ADRIANA MALUF ELIAS SALLUM
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina
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- Safety and immunogenicity of influenza A(H3N2) component vaccine in juvenile systemic lupus erythematosus(2023) AIKAWA, Nadia Emi; BORBA, Eduardo Ferreira; BALBI, Verena Andrade; SALLUM, Adriana Maluf Elias; BUSCATTI, Izabel Mantovani; CAMPOS, Lucia Maria Arruda; KOZU, Katia Tomie; GARCIA, Cristiana Couto; CAPAO, Artur Silva Vidal; PROENCA, Adriana Coracini Tonacio de; LEON, Elaine Pires; DUARTE, Alberto Jose da Silva; LOPES, Marta Heloisa; SILVA, Clovis Artur; BONFA, EloisaIntroduction Seasonal influenza A (H3N2) virus is an important cause of morbidity and mortality in the last 50 years in population that is greater than the impact of H1N1. Data assessing immunogenicity and safety of this virus component in juvenile systemic lupus erythematosus (JSLE) is lacking in the literature.Objective To evaluate short-term immunogenicity and safety of influenza A/Singapore (H3N2) vaccine in JSLE.Methods 24 consecutive JSLE patients and 29 healthy controls (HC) were vaccinated with influenza A/Singapore/INFIMH-16-0019/2016(H3N2)-like virus. Influenza A (H3N2) seroprotection (SP), seroconversion (SC), geometric mean titers (GMT), factor increase in GMT (FI-GMT) titers were assessed before and 4 weeks post-vaccination. Disease activity, therapies and adverse events (AE) were also evaluated.Results JSLE patients and controls were comparable in current age [14.5 (10.1-18.3) vs. 14 (9-18.4) years, p = 0.448] and female sex [21 (87.5%) vs. 19 (65.5%), p = 0.108]. Before vaccination, JSLE and HC had comparable SP rates [22 (91.7%) vs. 25 (86.2%), p = 0.678] and GMT titers [102.3 (95% CI 75.0-139.4) vs. 109.6 (95% CI 68.2-176.2), p = 0.231]. At D30, JSLE and HC had similar immune response, since no differences were observed in SP [24 (100%) vs. 28 (96.6%), p = 1.000)], SC [4 (16.7%) vs. 9 (31.0%), p = 0.338), GMT [162.3 (132.9-198.3) vs. 208.1 (150.5-287.8), p = 0.143] and factor increase in GMT [1.6 (1.2-2.1) vs. 1.9 (1.4-2.5), p = 0.574]. SLEDAI-2K scores [2 (0-17) vs. 2 (0-17), p = 0.765] and therapies remained stable throughout the study. Further analysis of possible factors influencing vaccine immune response among JSLE patients demonstrated similar GMT between patients with SLEDAI < 4 compared to SLEDAI >= 4 (p = 0.713), as well as between patients with and without current use of prednisone (p = 0.420), azathioprine (p = 1.0), mycophenolate mofetil (p = 0.185), and methotrexate (p = 0.095). No serious AE were reported in both groups and most of them were asymptomatic (58.3% vs. 44.8%, p = 0.958). Local and systemic AE were alike in both groups (p > 0.05).Conclusion This is the first study that identified adequate immune protection against H3N2-influenza strain with additional vaccine-induced increment of immune response and an adequate safety profile in JSLE. (www.clinicaltrials.gov, NCT03540823).
conferenceObject Yellow Fever Vaccination in Brazil: Short-Term Safety in Pediatric Autoimmune Rheumatic Diseases(2018) AIKAWA, Nadia E.; BALBI, Verena A.; TONACIO, Adriana C.; SALLUM, Adriana M. E.; CAMPOS, Lucia M. A.; KOZU, Katia T.; VENDRAMINI, Margarete B.; FONTOURA, Nicole; SARTORI, Ana M. C.; ANTONANGELO, Leila; SILVA, Clovis A.; BONFA, EloisaconferenceObject Dyslipidemia in Juvenile Dermatomyositis: The Role of Disease Activity(2012) KOZU, Katia T.; SILVA, Clovis Artur; BONFA, Eloisa; SALLUM, Adriana M.; PEREIRA, Rosa M. R.; VIANA, Vilma S.; BORBA, Eduardo F.; CAMPOS, Lucia M. A.- Juvenile fibromyalgia syndrome: Blunted heart rate response and cardiac autonomic dysfunction at diagnosis(2016) MAIA, Magda M.; GUALANO, Bruno; SA-PINTO, Ana L.; SALLUM, Adriana M. E.; PEREIRA, Rosa M. R.; LEN, Claudio A.; TERRERI, Maria T. A.; BARBOSA, Cassia M.; ROSCHEL, Hamilton; SILVA, Clovis A.Objective: To assess aerobic capacity and cardiac autonomic modulation in juvenile fibromyalgia syndrome (JFM) patients at diagnosis in response to graded exercise text. Methods: A multicenter cross-sectional study included 25 JFM patients and 25 healthy controls. Both groups participated only in physical education classes at school. A treadmill graded cardiorespiratory test was performed and the heart-rate (HR) response during exercise was evaluated by the chronotropic reserve (CR). Pain, functional ability, and health-related quality of life (HRQL) were assessed. Results: The median current age was similar in JFM and controls (15 vs. 15 years, p = 0.890), as well as body mass index (p = 0.332), female gender (p = 1.000), and Tanner stages (p = 0.822). The medians of HRQL parameters (total score/physical health/psychosocial health) were significantly lower in JFM vs. controls according to patient and parent self-reports (p < 0.001). The median of peak HR [181 (150-198) vs. 197 (181-202) bpm, p < 0.001], chronotropic reserve [84 (53-98) vs. 99 (84-103)%, p < 0.001], and resting to peal< [96 (65-181) vs. 127 (61-185) bpm, p = 0.010] were significantly lower in JFM compared to controls. The median of Delta EIRR1 [15 (3-39) vs. 35 (9-52) bpm, p < 0.0011, Delta FIRR2 [37 (20-57) vs. 51 (32-94) bpm, p < 0.001], peak VO2 [32.34 (24.24-39.65) vs. 36A (28.56-52.71) ml/kg/min, p = 0.005], peak speed [5 (4-6.3) vs. 5.9 (4.0-6.3) mph, p = 0.001], time to exhaustion [11.5 (8.5-14.5) vs. 14 (11-18) min, p < 0.0011, and working capacity on power [3.37 (2.04-5.6) vs. 3.89 (2.91-6.55) W/kg, p = 0.006] were significantly lower in JFM compared to controls. The frequency of chronotropic incompetence (<= 80%) was significantly higher in JFM vs. controls (p = 0.0006). Conclusions: This study identified chronotropic incompetence and delayed HR recovery in JFM patients, indicating autonomic dysfunction. Aerobic exercise training should be considered in all JFM patients and may improve cardiac autonomic impairment, thus reducing cardiovascular risk.
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 10 Citação(ões) na Scopus PENILE AND SCROTUM SWELLING IN JUVENILE DERMATOMYOSITIS(2011) SALLUM, Adriana Maluf Elias; SILVA, Marco Felipe Castro; MICHELIN, Cintia Maria; DUARTE, Ricardo Jordao; BARONI, Ronaldo Hueb; AIKAWA, Nadia Emi; SILVA, Clovis ArturEdema is a well-known feature of juvenile dermatomyositis (JDM). However, to our knowledge localized penile and scrotum swelling was not previously reported. During a 27-year period, 5,506 patients were followed up at the Pediatric Rheumatology Unit of our University Hospital and 157 patients (2.9%) had JDM. One of them (0.6%) had concomitant localized penile and scrotum swelling. He had severe disease activity since he was 7-year-old, manifested by diffuse cutaneous vasculitis, recurrent localized edema (limbs or face) and only one episode of generalized edema. At the age of 10, he presented edema of the genitalia associated with mild skin erythema. Penis, scrotum and testicular ultrasound as well as magnetic resonance imaging showed skin edema without testicular involvement. He was taking prednisone, methotrexate, cyclosporin, hydroxychloroquine and thalidomide. Improvement of skin rash, penile and scrotum swelling was noticed only with rituximab therapy. No adverse event was observed during anti-CD20 infusions and after six months of follow up. Penile and scrotum edema was a rare manifestation of JDM which improved with anti-CD20 monoclonal antibody treatment.conferenceObject EXPOSURE TO ENVIRONMENTAL FACTORS DURING PREGNANCY AND AFTER BIRTH TO THE BEGINNING OF JUVENILE IDIOPATHIC ARTHRITIS(2015) FRANCA, C. M. P.; SALLUM, A. M. E.; SILVA, C. A.; AIKAWA, N. E.; BRAGA, A. L. F.; FARHAT, S. C. L.- Risk Factors Associated with Juvenile Idiopathic Arthritis: Exposure to Cigarette Smoke and Air Pollution from Pregnancy to Disease Diagnosis(2018) FRANCA, Camila Maria Paiva; SALLUM, Adriana Maluf Elias; BRAGA, Alfesio Luis Ferreira; STRUFALDI, Fernando Louzada; SILVA, Clovis Artur Almeida; FARHAT, Sylvia Costa LimaObjective. To evaluate exposure to environmental factors inhaled during pregnancy and after birth until juvenile idiopathic arthritis (JIA) diagnosis among residents of a large city. Methods. This is an exploratory case-control study that consists of 66 patients with JIA and 124 healthy controls matched by age and sex, living in the Sao Paulo, Brazil, metropolitan area until JIA diagnosis, and whose mothers had resided in this region during pregnancy. A structured and reliable questionnaire (k index for test-retest was 0.80) assessed demographic data, gestational and perinatal-related factors, and exposure to inhalable environmental elements during pregnancy and after birth (occupational exposure to inhalable particles and/or volatile vapor, exposure to cigarette smoke, and the presence of industrial activities or gas stations near the home, work, daycare, or school). Tropospheric pollutants included particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O-3), and carbon monoxide (CO). Results. During pregnancy, intrauterine cigarette smoke exposure (OR 3.43, 95% CI 1.45-8.12, p = 0.005) and maternal occupational exposure (OR 13.69, 95% CI 4.4-42.3, p < 0.001) were significant independent risk factors for JIA diagnosis. In contrast, maternal employment (OR 0.06, 95% CI 0.02-0.2, p < 0.001) and ideal maternal weight gain (OR 0.36, 95% CI 0.2-0.8, p = 0.017) presented negative associations. Secondhand smoke exposure from birth to JIA diagnosis (OR 3.6, 95% CI 1.8-7.3, p < 0.001) and exposure to O-3 during the second year of life (OR 2.76, 95% CI 1.20-6.37, p = 0.017) were independent and significant risk factors for the pathogenesis of JIA. Conclusion. In our study, cigarette smoke exposure (intrauterine and after birth), exposure to O-3 in the second year of life, and maternal occupational exposure were identified as potential risk factors for JIA, warranting further study.
- Heart function in juvenile idiopathic arthritis patients: A biventricular two-dimensional speckle-tracking echocardiography study(2022) LIANZA, Alessandro C.; LEAL, Gabriela N.; AIKAWA, Nadia E.; KOZU, Katia T.; DINIZ, Maria De Fatima R.; SAWAMURA, Karen S. S.; MENEZES, Carolina R. B.; MARTINS, Camila Lino; CAMPOS, Lucia M.; ELIAS, Adriana M.; SILVA, Clovis A.Objectives We evaluated cardiac function in juvenile idiopathic arthritis (JIA) patients by 2D speckle-tracking echocardiography (2DSTE) and to assess possible associations with clinical, laboratorial, and treatment data. Methods A group of 42 JIA patients and 42 healthy controls were evaluated using both conventional echocardiography and 2DSTE. JIA patients underwent clinical and laboratory assessment. Results Conventional echocardiography data demonstrated normal left ventricular (LV) ejection fraction in both groups (71 vs. 71%; p = .69). 2DSTE analysis demonstrated that JIA patients presented significantly lower LV global systolic longitudinal strain (LVGLS) (-18.76 vs. -22%; p < .0001), LV systolic strain rate (LVSSR) (1.06 vs. 1.32 s(-1); p < .0001), LV diastolic strain rate (LVDSR) (1.58 vs. 1.8 s(-1); p < .0137), right ventricular global systolic strain (RVGLS) (-24.1% vs. -27.7%; p = .0002), and right ventricular systolic strain rate (RVSSR) (1.4 vs. 1.8 s(-1); p = .0035). JIA patients under biological agents presented higher LVGLS (p = .02) and RVLS (p = .01). We also detected an association between LVGLS and C-reactive protein [CRP; -20% in normal CRP (10/42) vs. -18% in elevated CRP patients (32/42), p = .03]. Conclusions JIA patients present different echocardiographic status from healthy patients. Moreover, our data suggest that JIA patients under biological agents present association with better cardiac function as shown by strain analysis.
conferenceObject NUTRITIONAL ASSESSMENT, BODY COMPOSITION AND PHASE ANGLE IN JUVENILE DERMATOMYOSITIS PATIENTS(2023) PUGLIESE, Camila; KOZU, Katia T.; CAMPOS, Lucia M. A.; AIKAWA, Nadia E.; SILVA, Clovis A. A.; ELIAS, Adriana M.