ANNA SARA SHAFFERMAN LEVIN

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Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina - Líder

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Agora exibindo 1 - 10 de 23
  • article 14 Citação(ões) na Scopus
    Bloodstream Infections caused by Klebsiella pneumoniae and Serratia marcescens isolates co-harboring NDM-1 and KPC-2
    (2021) BES, Taniela; NAGANO, Debora; MARTINS, Roberta; MARCHI, Ana Paula; PERDIGAO-NETO, Lauro; HIGASHINO, Hermes; PRADO, Gladys; GUIMARAES, Thais; LEVIN, Anna S.; COSTA, Silvia
    Carbapenem-resistant Enterobacteriaceae are a worldwide health problem and isolates carrying both bla(KPC-2) and bla(NDM-1) are unusual. Here we describe the microbiological and clinical characteristics of five cases of bloodstream infections (BSI) caused by carbapenem-resistant Klebsiella pneumoniae and Serratia marcescens having both bla(KPC-2) and bla(NDM-1). Of the five blood samples, three are from hematopoietic stem cell transplantation patients, one from a renal transplant patient, and one from a surgical patient. All patients lived in low-income neighbourhoods and had no travel history. Despite antibiotic treatment, four out of five patients died. The phenotypic susceptibility assays showed that meropenem with the addition of either EDTA, phenylboronic acid (PBA), or both, increased the zone of inhibition in comparison to meropenem alone. Molecular tests showed the presence of bla(KPC-2) and bla(NDM-1) genes. K. pneumoniae isolates were assigned to ST258 or ST340 by whole genome sequencing. This case-series showed a high mortality among patients with BSI caused by Enterobacteriae harbouring both carbapenemases. The detection of carbapenemase-producing isolates carrying both bla(KPC-2) and bla(NDM-1) remains a challenge when using only phenotypic assays. Microbiology laboratories must be alert for K. pneumoniae isolates producing both KPC-2 and NDM-1.
  • article 0 Citação(ões) na Scopus
    Conjugative transfer of plasmid p_8N_qac(MN687830.1) carrying qacA gene from Staphylococcus aureus to Escherichia coli C600: potential mechanism for spreading chlorhexidine resistance
    (2021) BES, Taniela Marli; NAGANO, Debora Satie; MARCHI, Ana Paula; CAMILO, Gaspar; PERDIGAO-NETO, Lauro Vieira; MARTINS, Roberta Ruedas; LEVIN, Anna Sara; COSTA, Silvia Figueiredo
    The methicillin resistant Staphylococcus aureus (MRSA) is recognized by its ability to acquire and transferring resistance genes through interspecies conjugative plasmids. However, transference of plasmids from Gram-positive cocci to Gram-negative bacilli is not well characterized. In this report, we describe the transfer of a conjugative plasmid carrying qacA from MRSA to Escherichia coli C600. We performed a conjugation experiment using a chlorhexidine resistant MRSA isolate (ST-105/SCCmec type III) carrying the gene qacA and qacC as the donor and a chlorhexidine susceptible E. coli C600 isolate as the receptor. Transconjugants were selected using MacConkey agar plates containing chlorhexidine in concentrations ranging from 0.25 to 16 g.L-1. To genotypically confirm the transfer of the resistance gene, the transconjugants were screened by Polymerase Chain Reaction (PCR) and submitted to Sanger's sequencing. MRSA isolates successfully transferred the chlorhexidine resistance gene (qacA) to the recipient E. coli strain C600. The E. coli transconjugant exhibited an important reduction of chlorhexidine susceptibility, with MICs increasing from <= 0.25 to >= 16 g.L-1 after conjugation. The qacA gene was detected by PCR as well as in the Sanger's sequencing analysis of DNA from transconjugant plasmids. To the best of our knowledge, this is the first report of the plasmid p_8N_qac(MN687830.1) carrying qacA and its transfer by conjugation from a MRSA to an E. coli. These findings increase concerns on the emergence of resistance dissemination across the genus and emphasizes the importance of continuous antiseptic stewardship.
  • article 21 Citação(ões) na Scopus
    In-depth analysis of laboratory parameters reveals the interplay between sex, age, and systemic inflammation in individuals with COVID-19*
    (2021) TEN-CATEN, Felipe; GONZALEZ-DIAS, Patricia; CASTRO, Icaro; OGAVA, Rodrigo L. T.; GIDDALURU, Jeevan; SILVA, Juan Carlo S.; MARTINS, Felipe; GONCALVES, Andre N. A.; COSTA-MARTINS, Andre G.; ARAUJO, Jose D.; VIEGAS, Ana Carolina; CUNHA, Fernando Q.; FARSKY, Sandra; BOZZA, Fernando A.; LEVIN, Anna S.; PANNARAJ, Pia S.; I, Thushan de Silva; MINOPRIO, Paola; SILVA, Fabiano Pinheiro da; ANDRADE, Bruno B.; I, Helder Nakaya
    Background: The progression and severity of COVID-19 vary significantly in the population. While the hallmarks of SARS-CoV-2 and severe COVID-19 within routine laboratory parameters are emerging, the impact of sex and age on these profiles is still unknown. Methods: A multidimensional analysis was performed involving millions of records of laboratory parameters and diagnostic tests for 178 887 individuals from Brazil, of whom 33 266 tested positive for SARS-CoV-2. Analyzed data included those relating to complete blood cell count, electrolytes, metabolites, arterial blood gases, enzymes, hormones, cancer biomarkers, and others. Findings: COVID-19 induced similar alterations in laboratory parameters in males and females. CRP and ferritin were increased, especially in older men with COVID-19, whereas abnormal liver function tests were common across several age groups, except for young women. Low peripheral blood basophils and eosinophils were more common in the elderly with COVID-19. Both male and female COVID-19 patients admitted to intensive care units displayed alterations in the coagulation system, and higher values for neutrophils, CRP, and lactate dehydrogenase. Conclusions: Our study uncovered the laboratory profiles of a large cohort of COVID-19 patients, which formed the basis of discrepancies influenced by aging and biological sex. These profiles directly linked COVID-19 disease presentation to an intricate interplay between sex, age, and immune activation.
  • article 6 Citação(ões) na Scopus
    Are mobile phones part of the chain of transmission of SARS- CoV-2 in hospital settings?
    (2021) ESPINOZA, Evelyn Patricia Sanchez; CORTES, Marina Farrel; NOGUERA, Saidy Vasconez; PAULA, Anderson Vicente de; GUIMARAES, Thais; BOAS, Lucy Santos Villas; PARK, Marcelo; SILVA, Cristina Carvalho da; MORALES, Ingra; NETO, Lauro Vieira Perdigao; TOZETTO-MENDOZA, Tania Regina; BOSZCZOWSKI, Icaro; SABINO, Ester Cerdeira; MENDES-CORREA, Maria Cassia; LEVIN, Anna Sara; COSTA, Silvia Figueiredo
    Mobile phones (MPs) have become an important work tool around the world including in hospitals. We evaluated whether SARS-CoV-2 can remain on the surface of MPs of first-line healthcare workers (HCW) and also the knowledge of HCWs about SARS-CoV-2 cross-transmission and conceptions on the virus survival on the MPs of HCWs. A crosssectional study was conducted in the COVID-19 Intensive Care Unit of a teaching hospital. An educational campaign was carried out on cross-transmission of SARS-CoV-2, and its permanence in fomites, in addition to the proper use and disinfection of MPs. Herewith an electronic questionnaire was applied including queried conceptions about hand hygiene and care with MP before and after the pandemic. The MPs were swabbed with a nylon FLOQ SwabTM, in an attempt to increase the recovery of SARS-CoV-2. All MP swab samples were subjected to SARS-CoV-2 RT-PCR; RT-PCR positive samples were subjected to viral culture in Vero cells (ATCC (R) CCL-81TM). Fifty-one MPs were swabbed and a questionnaire on hand hygiene and the use and disinfection of MP was applied after an educational campaign. Most HCWs increased adherence to hand hygiene and MP disinfection during the pandemic. Fifty-one MP swabs were collected and two were positive by RT-PCR (4%), with Cycle threshold (Ct ) values of 34-36, however, the cultures of these samples were negative. Although most HCWs believed in the importance of cross-transmission and increased adherence to hand hygiene and disinfection of MP during the pandemic, SARS-CoV-2 RNA was detected in MPs. Our results suggest the need for a universal policy in infection control guidelines on how to care for electronic devices in hospital settings.
  • article 2 Citação(ões) na Scopus
    Determinants of Health and Physical Activity Levels Among Breast Cancer Survivors During the COVID-19 Pandemic: A Cross-Sectional Study (vol 12, 624169, 2021)
    (2021) GURGEL, Aline Rachel Bezerra; MINGRONI-NETTO, Pedro; FARAH, Jose Carlos; BRITO, Christina May Moran de; LEVIN, Anna S.; BRUM, Patricia Chakur
  • article 24 Citação(ões) na Scopus
    Post-acute sequelae of SARS-CoV-2 infection (PASC): a protocol for a multidisciplinary prospective observational evaluation of a cohort of patients surviving hospitalisation in Sao Paulo, Brazil
    (2021) BUSATTO, Geraldo Filho; ARAUJO, Adriana Ladeira de; DUARTE, Alberto Jose da Silva; LEVIN, Anna Sara; GUEDES, Bruno Fukelmann; KALLAS, Esper Georges; PINNA, Fabio Rezende; SOUZA, Heraldo Possolo de; SILVA, Katia Regina da; SAWAMURA, Marcio Valente Yamada; SEELAENDER, Marilia; IMAMURA, Marta; GARCIA, Michelle Louvaes; FORLENZA, Orestes Vicente; NITRINI, Ricardo; DAMIANO, Rodolfo Furlan; ROCHA, Vanderson Geraldo; BATISTTELLA, Linamara Rizzo; CARVALHO, Carlos Roberto Ribeiro de
    Introduction COVID-19 may lead to persistent and potentially incapacitating clinical manifestations (post-acute sequelae of SARS-CoV-2 infection (PASC)). Using easy-to-apply questionnaires and scales (often by telephone interviewing), several studies evaluated samples of COVID-19 inpatients from 4 weeks to several months after discharge. However, studies conducting systematic multidisciplinary assessments of PASC manifestations are scarce, with thorough in-person objective evaluations restricted to modestly sized subsamples presenting greatest disease severity. Methods and analyses We will conduct a prospective observational study of surviving individuals (above 18 years of age) from a cohort of over 3000 subjects with laboratory-confirmed COVID-19 who were treated as inpatients at the largest academic health centre in Sao Paulo, Brazil (Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo). All eligible subjects will be consecutively invited to undergo a 1-2-day series of multidisciplinary assessments at 2 time-points, respectively, at 6-9 months and 12-15 months after discharge. Assessment schedules will include detailed multidomain questionnaires applied by medical research staff, self-report scales, objective evaluations of cardiopulmonary functioning, physical functionality and olfactory status, standardised neurological, psychiatric and cognitive examinations, as well as diagnostic laboratory, muscle ultrasound and chest imaging exams. Remaining material from blood tests will be incorporated by a local biobank for use in future investigations on inflammatory markers, genomics, transcriptomics, peptidomics and metabolomics. Ethics and dissemination All components of this programme have been approved by local research ethics committees. We aim to provide insights into the frequency and severity of chronic/post-COVID multiorgan symptoms, as well as their interrelationships and associations with acute disease features, sociodemographic variables and environmental exposures. Findings will be disseminated in peer-reviewed journals and at scientific meetings. Additionally, we aim to provide a data repository to allow future pathophysiological investigations relating clinical PASC features to biomarker data extracted from blood samples.
  • article 9 Citação(ões) na Scopus
    Determinants of Health and Physical Activity Levels Among Breast Cancer Survivors During the COVID-19 Pandemic: A Cross-Sectional Study
    (2021) GURGEL, Aline Rachel Bezerra; MINGRONI-NETTO, Pedro; FARAH, Jose Carlos; BRITO, Christina May Moran de; LEVIN, Anna S.; BRUM, Patricia Chakur
    Background: Increased exercise and physical activity levels are recommended throughout cancer therapy and survivorship. Nonetheless, the COVID-19 pandemic and consequent social distancing are likely to cause a decline in physical activity. Objective: to evaluate the level of unsupervised physical activity of breast cancer survivors during the COVID-19 pandemic, and the factors associated with difficulties in engaging and maintaining recommended physical activity levels. Methods: This is a cross-sectional epidemiological study with a sample of 37 breast cancer survivors. They participated in a canoeing training program (project Remama) at the University of Sao Paulo before the COVID-19 pandemic. Socioeconomic aspects, engagement in physical activity, motivation, and potential exposure to COVID-19 were investigated through an online survey, administered in September of 2020. Results: During the pandemic, participants increased their body weight (5 +/- 3.4 kg); 90% reported decreasing physical activity levels associated with increased sedentary time. Twenty-one (58%) participants exhibited some COVID-19-related symptoms, most used public transportation (59%), or returned to work during the period of a high incidence of COVID-19. The only factor associated with perceived difficulty in engaging in physical activities was having had more than three cancer treatments (RR: 2.14; 95% CI: 1.07-4.27). Conclusion: The COVID-19 pandemic led to a group of previously active breast cancer survivors to decrease their physical activity, gain weight, and have sedentary behavior. Specific tailored-care interventions are needed to prevent these occurrences, as overweight and physical inactivity may impose an additional risk for breast cancer recurrence and a severe course of COVID-19 in cancer patients.
  • article 7 Citação(ões) na Scopus
    SARS-CoV-2 in a stream running through an underprivileged, underserved, urban settlement in Sao Paulo, Brazil: A 7-month follow-up
    (2021) RAZZOLINI, Maria Tereza Pepe; BARBOSA, Mikaela Renata Funada; ARAUJO, Ronalda Silva de; OLIVEIRA, Ivo Freitas de; MENDES-CORREA, Maria Cassia; SABINO, Ester C.; GARCIA, Suzi Cristina; V, Anderson de Paula; VILLAS-BOAS, Lucy S.; COSTA, Silvia Figueiredo; DROPA, Milena; ASSIS, Denise Brandao de; LEVIN, Beatriz S.; LIMA, Antonio Carlos Pedroso de; LEVIN, Anna S.
    COVID-19 pandemic has led to concerns on the circulation of SARS-CoV-2 in the environment, its infectivity from the environment and, the relevance of transmission via environmental compartments. During 31 weeks, water samples were collected from a heavily contaminated stream going through an urban, underprivileged community without sewage collection. Our results showed a statistically significant correlation between cases of COVID-19 and SARS in the community, and SARS-CoV-2 concentrations in the water. Based on the model, if the concentrations of SARS-CoV-RNA (N1 and N2 target regions) increase 10 times, there is an expected increase of 104% [95%CI: (62-157%)] and 92% [95%CI: (51-143%)], respectively, in the number of cases of COVID-19 and SARS. We believe that differences in concentration of the virus in the environment reflect the epidemiological status in the community, which may be important information for surveillance and controlling dissemination in areas with vulnerable populations and poor sanitation. None of the samples were found infectious based cultures. Our results may be applicable globally as similar communities exist worldwide.
  • article 2 Citação(ões) na Scopus
    Disinfection of 3D-printed protective face shield during COVID-19 pandemic
    (2021) NOGUERA, Saidy Vasconez; ESPINOZA, Evelyn Patricia Sanchez; CORTES, Marina Farrel; OSHIRO, Izabel Cristina Vilela; SPADAO, Fernanda de Sousa; BRANDAO, Laura Maria Brasileiro; BARROS, Ana Natiele da Silva; COSTA, Sibeli; ALMEIDA, Bianca Leal de; SORIANO, Paula Gemignani; SALLES, Alessandra Grassi; ESCORCIO, Mirian Elizabete Marques; BARRETTI, Cristina Madeira; BAPTISTA, Fernanda Spadotto; ALVARENGA, Glaura Souza; MARINHO, Igor; LETAIF, Leila Suemi Harima; LI, Ho Ye; BACCHI, Pedro; SANTOS, Ana Rubia Guedes dos; REGADAS, Lucas Borges; BRAGA, Carlos Eduardo Lima; ZSIGMOND, Fabio; SEGURADO, Aluisio Cotrim; GUIMARAES, Thais; LEVIN, Anna Sara; BERTOLDI, Cristiane Aun; CATALANI, Luiz Henrique; ZANCUL, Eduardo de Senzi; COSTA, Silvia Figueiredo
    This study assessed the disinfection using 70% ethanol; H2O2-quaternary ammonium salt mixture; 0.1% sodium hypochlorite and autoclaving of four 3D-printed face shields with different designs, visor materials; and visor thickness (0.5-0.75 mm). We also investigated their clinical suitability by applying a questionnaire to health workers (HW) who used them. Each type of disinfection was done 40 times on each type of mask without physical damage. In contrast, autoclaving led to appreciable damage.
  • article 1 Citação(ões) na Scopus
    Psychological characteristics are associated with healthcare worker adherence to infection control practices
    (2021) ASSIS, Gracilene R.; BENUTI, Glaucia G.; MORETTO, Maria Livia T.; VIDIGAL, Claudia G.; SANTOS, Robert Plant dos; LOBO, Renata D.; PADOVEZE, Maria Clara; LIMA, Antonio Carlos Pedroso de; SINGER, Julio M.; LEVIN, Anna S.
    Background: Most bloodstream infections related to vascular catheters can be avoided if evidence-based practices are applied during insertion and maintenance. In practice, adherence by health care workers (HCWs) is unsatisfactory and is the main current challenge. The objective of this study is to investigate associations between adherence to infection control practices and performance in psychological tests. Methods: We conducted a prospective observational study in 4 intensive care units involving HCWs. Physicians were observed for adherence to hand hygiene (HH). Nurses were observed during central venous catheter dressing and handling. HCWs were then evaluated psychologically. Results: There were 7,572 observations of 248 HCWs. Adherence to different steps of central venous catheter manipulation ranged widely: from 13% for HH before procedure to 95% regarding the use of gloves. Adherence to HH ranged from 14% before to 99% after dressing. For physicians, HH ranged from 10% before touching patients to 98% after touching body fluids, and adherence was associated with age, self-esteem, and aggression. For nurses, adherence was positively associated with deference, and negatively associated with nurturance. Conclusions: Psychosocial variables affect the quality of care that HCWs provide. The next step would be to define what type of psychological interventions could be effective.