HO YEH LI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/54 - Laboratório de Bacteriologia, Hospital das Clínicas, Faculdade de Medicina
LIM/54 - Laboratório de Bacteriologia, Hospital das Clínicas, Faculdade de Medicina
2 resultados
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- Quantitative PCR as a marker for preemptive therapy and its role in therapeutic control in Trypanosoma cruzi/HIV coinfection(2024) FREITAS, Vera Lucia Teixeira de; NOVAES, Christina Terra Gallafrio; SARTORI, Ana Marli Christovam; CARVALHO, Noemia Barbosa; SILVA, Sheila Cristina Vicente da; NAKANISHI, erika Shimoda; SALVADOR, Fernando; CASTRO, Cleudson Nery de; BEZERRA, Rita Cristina; WESTPHALEN, Elizabeth Visone Nunes; OLIVEIRA, Caroline Medeji Ramos de; BUSSER, Felipe Delatorre; HO, Yeh-Li; BUCCHERI, Renata; BONILLA, Carolina; SHIKANAI-YASUDA, Maria AparecidaBackground Trypanosoma cruzi and HIV coinfection can evolve with depression of cellular immunity and increased parasitemia. We applied quantitative PCR (qPCR) as a marker for preemptive antiparasitic treatment to avoid fatal Chagas disease reactivation and analyzed the outcome of treated cases. Methodology This mixed cross-sectional and longitudinal study included 171 Chagas disease patients, 60 coinfected with HIV. Of these 60 patients, ten showed Chagas disease reactivation, confirmed by parasites identified in the blood, cerebrospinal fluid, or tissues, 12 exhibited high parasitemia without reactivation, and 38 had low parasitemia and no reactivation. Results We showed, for the first time, the success of the timely introduction of benznidazole in the non-reactivated group with high levels of parasitemia detected by qPCR and the absence of parasites in reactivated cases with at least 58 days of benznidazole. All HIV+ patients with or without reactivation had a 4.0-5.1 higher chance of having parasitemia than HIV seronegative cases. A positive correlation was found between parasites and viral loads. Remarkably, treated T. cruzi/HIV-coinfected patients had 77.3% conversion from positive to negative parasitemia compared to 19.1% of untreated patients. Additionally, untreated patients showed similar to 13.6 times higher Odds Ratio of having positive parasitemia in the follow-up period compared with treated patients. Treated and untreated patients showed no differences regarding the evolution of Chagas disease. The main factors associated with all-cause mortality were higher parasitemia, lower CD4 counts/mu L, higher viral load, and absence of antiretroviral therapy. Conclusion We recommend qPCR prospective monitoring of T. cruzi parasitemia in HIV+ coinfected patients and point out the value of pre-emptive therapy for those with high parasitemia. In parallel, early antiretroviral therapy introduction is advisable, aiming at viral load control, immune response restoration, and increasing survival. We also suggest an early antiparasitic treatment for all coinfected patients, followed by effectiveness analysis alongside antiretroviral therapy.
- Summary of Evidence and Recommendations: Guidelines for Care of Critically Ill Adult Patients with COVID-19 in the Americas(2021) REVEIZ, Ludovic; TOLEDO, Joao; TORRES, Marcela; IZCOVICH, Ariel; BALBIN, Graciela Josefina; SA, Marcio Borges; LISBOA, Thiago Costa; CUELLAR, Gustavo Gabriel; JAIMES, Fabian; DELSO, Luis Antonio Gorordo; MEZA, Juan Carlos; RESTREPO, Sonia; RODRIGUEZ, Angel; SALAZAR, Leonardo; SOSA, Ojino; UBIERGO, Sebastian Ugarte; LI, Ho Yeh; MENDEZ, Jairo; FUENTE, Luis de la; CASTRO, Jose Luis; LEMGRUBEI, Alexandre; CACCAVO, Francisco; BELTRAN, Mauricio; PEIRIS, Sasha; PARDO, RodrigoIntroduction. In 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has spread around the world. Approximately 5% of infected patients are critical cases that require admission to the intensive care unit (ICU). In these patients, COVID-19 can be complicated by acute respiratory distress syndrome, septic shock, and multi-organ failure, including kidney and heart failure. Objective. Summarize the recommendations included in the Guidelines for Care of Critically Ill Adult Patients with COVID-19 in the Americas, version 3, published by the Pan American Health Organization in 2021 to guide the management of critically ill adult patients with COVID-19 treated in the ICU, and address key aspects of implementation of the recommendations. Methodology. The guidelines and their recommendations were summarized. In addition, a systematic search was carried out in Pubmed, Lilacs, Health Systems Evidence, Epistemonikos, and gray literature on studies carried out in the Region of the Americas, in order to identify barriers, facilitators, and implementation strategies. Results. Forty-three recommendations are presented that address the identification of markers and risk factors for mortality, infection prevention and control, specimen collection, supportive care (ventilatory and hemodynamic), pharmacological treatment, early rehabilitation, use of imaging studies, prevention of complications, and discharge criteria for critical patients with COVID-19. Conclusions. The recommendations seek to provide knowledge on the management of critical patients with COVID-19 and offer considerations for implementation of the recommendations in the Region.