI-FILHO, Geraldo; RUBIN, Bruce K.; NAKAGAWA, Naomi KondoBackground: We showed previously that nasal mucociliary clearance was decreased in critically ill elderly subjects, most of whom had diabetes mellitus (DM) and/or hypertension (HTN). To determine if these changes were due to the effects of aging, disease, or critical illness, we studied nasal mucociliary clearance and mucus properties in an ambulatory population consisting of young, elderly, and healthy subjects and those with DM, HTN, or both. Methods: Of 440 subjects contacted, 252 entered the study. The subjects were divided into the following groups: (1) healthy (n = 79, 18-94 years, 50 men) and (2) DM and/or HTN, of which 37 had DM (14-90 years, 12 men), 52 had HTN (23-90 years, 12 men), and 84 had both DM and HTN (25-82 years, 33 men). Subjects were also grouped by age: < 40 years, 40 to 59 years, and >= 60 years. We assessed demographic and clinical data, quality of life using the 36-Item Short Form Health Survey (SF-36) questionnaire, nasal mucociliary clearance using the saccharine transit test (STT), and in vitro mucus properties by examining the sneeze (high airflow) clear-ability and contact angle. A logistic regression analysis for prolonged STT > 12 min was used, and we controlled for age, sex, and diseases. Results: Subjects aged > 60 years reported a decreased SF-36 physical component relative to other age groups. Sex, BMI, BP, heart rate, pulse oximetry, blood glucose level, and mucus properties were not associated with prolonged STT. Aging and DM and/or HTN independently increased the risk of prolonged STT. Conclusions: Aging and DM, HTN, or both diseases are independently associated with decreased nasal mucociliary clearance. This may predispose toward respiratory infections.
- Potentially inappropriate medications among elderly Brazilian outpatients(2013) FAUSTINO, Christine Grutzmann; PASSARELLI, Maria Cristina Guerra; JACOB-FILHO, WilsonCONTEXT AND OBJECTIVES: In Brazil, few studies have investigated the prevalence of potentially inappropriate medications (PIMs) among elderly outpatients. This study aimed to determine the prevalence of PIMs prescribed for elderly outpatients, identify the PIMs most commonly involved, and investigate whether age, sex and number of medications are related to prescription of such medications. DESIGN AND SETTING: Observational descriptive study developed in the Geriatrics Service of the Central Institute of Hospital das Clinicas (HC), Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil. METHODS: Prescriptions issued to 1,270 elderly patients (>= 60 years) were gathered from a database. These prescriptions had been written by geriatricians at a tertiary-level university hospital in Sao Paulo, Brazil, between February and May 2008. The prescriptions were divided according to sex and age group (60-69, 70-79 and >= 80). The Beers criteria were used to evaluate PIMs. RESULTS: Most of the sample comprised women (77%) and the mean age was 80.1 years. The mean prevalence of PIM prescriptions was 26.9%. Female sex and number of medications prescribed were associated with prescription of PIMs. The chance of having a PIM prescription was lower among patients >= 70 years. CONCLUSION: The greater prevalence of PIMs was correlated with female sex. The chance of having a PIM prescription was lower among patients >= 70 years and became greater with increasing numbers of medications prescribed (>= 7).
- Very low levels of education and cognitive reserve A clinicopathologic study(2013) FARFEL, Jose Marcelo; NITRINI, Ricardo; SUEMOTO, Claudia Kimie; GRINBERG, Lea Tenenholz; FERRETTI, Renata Eloah Lucena; LEITE, Renata Elaine Paraizo; TAMPELLINI, Edilaine; LIMA, Luzia; FARIAS, Daniela Souza; NEVES, Ricardo Caires; RODRIGUEZ, Roberta Diehl; MENEZES, Paulo Rossi; FREGNI, Felipe; BENNETT, David A.; PASQUALUCCI, Carlos Augusto; JACOB FILHO, WilsonObjective: We conducted a clinicopathologic study in a large population with very low levels of education to determine whether very few years of education could contribute to cognitive reserve and modify the relation of neuropathologic indices to dementia. Methods: In this cross-sectional study, we included 675 individuals 50 years of age or older from the Brazilian Aging Brain Study Group. Cognitive abilities were evaluated through a structured interview with an informant at the time of autopsy, including the Clinical Dementia Rating (CDR) scale. Neuropathologic examinations were performed using immunohistochemistry and following internationally accepted criteria. Multivariate linear regression models were conducted to determine whether the association between cognitive abilities (measured by CDR sum of boxes) and years of education was independent of sociodemographic variables and neuropathologic indices, including neuritic plaques, neurofibrillary tangles, lacunar infarctions, small-vessel disease, and Lewy bodies. In addition, interaction models were used to examine whether education modified the relation between neuropathologic indices and cognition. Results: Mean education was 3.9 +/- 3.5 years. Formal education was associated with a lower CDR sum of boxes (beta = -0.197; 95% confidence interval -0.343, -0.052; p = 0.008), after adjustment for sociodemographic variables and neuropathologic indices. Furthermore, education modified the relationship of lacunar infarcts with cognitive abilities (p = 0.04). Conclusions: Even a few years of formal education contributes to cognitive reserve.
- Estimating Premorbid Cognitive Abilities in Low-Educated Populations(2013) APOLINARIO, Daniel; BRUCKI, Sonia Maria Dozzi; FERRETTI, Renata Eloah de Lucena; FARFEL, Jose Marcelo; MAGALDI, Regina Miksian; BUSSE, Alexandre Leopold; JACOB-FILHO, WilsonObjective: To develop an informant-based instrument that would provide a valid estimate of premorbid cognitive abilities in low-educated populations. Methods: A questionnaire was drafted by focusing on the premorbid period with a 10-year time frame. The initial pool of items was submitted to classical test theory and a factorial analysis. The resulting instrument, named the Premorbid Cognitive Abilities Scale (PCAS), is composed of questions addressing educational attainment, major lifetime occupation, reading abilities, reading habits, writing abilities, calculation abilities, use of widely available technology, and the ability to search for specific information. The validation sample was composed of 132 older Brazilian adults from the following three demographically matched groups: normal cognitive aging (n = 72), mild cognitive impairment (n = 33), and mild dementia (n = 27). The scores of a reading test and a neuropsychological battery were adopted as construct criteria. Post-mortem inter-informant reliability was tested in a sub-study with two relatives from each deceased individual. Results: All items presented good discriminative power, with corrected item-total correlation varying from 0.35 to 0.74. The summed score of the instrument presented high correlation coefficients with global cognitive function (r = 0.73) and reading skills (r = 0.82). Cronbach's alpha was 0.90, showing optimal internal consistency without redundancy. The scores did not decrease across the progressive levels of cognitive impairment, suggesting that the goal of evaluating the premorbid state was achieved. The intraclass correlation coefficient was 0.96, indicating excellent inter-informant reliability. Conclusion: The instrument developed in this study has shown good properties and can be used as a valid estimate of premorbid cognitive abilities in low-educated populations. The applicability of the PCAS, both as an estimate of premorbid intelligence and cognitive reserve, is discussed.
- Depression and cardiovascular risk factors: evidence from a large postmortem sample(2013) SUEMOTO, Claudia K.; DAMICO, Marcio V.; FERRETTI, Renata E. L.; GRINBERG, Lea T.; FARFEL, Jose Marcelo; LEITE, Renata E. P.; NITRINI, Ricardo; LAFER, Beny; JACOB-FILHO, Wilson; PASQUALUCCI, Carlos A.Objectives We aimed to investigate the association of depression with cardiovascular risk factors and diseases (CVRFD) in a large population-based sample. Methods This cross-sectional study included 1012 deceased individuals greater than 50years of age from a general autopsy service located in SAo Paulo, Brazil. Demographics, socioeconomic profile, and CVRFD information were collected by caregivers from the deceased individuals from the Brain Bank of the Brazilian Aging Brain Study Group. Depression diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Mental Disorders was the main outcome. Results Depression was associated with female gender (odds ratio (OR)=1.86; 95% confidence interval (CI)=1.282.71, p=0.001), widowhood (OR=1.54; 95% CI=1.032.32, p=0.04), physical inactivity (OR=1.61; 95% CI=1.152.26, p=0.006), and smoking (OR=2.03; 95% CI=1.402.95, p<0.001) after multivariate logistic regression analysis. Other CVRFD were not associated with the presence of depression. Conclusions In our cross-sectional study, sedentary individuals and smokers showed a higher chance of depression during lifetime. Measures to control these common risk factors could decrease the incidence of depression.
- COLONOSCOPY COMPLICATIONS IN THE ELDERLY: the impact of age and multimorbidity(2013) STEIN, Francine de Cristo; HOJAIJ, Naira Hossepian Salles de Lima; SILVA, Jose Guilherme Nogueira da; BORGES, Luana Vilarinho; JACOB-FILHO, Wilson; HASHIMOTO, Claudio LyoitiContext Age has been considered an independent risk factor for colonoscopy complications, especially when associated with multimorbidity. Objectives The primary objective was to verify the relationships between age, multimorbidity and colonoscopy complications in the elderly. Methods A retrospective cohort including patients of 60 years or older who had undergone a colonoscopy. Data relating to age, multimorbidities according to the cumulative illness scale for geriatrics and the Charlson index and complications related to bowel preparation and procedure (sedation and exam) were collected. Results Of the 207 patients (mean age 70.47 ± 7.04) with appropriate indication for colonoscopy according to the American Society for Gastrointestinal Endoscopy, 43 (20.77%) patients had some colonoscopy complications: 1 (0.48%) with the sedation (apnea), 4 (1.93%) with the procedure (abdominal pain and bacteremia) and 38 (18.35%) with the bowel preparation (acute renal failure, hypotension). Individuals ≥80 years had an RR = 3.4 (1.2-10.1), P = 0.025, and those with a Charlson index 3 had an RR = 5.2 (1.6-16.8), P = 0.006, for complications. The cumulative illness rating scale for geriatrics was not associated with complications (P = 0.45). Conclusion There was a significant risk of complications in ≥80 years and in the group with a Charlson index 3. The cumulative illness rating scale for geriatrics was not a good predictor of risk in this sample.
- African ancestry protects against Alzheimer's disease-related neuropathology(2013) SCHLESINGER, D.; GRINBERG, L. T.; ALBA, J. G.; NASLAVSKY, M. S.; LICINIO, L.; FARFEL, J. M.; SUEMOTO, C. K.; FERRETTI, R. E. de Lucena; LEITE, R. E. P.; ANDRADE, M. P. de; SANTOS, A. C. F. dos; BRENTANI, H.; PASQUALUCCI, C. A.; NITRINI, R.; JACOB-FILHO, W.; ZATZ, M.Previous studies in dementia epidemiology have reported higher Alzheimer's disease rates in African-Americans when compared with White Americans. To determine whether genetically determined African ancestry is associated with neuropathological changes commonly associated with dementia, we analyzed a population-based brain bank in the highly admixed city of Sao Paulo, Brazil. African ancestry was estimated through the use of previously described ancestry-informative markers. Risk of presence of neuritic plaques, neurofibrillary tangles, small vessel disease, brain infarcts and Lewy bodies in subjects with significant African ancestry versus those without was determined. Results were adjusted for multiple environmental risk factors, demographic variables and apolipoprotein E genotype. African ancestry was inversely correlated with neuritic plaques (P = 0.03). Subjects with significant African ancestry (n = 112, 55.4%) showed lower prevalence of neuritic plaques in the univariate analysis (odds ratio (OR) 0.72, 95% confidence interval (CI) 0.55-0.95, P = 0.01) and when adjusted for age, sex, APOE genotype and environmental risk factors (OR 0.43, 95% CI 0.21-0.89, P = 0.02). There were no significant differences for the presence of other neuropathological alterations. We show for the first time, using genetically determined ancestry, that African ancestry may be highly protective of Alzheimer's disease neuropathology, functioning through either genetic variants or unknown environmental factors. Epidemiological studies correlating African-American race/ethnicity with increased Alzheimer's disease rates should not be interpreted as surrogates of genetic ancestry or considered to represent African-derived populations from the developing nations such as Brazil. Molecular Psychiatry (2013) 18, 79-85; doi:10.1038/mp.2011.136; published online 8 November 2011
- The human cerebral cortex is neither one nor many: neuronal distribution reveals two quantitatively different zones in the gray matter, three in the white matter, and explains local variations in cortical folding(2013) RIBEIRO, Pedro F. M.; VENTURA-ANTUNES, Lissa; GABI, Mariana; MOTA, Bruno; GRINBERG, Lea T.; FARFEL, Jose M.; FERRETTI-REBUSTINI, Renata E. L.; LEITE, Renata E. P.; FILHO, Wilson J.; HERCULANO-HOUZEL, SuzanaThe human prefrontal cortex has been considered different in several aspects and relatively enlarged compared to the rest of the cortical areas. Here we determine whether the white and gray matter of the prefrontal portion of the human cerebral cortex have similar or different cellular compositions relative to the rest of the cortical regions by applying the Isotropic Fractionator to analyze the distribution of neurons along the entire anteroposterior axis of the cortex, and its relationship with the degree of gyrification, number of neurons under the cortical surface, and other parameters. The prefrontal region shares with the remainder of the cerebral cortex (except for occipital cortex) the same relationship between cortical volume and number of neurons. In contrast, both occipital and prefrontal areas vary from other cortical areas in their connectivity through the white matter, with a systematic reduction of cortical connectivity through the white matter and an increase of the mean axon caliber along the anteroposterior axis. These two parameters explain local differences in the distribution of neurons underneath the cortical surface. We also show that local variations in cortical folding are neither a function of local numbers of neurons nor of cortical thickness, but correlate with properties of the white matter, and are best explained by the folding of the white matter surface. Our results suggest that the human cerebral cortex is divided in two zones (occipital and non-occipital) that differ in how neurons are distributed across their gray matter volume and in three zones (prefrontal, occipital, and non-occipital) that differ in how neurons are connected through the white matter. Thus, the human prefrontal cortex has the largest fraction of neuronal connectivity through the white matter and the smallest average axonal caliber in the white matter within the cortex, although its neuronal composition fits the pattern found for other, non-occipital areas.