EDUARDO FERREIRA BORBA NETO

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Departamento de Clínica Médica, Faculdade de Medicina - Docente
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina

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  • article 9 Citação(ões) na Scopus
    Erratic control of breathing during exercise in patients with systemic lupus erythematosus: a pilot-study
    (2011) PRADO, D. M. L. do; GUALANO, B.; MIOSSI, R.; LIMA, F. R.; ROSCHEL, H.; BORBA, E.; BONFA, E.; PINTO, A. L. de Sa
    Purpose: The aim of this study was to provide a comprehensive evaluation of the pattern and timing of breathing during incremental exercise in a sample of women living with systemic lupus erythematosus (SLE). Methods: In this cross-sectional study, 20 women with SLE without pulmonary involvement were compared with 20 gender-, body mass index- (BMI), and age-matched healthy individuals. By using a cardiopulmonary incremental exercise test, the following parameters were assessed: tidal volume (VT); breathing frequency (BF); total respiratory time (TOT); inspiratory time (TI); expiratory time (TE); inspiratory time to total time (TI/TOT); mean inspiratory flow (VT/TI); ventilatory equivalent for carbon dioxide (VE/VCO(2)) and end-tidal carbon dioxide pressure (PETCO(2)). Results: BF and BF/VT were significantly higher in patients with SLE versus controls, whereas VT, TE, TI and TOT were significantly lower in the former group (p < 0.05). Additionally, patients with SLE presented higher VE/VCO(2) and lower PETCO(2) than controls (p < 0.05), suggesting a ventilatory inefficiency. Conclusion: We reported compelling evidence of abnormal pattern and timing of breathing during incremental exercise in SLE. Considering that an erratic control of breathing may play an important role in exercise intolerance and fatigue, respiratory exercises emerge as a potential treatment for these symptoms in patients with SLE. Lupus (2011) 20, 1535-1540.
  • article 22 Citação(ões) na Scopus
    Dyslipidaemia in juvenile dermatomyositis: the role of disease activity
    (2013) KOZU, K. T.; SILVA, C. A.; BONFA, E.; SALLUM, A. M.; PEREIRA, R. M. R.; VIANA, V. S.; BORBA, E.; CAMPOS, L. M.
    Objective To evaluate the presence of dyslipidaemia in JDM and its possible risk factors. Methods Twenty-five JDM patients were compared to 25 healthy controls according to demographic data, body composition, fasting lipoproteins, glycaemia, insulin, antibodies and muscle enzymes. JDM scores were assessed: CMAS, MMT, DAS, MYOACT and MYTAX. Results Abnormal lipid profile was found in nine patients and four controls (36% vs. 16%, p=0.196). TDM patients demonstrated significant higher levels of triglycerides (TG) [80(31-340) vs. 61(19-182) mgldL, p=0.011 j and higher frequency of abnormal levels of high density lipoproteins (HDL) (28% vs. 4%, p=0.04) when compared to controls. JDM patients with dyslipidaemia demonstrated significant lower median of HDL levels 129(0-49) vs. 50(39-72) mgldL, p=0.0005, higher frequency of low HDL levels (77% vs. 0%, p=0.0001),.higher TG levels [128(31-340) vs. 69(46-138) mgldL, p=0.011), and also a higher frequency of increased levels of TG (44% vs. 0%, p=0.01), and TC (33% vs. 0%, p=0.03) when compared to those without this condition. Positive anti-LPL antibody was detected in just one JDM patient with abnormal lipid profile. JDM with dyslipidaemia had higher ESR (26 vs. I 4.5mmllsthour, p=0.006), CRP (2.1 vs. 0.4mgldL, p=0.01), DAS (6 vs. 2, p=0.008), MYOACT(0.13 vs. 0.01, p=0.012), MYTAX(0.06vs.0,p=0.018), and lower scores of CMAS (47 vs. 52, p=0.024) and MMT (78 vs. 80, p=0.001) compared to JDM without dyslipidaemia. Positive correlations were detected between TG levels and CRP (7-.19.697, p=0.001), DAS (r-0.610, p=0.001), MYOACT (r=0.661, p=0.001),114YTAX (r-0.511, p=0.008), and negative correlations with CMAS (r=-0.506, p=0.009) and MMT (r=-0.535, p=0.005). No differences were found between these groups regarding body composition, lipodystrophy, anti-LPL antibodies, and treatment except by higher frequency of cyclosporine current use in patients with dys.lipidaemia (33% vs. 0%, p=0.03). Conclusions Dyslipidaemia in JDM patients was characterised by increased levels of TG and low levels of HDL. Disease activity and cyclosporine use were the mainly factors associated to these abnormalities.
  • article 22 Citação(ões) na Scopus
    Penile anthropometry in systemic lupus erythematosus patients
    (2011) VECCHI, A. P.; BORBA, E. F.; BONFA, E.; COCUZZA, M.; PIERI, P.; KIM, C. A.; SILVA, C. A.
    The aim of this study was to evaluate penile anthropometry in systemic lupus erythematosus (SLE) patients compared with healthy controls and the possible relevant pubertal, clinical, hormonal and treatment factors that could influence penile dimensions. Twenty-five consecutive SLE patients were assessed by urological examination, sexual function, testicular ultrasound, hormones, sperm analysis, genetic analysis, clinical features and treatment. The control group included 25 age-matched healthy males. SLE patients had a lower median penis length and circumference [8 (7.5-10) vs. 10 (8-13) cm, p = 0.0001; 8 (7-10) vs. 10 (7-11) cm, p = 0.001; respectively], lower median testicular volume by right and left Prader [15 (10-25) vs. 20 (12-25) ml, p = 0.003; 15 (10-25) vs. 20 (12-25) ml, p = 0.006; respectively], higher median of follicle-stimulating hormone [5.8 (2.1-25) vs. 3.3 (1.9-9) IU/l, p = 0.002] and lower morning total testosterone levels (28% vs. 0%, p = 0.009) compared with controls. In spite of that, erectile dysfunction was not observed in patients or controls. Analyses of lupus patients revealed that the median penis circumference was lower in patients with disease onset before first ejaculation compared with those with disease onset after first ejaculation [7.8 (7-10) vs. 9.0 (7.5-10) cm, p = 0.026]. No differences were observed in the median penile anthropometry regarding sexual dysfunction (p = 0.610), lower morning total testosterone levels (p = 0.662), oligo/azoospermia (p = 0.705), SLE Disease Activity Index >= 4 (p = 0.562), Systemic Lupus International Collaborating Clinics/ACR Damage Index >= 1 (p = 0.478), prednisone cumulative dose (p = 0.789) and intravenous cyclophosphamide therapy (p = 0.754). Klinefelters syndrome (46XY/47XXY) was diagnosed in one (4%) SLE patient with decreased penile size whereas Y-chromosomal microdeletions was absent in all of them. In conclusion, we have identified reduced penile dimensions in SLE patients with no deleterious effect in erectile function. Disease onset before first ejaculation seems to affect penis development in pre-pubertal lupus. Lupus (2011) 20, 512-518.
  • article 27 Citação(ões) na Scopus
    Ovarian reserve in adult patients with childhood-onset lupus: a possible deleterious effect of methotrexate?
    (2014) ARAUJO, D. B. de; YAMAKAMI, L. Y. S.; AIKAWA, N. E.; BONFA, E.; VIANA, V. S. T.; PASOTO, S. G.; PEREIRA, R. M. R.; SERAFIN, P. C.; BORBA, E. F.; SILVA, C. A.
    Objectives: To assess ovarian reserve markers and anti-corpus luteum antibodies (anti-CoL) in adult patients with childhood-onset systemic lupus erythematosus (c-SLE). Method: Fifty-seven adult c-SLE female patients and 21 healthy controls were evaluated for anti-CoL. Ovarian reserve was assessed by: follicle stimulating hormone (FSH), luteinizing hormone (LH), oestradiol, anti-Mullerian hormone (AMH), and antral follicle count (AFC). Demographic data, menstrual abnormalities, disease activity, damage, and treatment were also analysed. Results: The median current age was similar in adult c-SLE patients and controls (27.7 vs. 27.7 years, p = 0.414). The medians of AMH (1.1 vs. 1.5 ng/mL, p = 0.037) and AFC (6 vs. 16, p < 0.001) were significantly reduced in SLE patients compared to controls without significant menstrual abnormalities. Anti-CoL were solely observed in c-SLE patients (16% vs. 0%, p = 0.103) and were not associated with demographic data, ovarian reserve parameters, disease activity/damage, and treatment. Further evaluation of c-SLE patients treated with cyclophosphamide revealed a higher median of FSH levels compared to c-SLE patients not treated with cyclophosphamide and controls (8.8 vs. 5.7 vs. 5.6 IU/L, p = 0.032) and lower median AMH (0.4 vs. 1.5 vs. 1.5 ng/mL, p = 0.004) and AFC (4.0 vs. 6.5 vs. 16 IU/L, p = 0.001) levels. Nineteen patients treated exclusively with methotrexate demonstrated a negative correlation between the cumulative dose and AMH levels (p = 0.027, r = -0.507). Conclusions: The present study demonstrated for the first time that a high cumulative methotrexate dose is a possible cause of subclinical ovarian dysfunction in adult c-SLE patients. Further studies are required to confirm this deleterious effect in other rheumatic diseases, particularly juvenile idiopathic arthritis and idiopathic inflammatory myopathy.
  • article 4 Citação(ões) na Scopus
    Increased corticotropin-releasing hormone (CRH) expression in cutaneous lupus lesions
    (2015) SCHMITZ, M. K.; BOTTE, D. A.; SOTTO, M. N.; BORBA, E. F.; BONFA, E.; MELLO, S. B. V. de
    Objective Corticotropin-releasing hormone (CRH) and pro-opiomelanocortin (POMC) axis activation leads to the production of hormones, such as adrenocorticotrophic hormone (ACTH) and the -melanocyte stimulating hormone (-MSH). Data regarding the role of these hormones in systemic lupus erythematosus (SLE) are scarce. In the present study we aim to evaluate the participation of this axis in the cutaneous involvement of SLE. Methods Seventeen SLE patients were clinically evaluated, and biopsies from affected and unaffected skin of these patients were compared with 17 healthy control individuals. Immunohistochemical analyses for CRH, ACTH, -MSH, and MC-1R were performed, and the serum levels of -MSH, IL-1, IL-1ra, IL-6, IL-10, IL-12p70, IL-17, TNF-, and IFN- were measured. Results The affected skin of the SLE patients exhibited higher CRH expression in the deep dermis compared to the skin of the controls (p=0.024), whereas the tissue expression of ACTH, cortisol, -MSH and its receptor MC-1R were comparable in SLE patients and controls. Higher serum levels of IFN- (p=0.041), TNF- (p=0.001) and IL-6 (p=0.049) were observed in SLE patients compared with controls, while -MSH levels were similar in both groups. Conclusion The novel finding of elevated CRH expression solely in the affected skin deep dermis supports the notion of a cutaneous local dysfunction of the CRH-POMC axis in the pathogenesis of cutaneous SLE lesions.
  • article 18 Citação(ões) na Scopus
    Abnormal chronotropic reserve and heart rate recovery in patients with SLE: a case-control study
    (2011) PRADO, D. M. Leite do; GUALANO, B.; MIOSSI, R.; SA-PINTO, A. L.; LIMA, F. R.; ROSCHEL, H.; BORBA, E. F.; BONFA, E.
    Abnormal heart-rate (HR) response during or after a graded exercise test has been recognized as a strong and an independent predictor of all-cause mortality in healthy and diseased subjects. The purpose of the present study was to evaluate the HR response during exercise in women with systemic lupus erythematosus (SLE). In this case-control study, 22 women with SLE (age 29.5 perpendicular to 1.1 years) were compared with 20 gender-, BMI-, and age-matched healthy subjects (age 26.5 +/- 1.4 years). A treadmill cardiorespiratory test was performed and HR response during exercise was evaluated by the chronotropic reserve (CR). HR recovery (Delta HRR) was defined as the difference between HR at peak exercise and at both first (Delta HRR1) and second (Delta HRR2) minutes after exercising. SLE patients presented lower peak VO(2) when compared with healthy subjects (27.6 perpendicular to 0.9 vs. 36.7 perpendicular to 1.1 ml/kg/min, p = 0.001, respectively). Additionally, SLE patients demonstrated lower CR (71.8 +/- 2.4 vs. 98.2 +/- 2.6%, p = 0.001), Delta HRR1 (22.1 +/- 2.5 vs. 32.4 +/- 2.2%, p = 0.004) and Delta HRR2 (39.1 +/- 2.9 vs. 50.8 +/- 2.5%, p = 0.001) than their healthy peers. In conclusion, SLE patients presented abnormal HR response to exercise, characterized by chronotropic incompetence and delayed Delta HRR. Lupus (2011) 20, 717-720.
  • article 15 Citação(ões) na Scopus
    Primary antiphospholipid syndrome: absence of premature atherosclerosis in patients without traditional coronary artery disease risk factors
    (2016) ANDRADE, D.; BORTOLOTTO, L.; BONFA, E.; BORBA, E.
    Objective To investigate if patients with Primary Antiphospholipid Syndrome (PAPS) with venous and/or arterial thrombosis without traditional coronary artery disease (CAD) risk factors develop early atherosclerotic vascular damage. Methods 27 female patients with PAPS (Sidney criteria) and 27 age, body mass index (BMI), and sex matched controls were consecutively selected. Exclusion criteria were: black race, age 55 years, traditional cardiovascular risk factors, other thrombophilias or connective tissue diseases, corticosteroids use and pregnancy. All subjects underwent Pulse Wave Velocity (PWV) and Echo-Tracking (ET), both in carotidal bed, to analyse vascular functional properties. Results Age (p=0.92) and BMI (p=0.91) were comparable in both groups. PAPS patients and controls had similar PWV (9.071.08m/s vs 9.42 +/- 1.47m/s, p=0.34) as well as echo tracking parameters such as intima-media thickness (683 +/- 171 mu m vs 636 +/- 140 mu m, p=0.52), carotideal diameter (p=0.26), distensibility (p=0.92), compliance coefficients (p=0.36) and elastic modulus (p=0.78). Patients with exclusively venous thrombosis showed lower PWV than patients with arterial thrombosis (8.55 +/- 0.70m/s vs 9.56 +/- 0.94m/s, p=0.01), but no difference regarding intima-media thickness (683 +/- 171 mu m vs 636 +/- 140 mu m, p=0.52) was observed. Conclusion Patients with PAPS do not seem to be at higher risk of developing premature atherosclerosis. Patients who suffered exclusively venous thrombosis seem to be at lower risk than those with exclusively arterial events. Other studies need to confirm our findings.
  • conferenceObject
    PERIPHERAL NERVOUS SYSTEM DISEASE IN SYSTEMIC LUPUS ERYTHEMATOSUS: THE ROLE OF PREDISPOSING CONDITIONS
    (2018) FARGETTI, S.; BONFA, E.; SHINJO, S. K.; PASOTO, S. G.; SEGURO, L. P. C.; LOPES, M. R. U.; GONCALVES, C. R.; BORBA, E. F.
  • conferenceObject
    SHORT AND LONG-TERM FOLLOW-UP OF PERIPHERAL NEUROPATHY DUE TO SYSTEMIC LUPUS ERYTHEMATOSUS: EVIDENCE OF A FAVORABLE OUTCOME
    (2018) FARGETTI, S.; BONFA, E.; SHINJO, S. K.; PASOTO, S. G.; SEGURO, L. P. C.; LOPES, M. R. U.; GONCALVES, C. R.; BORBA, E. F.
  • article 56 Citação(ões) na Scopus
    Factors predictive of serious infections over time in systemic lupus erythematosus patients: data from a multi-ethnic, multi-national, Latin American lupus cohort
    (2019) PIMENTEL-QUIROZ, V. R.; UGARTE-GIL, M. F.; HARVEY, G. B.; WOJDYLA, D.; PONS-ESTEL, G. J.; QUINTANA, R.; ESPOSTO, A.; GARCIA, M. A.; CATOGGIO, L. J.; CARDIEL, M. H.; BARILE, L. A.; AMIGO, M-C; I, E. Sato; BONFA, E.; BORBA, E.; COSTALLAT, L. T. Lavras; NEIRA, O. J.; MASSARDO, L.; GUIBERT-TOLEDANO, M.; CHACON-DIAZ, R.; ALARCON, G. S.; PONS-ESTEL, B. A.; SORIANO, Enrique R.; RECALDE, Maria Flavia Ceballos; VELOZO, Edson; MANNI, Jorge A.; GRIMAUDO, Sebastian; SARANO, Judith; MALDONADO-COCCO, Jose A.; ARRIOLA, Maria S.; GOMEZ, Graciela; MARCOS, Ana Ines; MARCOS, Juan Carlos; SCHERBARTH, Hugo R.; LOPEZ, Jorge A.; MOTTA, Estela L.; DRENKARD, Cristina; GAMRON, Susana; BULIUBASICH, Sandra; ONETTI, Laura; CAEIRO, Francisco; ALVARELLOS, Alejandro; SAURIT, Veronica; GENTILETTI, Silvana; QUAGLIATTO, Norberto; GENTILETTI, Alberto A.; MACHADO, Daniel; ABDALA, Marcelo; PALATNIK, Simon; BERBOTTO, Guillermo A.; BATTAGLIOTTI, Carlos A.; SOUZA, Alexandre Wagner S.; BERTOLO, Manoel Barros; COIMBRA, Ibsen Bellini; BRENOL, Joao C. Tavares; MONTICIELO, Odirlei; XAVIER, Ricardo; CAVALCANTI, Fernando de Souza; DUARTE, Angela Luzia Branco; MARQUES, Claudia Diniz Lopes; SILVA, Nilzio Antonio da; SILVA, Ana Carolina de O e; PACHECO, Tatiana Ferracine; MOLINA-RESTREPO, Jose Fernando; MOLINA-LOPEZ, Javier; VASQUEZ, Gloria; RAMIREZ, Luis A.; URIBE, Oscar; IGLESIAS-GAMARRA, Antonio; IGLESIAS-RODRIGUEZ, Antonio; EGEA-BERMEJO, Eduardo; GUZMAN-MORENO, Renato A.; RESTREPO-SUAREZ, Jose F.; REYES-LLERENA, Gil Alberto; HERNANDEZ-MARTINEZ, Alfredo; JACOBELLI, Sergio; GUZMAN, Leonardo R.; GARCIA-KUTZBACH, Abraham; CASTELLANOS, Claudia; CAJAS, Erwin; PASCUAL-RAMOS, Virginia; SILVEIRA, Luis H.; TORRE, Ignacio Garcia De La; OROZCO-BAROCIO, Gerardo; ESTRADA-CONTRERAS, Magali L.; POZO, Maria Josefina Sauza del; BACA, Laura E. Aranda; QUEZADA, Adelfia Urenda; HUERTA-YANEZ, Guillermo F.; ACEVEDO-VAZQUEZ, Eduardo M.; ALFARO-LOZANO, Jose Luis; CUCHO-VENEGAS, Jorge M.; SEGAMI, Maria Ines; CHUNG, Cecilia P.; ALVA-LINARES, Magaly; ABADI, Isaac; RANGEL, Neriza; SNIH, Soham Al Snih Al; ESTEVA-SPINETTI, Maria H.; VIVAS, Jorge
    Aim The aim of this study was to identify factors predictive of serious infections over time in patients with systemic lupus erythematosus (SLE). Methods A multi-ethnic, multi-national Latin American SLE cohort was studied. Serious infection was defined as one that required hospitalization, occurred during a hospitalization or led to death. Potential predictors included were sociodemographic factors, clinical manifestations (per organ involved, lymphopenia and leukopenia, independently) and previous infections at baseline. Disease activity (SLEDAI), damage (SLICC/ACR Damage Index), non-serious infections, glucocorticoids, antimalarials (users and non-users), and immunosuppressive drugs use; the last six variables were examined as time-dependent covariates. Cox regression models were used to evaluate the predictors of serious infections using a backward elimination procedure. Univariable and multivariable analyses were performed. Results Of the 1243 patients included, 1116 (89.8%) were female. The median (interquartile range) age at diagnosis and follow-up time were 27 (20-37) years and 47.8 (17.9-68.6) months, respectively. The incidence rate of serious infections was 3.8 cases per 100 person-years. Antimalarial use (hazard ratio: 0.69; 95% confidence interval (CI): 0.48-0.99; p = 0.0440) was protective, while doses of prednisone >15 and <= 60 mg/day (hazard ratio: 4.18; 95 %CI: 1.69-10.31; p = 0.0019) and >60 mg/day (hazard ratio: 4.71; 95% CI: 1.35-16.49; p = 0.0153), use of methylprednisolone pulses (hazard ratio: 1.53; 95% CI: 1.10-2.13; p = 0.0124), increase in disease activity (hazard ratio: 1.03; 95% CI: 1.01-1.04; p = 0.0016) and damage accrual (hazard ratio: 1.22; 95% CI: 1.11-1.34; p < 0.0001) were predictive factors of serious infections. Conclusions Over time, prednisone doses higher than 15 mg/day, use of methylprednisolone pulses, increase in disease activity and damage accrual were predictive of infections, whereas antimalarial use was protective against them in SLE patients.