RODRIGO MARTINS ABREU
Projetos de Pesquisa
Unidades Organizacionais
LIM/07 - Laboratório de Gastroenterologia Clínica e Experimental, Hospital das Clínicas, Faculdade de Medicina
13 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 13
- Assessment of the prevalence of vertical hepatitis B transmission in two consecutive generations(2018) NAKANO, Larissa Akeme; KATAYOSE, Jessica Toshie; ABREU, Rodrigo Martins; MENDES, Luis Claudio Alfaia; MARTINS, Maria Cleusa; PINTO, Vanusa Barbosa; CARRILHO, Flair Jose; ONO, Suzane KiokoIntroduction: Hepatitis B is an important public health problem in the world and one of the forms of contagion would be through vertical transmission. Precose diagnosis allows the adoption of prophylaxis measures, which results in prevention in more than 90% of cases. Objective: To describe the prevalences of vertical transmission and compare two generations (mother/patient and patient/child). Method: This was a cross-sectional study, which included 101 patients. The interviews were performed through the application of the instrument of data collection and information of the physical file before the medical consultation. Results: The mean +/- SD of age was 50.9 +/- 13.1 years, the male gender predominated, with 56.4% of the patients, and the predominance was white, with 43.6%. Vertical transmission between mother and patient occurred in 17.8% and between patient and child, in 7.9%. In all of the eight cases of vertical transmission, the diagnosis was after the birth of children infected with HBV, and in 3/8 (37.5%), there was more than one case of infection by this mechanism per patient, totaling 13 children with the disease. Conclusion: There was a reduction in vertical transmission, showing that preventive measures were effective.
- Panorama do tratamento hemodialítico financiado pelo Sistema Único de Saúde - Uma perspectiva econômica(2015) MENEZES, Fabiana Gatti de; BARRETO, Daniela Veit; ABREU, Rodrigo Martins; ROVEDA, Fabiana; PECOITS FILHO, Roberto Flavio SilvaIntroduction: End-stage renal disease (ESRD) is a public health problem and, in Brazil, lacks of data on one of the main treatments, hemodialysis, are still identified. Objective: To determine, through description of resources used in ESRD treatment and its complications, the cost associated to hemodialysis and supplementary medical therapy in patients attended by Brazilian Public Health (SUS). Methods: Methods of cross-sectional and prospective cohort observational analysis were conducted using public data, where information about inpatient and outpatient resource use and patients' characteristics were collected. From described resource use, costs were calculated. In cross-sectional analysis subjects who underwent hemodialysis between January/2008 and November/2012 were considered and in prospective cohort, started in 2009. Descriptive analyses were performed. Results: 91,475 and 118,847 hemodialysis procedures were performed in 2008 and 2012, respectively, and 24.8% of increase was estimated until 2017. Analysis by federation unit showed that São Paulo, Minas Gerais and Rio de Janeiro states represented almost half of the procedures observed, with mean cost per patient of US$ 7,932.52 in 2008 and US$ 9,112.75 in 2011. In the cohort, composed by 96,600 subjects, the most used drug was alfaepoetin and 8% of the sample used calcitriol 1.0 mcg. The occurrence of complications was observed in 28.2% of patients. Conclusion: After data analysis, different aspects of hemodialysis use were demonstrated, with an increase in amount of procedures and, also, in disease related expenses.
- Cost-effectiveness analysis of paricalcitol versus calcitriol for the treatment of SHPT in dialytic patients from the SUS perspective(2016) MENEZES, Fabiana Gatti de; ABREU, Rodrigo Martins; ITRIA, AlexanderAbstract Introduction: Secondary hyperparathyroidism (SHPT) is a consequence of chronic kidney disease. The treatment at the Brazilian Unified Heath System (SUS) is performed with calcitriol, a drug which favors hypercalcemia and/or hyperphosphatemia, hindering the control of SHPT. Another option is paricalcitol, which causes parathormone (PTH) suppression faster than calcitriol, with minor changes in calcium-phosphorus product and calcium and phosphorus serum levels. Objective: This study aims to develop a cost-effectiveness analysis of paricalcitol versus calcitriol for patients in dialytic treatment with SHPT, from the SUS perspective. Methods: A Markov decision model was developed for patients ≥ 50 years old with end stage renal disease in dialytic treatment and SHPT. Quarterly cycles and a lifetime time horizon were considered. Life years (LY) gained were assessed as clinical outcome. Clinical and economic inputs were obtained from systematic literature review and official databases. Costs are presented in Brazilian real (BRL), for the year 2014. Results: In the base case: paricalcitol generated a clinical benefit of 16.28 LY gained versus 14.11 LY gained with calcitriol, total costs of BRL 131,064 and BRL 114,262, respectively, determining an incremental cost-effectiveness ratio of BRL 7,740 per LY gained. The data robustness was confirmed by the sensitivity analysis. Conclusions: According to cost-effectiveness threshold recommended by the World Health Organization for 2013, the treatment of SHPT in patients on dialysis with paricalcitol is cost-effective when compared to calcitriol, from the public healthcare system perspective, in Brazil.
- Assessment of Adherence to Prescribed Therapy in Patients with Chronic Hepatitis B(2016) ABREU, Rodrigo Martins; FERREIRA, Camila da Silva; FERREIRA, Aline Siqueira; REMOR, Eduardo; NASSER, Paulo Dominguez; CARRILHO, Flair Jose; ONO, Suzane KiokoEvidence shows that treatment for hepatitis B virus (HBV) can suppress viral load. Among the factors directly linked to therapeutic success is adherence to the treatment. Several instruments to assess adherence are available, but they are not validated for use in chronic hepatitis B. The purpose of this paper was to adapt and validate the ""Assessment of Adherence to Antiretroviral Therapy Questionnaire-HIV"" (CEAT-VIH) for patients with chronic hepatitis B (referred to herein as CEAT-HBV). The validity of the adapted questionnaire evidence was established through concurrent, criterion, and construct validities. We found negative and significant correlation between the domain ""degree of compliance to antiviral therapy"" assessed by CEAT-HBV and the Morisky test (r = -0.62, P < 0.001) and between the domain ""barriers to adherence"" and HBV viral load (r = -0.42, P < 0.001). In terms of the construct's discriminative capacity, scores greater than or equal to 80 detected antiviral therapy success, which are necessary for the prediction of an undetectable HBV viral load. Thus, a cutoff value of 80.5 was set with a value of 81% for sensitivity and 67% for specificity. The CEAT-HBV identified 43% (n = 79) non-adherent patients and was shown to be a useful tool in clinical practice.
- Clinical Features of Refractory Ascites in Outpatients(2017) CALY, Wanda Regina; ABREU, Rodrigo Martins; BITELMAN, Bernardo; CARRILHO, Flair Jose; ONO, Suzane KiokoOBJECTIVES: To present the clinical features and outcomes of outpatients who suffer from refractory ascites. METHODS: This prospective observational study consecutively enrolled patients with cirrhotic ascites who submitted to a clinical evaluation, a sodium restriction diet, biochemical blood tests, 24 hour urine tests and an ascitic fluid analysis. All patients received a multidisciplinary evaluation and diuretic treatment. Patients who did not respond to the diuretic treatment were controlled by therapeutic serial paracentesis, and a transjugular intrahepatic portosystemic shunt was indicated for patients who required therapeutic serial paracentesis up to twice a month. RESULTS: The most common etiology of cirrhosis in both groups was alcoholism [49 refractory (R) and 11 non-refractory ascites (NR)]. The majority of patients in the refractory group had Child-Pugh class B cirrhosis (p=0.034). The nutritional assessment showed protein-energy malnutrition in 81.6% of the patients in the R group and 35.5% of the patients in the NR group, while hepatic encephalopathy, hernia, spontaneous bacterial peritonitis, upper digestive hemorrhage and type 2 hepatorenal syndrome were present in 51%, 44.9%, 38.8%, 38.8% and 26.5% of the patients in the R group and 9.1%, 18.2%, 0%, 0% and 0% of the patients in the NR group, respectively (p=0.016, p=0.173, p=0.012, p=0.012, and p=0.100, respectively). Mortality occurred in 28.6% of the patients in the R group and in 9.1% of the patients in the NR group (p=0.262). CONCLUSION: Patients with refractory ascites were malnourished, suffered from hernias, had a high prevalence of complications and had a high postoperative death frequency, which was mostly due to infectious processes.
- Pegylated interferon alfa for chronic hepatitis B: systematic review and meta-analysis(2016) KIM, V.; ABREU, R. M.; NAKAGAWA, D. M.; BALDASSARE, R. M.; CARRILHO, F. J.; ONO, S. K.Conventional interferon alfa and nucleos(t)ide analogues, such as lamivudine, are frequently used for chronic hepatitis B (CHB) treatment, but are associated with adverse effects and viral resistance. Here we performed a systematic review and meta-analysis evaluating all studies of pegylated interferon alfa (PEG-IFN) treatment in hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients with CHB. We searched electronic databases - PubMed, EMBASE, Cochrane Library and LILACS - for randomized controlled trials evaluating PEG-IFN therapy between 1999 and September 2014. Virological response was the primary outcome. We identified 14 studies involving 2829 patients. Our analysis revealed that PEG-IFN+lamivudine combination therapy produced better virological and biochemical responses than PEG-IFN monotherapy in HBeAg-positive and HBeAg-negative patients at the end of treatment. PEG-IFN+adefovir dipivoxil achieved better seroconversion rate than PEG-IFN in HBeAg-positive patients at the end of treatment. The present findings demonstrated a beneficial response rate following PEG-IFN combination therapy with nucelos(t)ides among HBeAg-positive and HBeAg-negative patients with CHB. Further trials are needed to investigate simultaneous and sequential therapy strategies.
- UGT1A1*28 relationship with abnormal total bilirubin levels in chronic hepatitis C patients Outcomes from a case-control study(2017) SOUZA, Marcelo Moreira Tavares de; VAISBERG, Victor Van; ABREU, Rodrigo Martins; FERREIRA, Aline Siqueira; DASILVAFERREIRA, Camila; NASSER, Paulo Dominguez; PASCHOALE, Helena Scavone; CARRILHO, Flair Jose; ONO, Suzane KiokoGilbert syndrome (GS) is a frequent benign clinical condition, marked by intermittent unconjugated hyperbilirubinemia, mostly due to the polymorphism uridine diphosphate-glucuronosyltransferase 1A1* 28 (UGT1A1* 28). Hyperbilirubinemia has been reported in a GS patient undergoing hepatitis C treatment, and other UGT isoforms polymorphisms have been linked to worse outcomes in viral hepatitis. Yet, little is known to GS contributions' to the liver disease scenario. Our aim was to assess UGT1A1 genotypes' frequency in chronic hepatitis C (CHC) patients and correlate with total bilirubin (TB). This is a case-control study in a large tertiary medical center. Cases were CHC patients confirmed by hepatitis C virus (HCV)-polymerase chain reaction. Exclusion criteria were hepatitis B virus or human immunodeficiency virus (HIV) coinfection. Control were healthy blood donors. UGT1A1 promoter region gene genotyping was performed, and bilirubin serum levels were available for HCV patients. Genotypes and alleles frequencies were similar in case (n= 585; P= 0.101) and control groups (n= 313; P= 0.795). Total bilirubin increase was noticed according to thymine-adenine repeats in genotypes (P < 0.001), and the TB greater than 1mg/dL group had more UGT1A1* 28 subjects than in the group with TB values < 1mg/dL (18.3 vs 5.3; P < 0.001). Bilirubin levels are linked to the studied polymorphisms, and this is the first time that these findings are reported in a chronic liver disease sample. Among patients with increased TB levels, the frequency of UGT1A1* 28 is higher than those with normal TB. Personalized care should be considered to GS, regarding either abnormal bilirubin levels or drug metabolism.
bookPart Distúrbios genéticos do metabolismo da bilirrubina(2017) MOTTA, Marina Pamponet; ABREU, Rodrigo Martins; ONO, Suzane KiokoconferenceObject Four years real-life experience with antiviral adherence in chronic hepatitis B infection in a tertiary university hospital(2015) ABREU, Rodrigo M.; BASSIT, Leda C.; TAO, Sijia; JIANG, Yong; PARANAGUA-VEZOZZO, Denise; SCHINAZI, Raymond F.; CARRILHO, Flair J.; ONO, Suzane K.- A Fast and Cost-Effective Method for Identifying a Polymorphism of Interleukin 28B Related to Hepatitis C(2013) FERREIRA, Camila da Silva; ABREU, Rodrigo Martins; SILVA, Marlone Cunha da; FERREIRA, Aline Siqueira; NASSER, Paulo Dominguez; CARRILHO, Flair Jose; ONO, Suzane KiokoApproximately 170 million people are chronic carriers of hepatitis C virus (HCV). Patients with chronic hepatitis C are currently treated with pegylated interferon and ribavirin (PEG-IFN/RBV). A genome-wide association with PEG-IFN/RBV treatment response and a single nucleotide polymorphism (rs12979860) has been identified near the interleukin 28B gene that encodes interferon-lambda-3. In this paper, we describe an innovative, fast, and low-cost multiplex polymerase chain reaction with confronting two-pair primers that detects the rs12979860 polymorphism. The assay is internally controlled and does not require the use of restriction endonucleases or special equipment. Moreover, the assay decreases costs, being about 40% cheaper than direct sequencing methods.