MARCELO ZUGAIB

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Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina - Docente
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina

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  • article 14 Citação(ões) na Scopus
    Obesidade materna em gestações de alto risco e complicações infecciosas no puerpério
    (2012) PAIVA, Leticia Vieira de; NOMURA, Roseli Mieko Yamamoto; DIAS, Maria Carolina Goncalves; ZUGAIB, Marcelo
    Objective: To analyze the association between maternal obesity and postnatal infectious complications in high-risk pregnancies. Methods: Prospective study from August 2009 through August 2010 with the following inclusion criteria: women up to the 5th postpartum day; age L 18 years; high-risk pregnancy; singleton pregnancy with live fetus at labor onset; delivery at the institution; maternal weight measured on day of delivery. The nutritional status in late pregnancy was assessed by the body mass index (BMI), with the application of the Atalah et al. curve. Patients were graded as underweight, adequate weight, overweight, or obese. Postpartum complications investigated during the hospital stay and 30 days post-discharge were: surgical wound infection and/or secretion, urinary infection, postpartum infection, fever, hospitalization, antibiotic use, and composite morbidity (at least one of the complications mentioned). Results: 374 puerperal women were included, graded according to the final BMI as: underweight (n = 54, 14.4%); adequate weight (n = 126, 33.7%); overweight (n = 105, 28.1%); and obese (n = 89, 23.8%). Maternal obesity was shown to have a significant association with the following postpartum complications: surgical wound infection (16.7%, p = 0.042), urinary infection (9.0%, p = 0.004), antibiotic use (12.3%, p < 0.001), and composite morbidity (25.6%, p = 0.016). By applying the logistic regression model, obesity in late pregnancy was found to be an independent variable regardless of the composite morbidity predicted (OR: 2.09; 95% CI: 1.15-3.80, p = 0.015). Conclusion: Maternal obesity during late pregnancy in high-risk patients is independently associated with postpartum infectious complications, which demonstrates the need for a closer follow-up of maternal weight gain in these pregnancies.
  • conferenceObject
    Effects of Human Amniotic Fluid Stem Cells in a Model of Aorta Allograft Vasculopathy
    (2012) SANTANA, A. C.; DELLE, H.; CAVAGLIERI, R. C.; LOPES, M. A. B.; FRANCISCO, R. P. V.; ZUGAIB, M.; BYDLOWSKI, S. P.; NORONHA, I. L.
    Chronic allograft vasculopathy (CAV) is an important cause of graft loss. Considering the immune-in flammatory events involved in the development of CAV, therapeutic approaches to target this process are of relevance. Human amniotic fluid derived stem cells (hAFSC), a class of fetal, pluripotent stem cells with intermediate characteristics between embryonic and adult stem cells display immunomodulatory properties. hAFSC express mesenchymal and embryonic markers, show high proliferation rates, but do not induce tumor formation and their use does not raise ethical issues. Thus, we sought to investigate the effect of hAFSC on CAV in a model of aorta transplantation. Orthotopic aorta transplantation was performed using Fisher (F344) rats as donors and Lewis rats as recipients. Rats were divided into 3 groups: syngeneic (SYNG), untreated F344 receiving aorta from F344 (n=8); allogeneic (ALLO), Lewis rats receiving allogeneic aorta from F344 (n=8); and ALLO+hAFSC, ALLO rats treated with hAFSC (106 cells) (n=8). Histological analysis and immunohistochemistry were performed 30 days post transplantation. ALLO developed a robust aortic neointimal formation, accompanied by a high number of ED1+ and CD43+ cells, and enhanced expression of α-SMA in theneointima. Treatment with hAFSC diminished neointimal thickness and induced a significant decrease of ED1+, CD43+ cells and α-SMA expression in the neointima. Comparative analyses in the differents groups PARAMETERS SYNG ALLO ALLO+hAFSC Neointima thickness (μm) 0±0 208.7±25.4* 180.7±23.7* ED-1+ (cells/mm2) 0±0 4.845±841* 1.100±276*, #CD43+ (cells/mm2) 0±0 4.064±563* 1.080±309*,#α-SMA (%) 0±0 25±6* 8±3*, #*p<0.05 vs. SYNG; #P<0.05 vs. ALLO These preliminary results showed that hAFSC suppressed inflammation and myofibroblast migration to the intima, which may contribute to ameliorate vascular changes in CAV.
  • article 2 Citação(ões) na Scopus
    Expression of angiogenic factors in placenta of stressed rats
    (2012) CORREA, Isis Paloppi; RUANO, Rodrigo; TAKIUTI, Nilton Hideto; FRANCISCO, Rossana Pulcinelli Vieira; BEVILACQUA, Estela; ZUGAIB, Marcelo
    The aim of the present study was to analyse the influence of stress on pregnant rats, particularly in terms of maternal, placental and fetal weight, placental morphology and placental gene expression of the angiogenic factors Vegfa and Pgf and their receptors. The parameters were evaluated on gestation Day 20. Maternal, fetal and placental weights were statistically lower in stressed animals than controls, suggesting abnormalities in gestational physiology. Morphologically the placentas of rats subjected to stress were reduced in size and weight, with few glycogen cells and a significant increase in the number of apoptotic cells. Stress caused an increase in placental gene expression of Vegfa (P < 0.05) and a reduction in Pgf, Flt1 and Kdr expression (P < 0.05). It has been suggested that increased VEGF is associated with vasodilatation and hypotension, but in this model persistent hypertension was present. This study suggests that the limited hypotensive Vegfa response to stress-induced hypertension could result from reduced expression of Flt1/Kdr disrupting specific VEGF pathways. These findings may elucidate one of the multiple possible factors underlying how stress modulates placental physiology, and could aid the understanding of stress-induced gestational disorders.
  • conferenceObject
  • article 8 Citação(ões) na Scopus
    Prenatal detection and postnatal management of an intranasal glioma
    (2012) OKUMURA, Maria; FRANCISCO, Rossana Pulcineli Vieira; LUCATO, Leandro Tavares; ZERBINI, Maria Claudia Nogueira; ZUGAIB, Marcelo
    Nasal gliomas are rare benign congenital midline tumors composed of heterotopic neuroglial tissue. They have potential for intracranial extension through a bony defect in the skull base. Neuroimaging is essential for identifying nasal lesions and for determining their exact location and any possible intracranial extension. Computed tomography is often the initial imaging study obtained because it provides good visualization of the bony landmarks of the skull base; it is not, however, well suited for soft tissue imaging. Magnetic resonance imaging has better soft tissue resolution and may be the best initial study in patients seen early in life because the anterior skull base consists of an unossified cartilage and may falsely appear as if there is a bony dehiscence on computed tomography. A frontal craniotomy approach is recommended if intracranial extension is identified, followed by a transnasal endoscopic approach for intranasal glioma. A case is presented of a huge fetal facial mass that was shown by ultrasound that protruded through the left nostril at 33 weeks of gestation. Computed tomography of the neonate suggested a transethmoidal encephalocele. Magnetic resonance imaging showed a huge mass occupying the nasopharynx and the nasal cavity and protruding externally to the face but ruled out bony discontinuity in the skull base and, therefore, any intracranial connection. The infant underwent an endoscopic resection of the mass via oral and nasal routes and pathologic examination revealed intranasal glioma.
  • conferenceObject
    Longitudinal serum levels of Placental Growth Factor and sFlt-1 throughout gestation in normotensive pregnancies and those complicated by hypertensive disorders
    (2013) COSTA, R. A.; HOSHIDA, M. S.; ALVES, E. A.; V, R. P. Francisco; ZUGAIB, M.
    Background: Preeclampsia (PE) prevalence is higher in women with chronic hypertension (CH). Predictive markers for PE in this group could be particularly important. We aimed to evaluate serum levels of PlGF and sFlt-1 throughout pregnancies complicated by isolated PE, CH and PE superimposed on CH (PE+CH) compared to normotensive (NT) pregnancies. Methods: Peripheral blood samples have been collected from NT and CH pregnancies at gestational ages of 20, 26, 32 and 36 weeks and stored to be assayed by ELISA. This study was approved by local Ethics Committee. To date, samples have been partially assayed. Results: Levels of sFlt-1 increased throughout pregnancy in all groups. Levels of PlGF increased until 32 weeks in pregnancies not complicated by PE (NT and CH) and until 26 weeks in those complicated by PE (PE and PE+HC), thereafter PlGF levels decreased in all groups. Conclusions: preliminary data, still too short for statistical testing.
  • article 10 Citação(ões) na Scopus
    Fetal Growth Pattern and Prediction of Low Birth Weight in Gastroschisis
    (2015) CENTOFANTI, Sandra F.; BRIZOT, Maria de Lourdes; LIAO, Adolfo W.; FRANCISCO, Rossana P. V.; ZUGAIB, Marcelo
    Objectives: To examine growth patterns and predictions of low birth weight in gastroschisis fetuses. Methods: This is a retrospective study of isolated fetal gastroschisis before week 24. Ultrasound fetal biometric parameters - head circumference (HC), abdominal circumference (AC), femur length, HC/AC ratio and estimated fetal weight (EFW) - were plotted against normal growth charts. The percentage difference in mean values between normal and gastroschisis fetuses was determined. The growth deficit for each ultrasound parameter was calculated for the fetuses with 1 examination in each designated period (period I: weeks 20-25(+6); period II: weeks 26-31(+6); period III: from week 32 until term). For low birth weight prediction, measurements below the 10th percentile in periods I and II were tested. Results: Seventy pregnancies were examined. For all fetal parameters, the mean measurements were lower in fetuses with gastroschisis (p < 0.005). The EFW revealed an increased growth deficit between the periods (p = 0.030). HC was predictive of low birth weight in period II (OR = 6.07; sensitivity = 70.8%; specificity = 71.4%). Conclusions: Fetuses with gastroschisis present a reduced growth pattern, and it appears that no growth recovery occurs after the growth restriction has been established. Between week 26 and week 31(+6), an HC measurement below the 10th percentile is associated with an increased risk of low birth weight. (C) 2015 S. Karger AG, Basel
  • article 22 Citação(ões) na Scopus
    Association between magnesium status, oxidative stress and inflammation in preeclampsia: A case-control study
    (2015) ROCHA, Vivianne de Sousa; ROSA, Fernanda Brunacci Della; RUANO, Rodrigo; ZUGAIB, Marcelo; COLLI, Celia
    Background & aims: Preeclampsia is responsible for more than one-third of all maternal deaths in Brazil. The objectives of the present study were to evaluate magnesium status and its association with oxidative stress and inflammation in preeclamptic women, and to identify the predictor variables of the disorder. Methods: The study population consisted of 36 women divided into preeclamptic (n = 18) and control groups (n = 18). The preeclamptic group included women (>= 20 weeks of pregnancy) with arterial pressure >= 140/90 mmHg and proteinuria >03 g/24 h, while the control group comprised pregnant women with no clinical/obstetric complications. Magnesium intake was assessed via a food frequency questionnaire validated for pregnant women in Brazil. Plasma, erythrocyte and urinary magnesium levels were determined by flame atomic absorption spectroscopy, while oxidative stress and inflammatory markers were assessed using standard protocols. Logistic regression analysis was used to identify the predictors of preeclampsia. Results: Preeclamptic and control groups were similar with respect to magnesium intake and urinary excretion, while plasma and erythrocyte magnesium concentrations were higher in the former group. Plasma magnesium was positively correlated with catalase and glutathione peroxidase activities and with concentrations of interleukin-6 and tumor necrosis factor alpha. Regression analysis showed that plasma magnesium and urinary 8-isoprostane were associated with preeclampsia. Conclusion: Magnesium status appears to result from homeostatic imbalance and physiological alterations typical of preeclampsia. Increased plasma magnesium and decreased urinary 8-isoprostane were considered predictors of preeclampsia.
  • bookPart
    Diagnóstico de gravidez
    (2013) CHAU, Juang Horng; RUANO, Rodrigo; ZUGAIB, Marcelo
  • conferenceObject
    Glycemic Control and Fetal Growth in Patients With Gestational Diabetes
    (2012) TRINDADE, Thatianne C.; FRANCISCO, Rossana P.; ZUGAIB, Marcelo