FLAVIO JOTA DE PAULA

Índice h a partir de 2011
13
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Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico

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Agora exibindo 1 - 8 de 8
  • article
    First Report of Granulicatella sp. Endocarditis in a Kidney Transplant Patient
    (2017) PAULA, Flávio Jota de; NEVES, Precil Diego Miranda de Menezes; BRIDI, Ramaiane Aparecida; SONG, Alice Tung Wan; DAVID-NETO, Elias
    Abstract Granulicatella and Abiotrophia are genera of fastidious Gram-positive cocci commensal of the oral, genitourinary, and intestinal flora. We report the first case of infective endocarditis caused by Granulicatella sp. in a kidney transplant recipient. A 67-year-old male kidney transplant recipient was admitted to the hospital for investigation of fever, abdominal pain, and diarrhea. On physical examination, he was dehydrated. Laboratory tests identified impaired renal function (creatinine level of 15.5 mg/dl; reference, 3.0 mg/dl), metabolic acidosis, and electrolyte disturbances. Cryptosporidium sp. was identified as the cause of the diarrhea, and the infection was treated with nitazoxanide. On admission, cultures of blood, urine, and stool samples were negative. Echocardiography results were normal. Despite the antimicrobial treatment, the fever persisted. A transthoracic echocardiogram revealed infective endocarditis of the mitral valve, and Granulicatella spp. were isolated in blood cultures. Although the patient was treated with penicillin and amikacin, he evolved to septic shock of pulmonary origin and died. Infective endocarditis caused by Granulicatella sp. should be suspected in cases of culture-negative endocarditis.
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    TRANSURETHRAL RESECTION OR INCISION OF THE PROSTATE AFTER RENAL TRANSPLANTATION: IS THERE A SAFER TIME FOR THE PROCEDURE?
    (2017) PIOVESAN, Afonso Celso; LOCALI, Rafael Fagionato; MELLO, Marcos; YAMACAKE, Kleiton G. R.; KANASHIRO, Hideki; EBAID, Gustavo Xavier; ANTONOPOULOS, Ioannis; PAULA, Flavio Jota de; NAHAS, William Carlos
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    KIDNEY TRANSPLANTATION IN PATIENTS WITH BLADDER AUGMENTATION: LONG TERM OUTCOMES
    (2017) YAMACAKE, Kleiton; PIOVESAN, Affonso; FALCI, Renato; MESSI, Gustavo; ANTONOPOULOS, Ioannis; PAULA, Flavio Jota de; LOCALI, Rafael; DAVID-NETO, Elias; NAHAS, William
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    TRANSPLANTABILITY EVALUATION IN HIGH RISK PATIENTS WITH END STAGE RENAL DISEASE ENROLLED IN THE WAITING LIST OF KIDNEY TRANSPLANTATION. AN OBSERVATIONAL COHORT STUDY
    (2017) IZQUIERDO, Andrea Andrade; ONUSIC, Vivian L.; OTTO JR., Jose; LEMOS, Francine Bc; PAULA, Flavio J. De; NAHAS, William C.; DAVID-NETO, Elias
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    IMPACT OF EVEROLIMUS ADDED TO TACROLIMUS/MYCOPHENOLATE/ PREDNISONE ON CMV DISEASE AND ACUTE REJECTION IN SENSITIZED KIDNEY TRANSPLANT RECIPIENTS. A SINGLE CENTER, RANDOMIZED AND CONTROLLED, PILOT STUDY
    (2017) SOUZA, Patricia; VENTURA, Carlucci; AGENA, Fabiana; BARRETO, Noemia; REUSING, Jose Otto; ONUSIC, Vivian; ZOCOLER, Nelson; PAULA, Flavio De; DAVID-NETO, Elias
  • article 4 Citação(ões) na Scopus
    Severe type 1 upgrading leprosy reaction in a renal transplant recipient: a paradoxical manifestation associated with deficiency of antigen-specific regulatory T-cells?
    (2017) VIEIRA, Ana Paula; TRINDADE, Maria Angela Bianconcini; PAULA, Flavio Jota de; SAKAI-VALENTE, Neusa Yurico; DUARTE, Alberto Jose da Silva; LEMOS, Francine Brambate Carvalhinho; BENARD, Gil
    Background: Due to its chronic subclinical course and large spectrum of manifestations, leprosy often represents a diagnostic challenge. Even with proper anti-mycobacteria treatment, leprosy follow up remains challenging: almost half of leprosy patients may develop reaction episodes. Leprosy is an infrequent complication of solid organ transplant recipients. This case report illustrates the challenges in diagnosing and managing leprosy and its reactional states in a transplant recipient. Case presentation: A 53-year-old man presented 34 months after a successful renal transplantation a borderline-tuberculoid leprosy with signs of mild type 1 upgrading reaction (T1R). Cutaneous manifestations were atypical, and diagnosis was only made when granulomatous neuritis was found in a cutaneous biopsy. He was successfully treated with the WHO recommended multidrug therapy (MDT: rifampicin, dapsone and clofazimine). However he developed a severe T1R immediately after completion of the MDT but no signs of allograft rejection. T1R results from flare-ups of the host T-helper-1 cell-mediated immune response against Mycobacterium leprae antigens in patients with immunologically unstable, borderline forms of leprosy and has been considered an inflammatory syndrome in many aspects similar to the immune reconstitution inflammatory syndromes (IRS). The T1R was successfully treated by increasing the prednisone dose without modifying the other immunosuppressive drugs used for preventing allograft rejection. Immunological study revealed that the patient had a profound depletion of both in situ and circulating regulatory T-cells and lack of expansion of the Tregs upon M. leprae stimulation compared to T1R leprosy patients without iatrogenic immunosuppression. Conclusions: Our case report highlights that leprosy, especially in the transplant setting, requires a high degree of clinical suspicion and the contribution of histopathology. It also suggests that the development of upgrading inflammatory syndromes such as T1R can occur despite the sustained immunosuppressors regimen for preventing graft rejection. Our hypothesis is that the well-known deleterious effects of these immunosuppressors on pathogen-induced regulatory T-cells contributed to the immunedysregulation and development T1R.
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    Defining a BKV Cutt-Off and Profile for Early Detection of BKV Associated Nephropathy
    (2017) NIHEI, C.; AGENA, F.; PAULA, F.; DAVID, D.; FINK, M.; PIERROTTI, L.; DAVID-NETO, E.