EDUARDO FERREIRA BORBA NETO

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Departamento de Clínica Médica, Faculdade de Medicina - Docente
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina

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  • conferenceObject
    Factors Associated with Accrual of Damage over Time in Patients with SLE: Results from a Multinational Latin American Cohort
    (2019) MIMICA, Milena; PADILLA, Oslando; AGUILERA, Felipe; CAVALCANTI, Fernando; BORBA, Eduardo; GUIBERT-TOLEDANO, Marlene; CHACON-DIAZ, Rosa; VASQUEZ, Gloria; PONS-ESTEL, Guillermo; CARDIEL, Mario; NEIRA, Oscar; AMIGO, Mary-Carmen; BONFA, Eloisa; ALARCON, Graciela; PONS-ESTEL, Bernardo A.; MASSARDO, Loreto
  • article 56 Citação(ões) na Scopus
    Factors predictive of serious infections over time in systemic lupus erythematosus patients: data from a multi-ethnic, multi-national, Latin American lupus cohort
    (2019) PIMENTEL-QUIROZ, V. R.; UGARTE-GIL, M. F.; HARVEY, G. B.; WOJDYLA, D.; PONS-ESTEL, G. J.; QUINTANA, R.; ESPOSTO, A.; GARCIA, M. A.; CATOGGIO, L. J.; CARDIEL, M. H.; BARILE, L. A.; AMIGO, M-C; I, E. Sato; BONFA, E.; BORBA, E.; COSTALLAT, L. T. Lavras; NEIRA, O. J.; MASSARDO, L.; GUIBERT-TOLEDANO, M.; CHACON-DIAZ, R.; ALARCON, G. S.; PONS-ESTEL, B. A.; SORIANO, Enrique R.; RECALDE, Maria Flavia Ceballos; VELOZO, Edson; MANNI, Jorge A.; GRIMAUDO, Sebastian; SARANO, Judith; MALDONADO-COCCO, Jose A.; ARRIOLA, Maria S.; GOMEZ, Graciela; MARCOS, Ana Ines; MARCOS, Juan Carlos; SCHERBARTH, Hugo R.; LOPEZ, Jorge A.; MOTTA, Estela L.; DRENKARD, Cristina; GAMRON, Susana; BULIUBASICH, Sandra; ONETTI, Laura; CAEIRO, Francisco; ALVARELLOS, Alejandro; SAURIT, Veronica; GENTILETTI, Silvana; QUAGLIATTO, Norberto; GENTILETTI, Alberto A.; MACHADO, Daniel; ABDALA, Marcelo; PALATNIK, Simon; BERBOTTO, Guillermo A.; BATTAGLIOTTI, Carlos A.; SOUZA, Alexandre Wagner S.; BERTOLO, Manoel Barros; COIMBRA, Ibsen Bellini; BRENOL, Joao C. Tavares; MONTICIELO, Odirlei; XAVIER, Ricardo; CAVALCANTI, Fernando de Souza; DUARTE, Angela Luzia Branco; MARQUES, Claudia Diniz Lopes; SILVA, Nilzio Antonio da; SILVA, Ana Carolina de O e; PACHECO, Tatiana Ferracine; MOLINA-RESTREPO, Jose Fernando; MOLINA-LOPEZ, Javier; VASQUEZ, Gloria; RAMIREZ, Luis A.; URIBE, Oscar; IGLESIAS-GAMARRA, Antonio; IGLESIAS-RODRIGUEZ, Antonio; EGEA-BERMEJO, Eduardo; GUZMAN-MORENO, Renato A.; RESTREPO-SUAREZ, Jose F.; REYES-LLERENA, Gil Alberto; HERNANDEZ-MARTINEZ, Alfredo; JACOBELLI, Sergio; GUZMAN, Leonardo R.; GARCIA-KUTZBACH, Abraham; CASTELLANOS, Claudia; CAJAS, Erwin; PASCUAL-RAMOS, Virginia; SILVEIRA, Luis H.; TORRE, Ignacio Garcia De La; OROZCO-BAROCIO, Gerardo; ESTRADA-CONTRERAS, Magali L.; POZO, Maria Josefina Sauza del; BACA, Laura E. Aranda; QUEZADA, Adelfia Urenda; HUERTA-YANEZ, Guillermo F.; ACEVEDO-VAZQUEZ, Eduardo M.; ALFARO-LOZANO, Jose Luis; CUCHO-VENEGAS, Jorge M.; SEGAMI, Maria Ines; CHUNG, Cecilia P.; ALVA-LINARES, Magaly; ABADI, Isaac; RANGEL, Neriza; SNIH, Soham Al Snih Al; ESTEVA-SPINETTI, Maria H.; VIVAS, Jorge
    Aim The aim of this study was to identify factors predictive of serious infections over time in patients with systemic lupus erythematosus (SLE). Methods A multi-ethnic, multi-national Latin American SLE cohort was studied. Serious infection was defined as one that required hospitalization, occurred during a hospitalization or led to death. Potential predictors included were sociodemographic factors, clinical manifestations (per organ involved, lymphopenia and leukopenia, independently) and previous infections at baseline. Disease activity (SLEDAI), damage (SLICC/ACR Damage Index), non-serious infections, glucocorticoids, antimalarials (users and non-users), and immunosuppressive drugs use; the last six variables were examined as time-dependent covariates. Cox regression models were used to evaluate the predictors of serious infections using a backward elimination procedure. Univariable and multivariable analyses were performed. Results Of the 1243 patients included, 1116 (89.8%) were female. The median (interquartile range) age at diagnosis and follow-up time were 27 (20-37) years and 47.8 (17.9-68.6) months, respectively. The incidence rate of serious infections was 3.8 cases per 100 person-years. Antimalarial use (hazard ratio: 0.69; 95% confidence interval (CI): 0.48-0.99; p = 0.0440) was protective, while doses of prednisone >15 and <= 60 mg/day (hazard ratio: 4.18; 95 %CI: 1.69-10.31; p = 0.0019) and >60 mg/day (hazard ratio: 4.71; 95% CI: 1.35-16.49; p = 0.0153), use of methylprednisolone pulses (hazard ratio: 1.53; 95% CI: 1.10-2.13; p = 0.0124), increase in disease activity (hazard ratio: 1.03; 95% CI: 1.01-1.04; p = 0.0016) and damage accrual (hazard ratio: 1.22; 95% CI: 1.11-1.34; p < 0.0001) were predictive factors of serious infections. Conclusions Over time, prednisone doses higher than 15 mg/day, use of methylprednisolone pulses, increase in disease activity and damage accrual were predictive of infections, whereas antimalarial use was protective against them in SLE patients.
  • article 11 Citação(ões) na Scopus
    Is serum uric acid a predictor of long-term renal outcome in lupus nephritis?
    (2019) UGOLINI-LOPES, Michelle Remiao; GAVINIER, Samara S.; LEON, Elaine; VIANA, Vilma Trindade; BORBA, Eduardo Ferreira; BONFA, Eloisa
    Background/objective Recent studies observed an association between increased serum uric acid (SUA) levels and renal damage in lupus. However, the predictive value of UA for the development of long-term renal dysfunction in lupus nephritis (LN) is still unknown. The aim of this study was to evaluate if SUA may be a predictor of long-term renal outcome in LN. Methods Eighty biopsy-proven LN patients > 7 years of follow-up were selected. SUA levels were measured in sera stored at - 70 degrees C. All patients had serum stored from LN baseline, and 32 also had stored serum from 6 and 12 months after LN. Renal outcome was addressed after 7 years of follow-up to determine if SUA could be a predictor of long-term renal outcome. A good long-term renal outcome in 7 years was defined as a creatinine clearance (CrCl) >= 90.0 mL/min/1.73 m(2), and poor if CrCl < 90 mL/min/1.73 m(2). Patients were divided in two groups according to the renal outcome to assess whether SUA levels at different time points of follow-up could differentiate such groups. An ROC curve was plotted to assess accuracy. Results SUA levels at baseline and 6 months were not able to differentiate good from poor long-term renal outcomes in LN (respectively p = 0.37, p = 0.28), but at 12 months (p = 0.02), they could clearly differentiate the two groups. ROC curve (12 months) accuracy was 0.76. SUA cutoff was 6.05 mg/dL (sensitivity = 0.67, specificity = 0.89, positive predictive value = 0.85, negative predictive value = 0.73). Conclusion SUA levels < 6.05 mg/dL at 12 months of follow-up is a predictor of good long-term renal outcome in lupus nephritis.
  • article 19 Citação(ões) na Scopus
    Brazilian recommendations on the safety and effectiveness of the yellow fever vaccination in patients with chronic immune-mediated inflammatory diseases
    (2019) PILEGGI, Gecilmara Salviato; MOTA, Licia Maria Henrique Da; KAKEHASI, Adriana Maria; SOUZA, Alexandre Wagner De; ROCHA, Aline; MELO, Ana Karla Guedes de; FONTE, Caroline Araujo M. da; BORTOLETTO, Cecilia; BRENOL, Claiton Viegas; MARQUES, Claudia Diniz Lopes; ZALTMAN, Cyrla; BORBA, Eduardo Ferreira; REIS, Enio Ribeiro; FREIRE, Eutilia Andrade Medeiros; KLUMB, Evandro Mendes; CHRISTOPOULOS, Georges Basile; LAURINDO, Ieda Maria M.; BALLALAI, Isabella; COSTA, Izaias Pereira Da; MICHELIN, Lessandra; VALADARES, Lilian David de Azevedo; CHEBLI, Liliana Andrade; LACERDA, Marcus; TOSCANO, Maria Amazile Ferreira; YAZBEK, Michel Alexandre; VIEIRA, Rejane Maria R. De Abreu; MAGALHAES, Renata; KFOURI, Renato; RICHTMANN, Rosana; MERENLENDER, Selma Da Costa Silva; VALIM, Valeria; ASSIS, Marcos Renato De; KOWALSKI, Sergio Candido; TREVISANI, Virginia Fernandes Moca
    Background: In Brazil, we are facing an alarming epidemic scenario of Yellow fever (YF), which is reaching the most populous areas of the country in unvaccinated people. Vaccination is the only effective tool to prevent YF. In special situations, such as patients with chronic immune-mediated inflammatory diseases (CIMID), undergoing immunosuppressive therapy, as a higher risk of severe adverse events may occur, assessment of the risk-benefit ratio of the yellow fever vaccine (YFV) should be performed on an individual level. Main body of the abstract: Faced with the scarcity of specific orientation on YFV for this special group of patients, the Brazilian Rheumatology Society (BRS) endorsed a project aiming the development of individualized YFV recommendations for patients with CIMID, guided by questions addressed by both medical professionals and patients, followed an internationally validated methodology (GIN-McMaster Guideline Development). Firstly, a systematic review was carried out and an expert panel formed to take part of the decision process, comprising BRS clinical practitioners, as well as individuals from the Brazilian Dermatology Society (BDS), Brazilian Inflammatory Bowel Diseases Study Group (GEDIIB), and specialists on infectious diseases and vaccination (from Tropical Medicine, Infectious Diseases and Immunizations National Societies); in addition, two representatives of patient groups were included as members of the panel. When the quality of the evidence was low or there was a lack of evidence to determine the recommendations, the decisions were based on the expert opinion panel and a Delphi approach was performed. A recommendation was accepted upon achieving >= 80% agreement among the panel, including the patient representatives. As a result, eight recommendations were developed regarding the safety of YFV in patients with CIMID, considering the immunosuppression degree conferred by the treatment used. It was not possible to establish recommendations on the effectiveness of YFV in these patients as there is no consistent evidence to support these recommendations. Conclusion: This paper approaches a real need, assessed by clinicians and patient care groups, to address specific questions on the management of YFV in patients with CIMID living or traveling to YF endemic areas, involving specialists from many areas together with patients, and might have global applicability, contributing to and supporting vaccination practices. We recommended a shared decision-making approach on taking or not the YFV.
  • article 39 Citação(ões) na Scopus
    Establishing Surrogate Kidney End Points for Lupus Nephritis Clinical Trials: Development and Validation of a Novel Approach to Predict Future Kidney Outcomes
    (2019) MACKAY, Meggan; DALL'ERA, Maria; FISHBEIN, Joanna; KALUNIAN, Kenneth; LESSER, Martin; SANCHEZ-GUERRERO, Jorge; LEVY, Deborah M.; SILVERMAN, Earl; PETRI, Michelle; ARRIENS, Cristina; LEWIS, Edmund J.; KORBET, Stephen M.; CONTI, Fabrizio; TESAR, Vladimir; HRUSKOVA, Zdenka; BORBA, Eduardo F.; BONFA, Eloisa; CHAN, Tak Mao; RATHI, Manish; GUPTA, K. L.; JHA, Vivekanand; HASNI, Sarfaraz; WEST, Melissa R.; SOLOMONS, Neil; HOUSSIAU, Frederic A.; ROMERO-DIAZ, Juanita; MEJIA-VILET, Juan; ROVIN, Brad H.
    Objective End points currently used in lupus nephritis (LN) clinical trials lack uniformity and questionably reflect long-term kidney survival. This study was undertaken to identify short-term end points that predict long-term kidney outcomes for use in clinical trials. Methods A database of 944 patients with LN was assembled from 3 clinical trials and 12 longitudinal cohorts. Variables from the first 12 months of treatment after diagnosis of active LN (prediction period) were assessed as potential predictors of long-term outcomes in a 36-month follow-up period. The long-term outcomes examined were new or progressive chronic kidney disease (CKD), severe kidney injury (SKI), and the need for permanent renal replacement therapy (RRT). To predict the risk for each outcome, hazard index tools (HITs) were derived using multivariable analysis with Cox proportional hazards regression. Results Among 550 eligible subjects, 54 CKD, 55 SKI, and 22 RRT events occurred. Variables in the final CKD HIT were prediction-period CKD status, 12-month proteinuria, and 12-month serum creatinine level. The SKI HIT variables included prediction-period CKD status, International Society of Nephrology (ISN)/Renal Pathology Society (RPS) class, 12-month proteinuria, 12-month serum creatinine level, race, and an interaction between ISN/RPS class and 12-month proteinuria. The RRT HIT included age at diagnosis, 12-month proteinuria, and 12-month serum creatinine level. Each HIT validated well internally (c-indices 0.84-0.92) and in an independent LN cohort (c-indices 0.89-0.92). Conclusion HITs, derived from short-term kidney responses to treatment, correlate with long-term kidney outcomes, and now must be validated as surrogate end points for LN clinical trials.
  • article 9 Citação(ões) na Scopus
    Complete urological evaluation including sperm DNA fragmentation in male systemic lupus erythematosus patients
    (2019) TISEO, B. C.; BONFA, E.; BORBA, E. F.; MUNHOZ, G. A.; WOOD, G. J. A.; SROUGI, M.; SILVA, C. A.; COCUZZA, M.
    Objective To evaluate sperm DNA fragmentation analysis in non-azoospermic male systemic lupus erythematosus (SLE) patients. Methods Twenty-eight consecutive male SLE patients (American College of Rheumatology criteria) and 34 healthy controls were evaluated for demographic/exposures data, urological evaluation, hormone profile and sperm analysis (including sperm DNA fragmentation). Clinical features, disease activity/damage scores and treatment were also evaluated. Results The median age (33 (20-52) vs. 36.5 (25-54) years, P = 0.329) and frequency of varicocele (25% vs. 32%, P = 0.183) were similar in SLE patients and healthy controls. Sperm DNA fragmentation showed significantly higher levels of cells class III (44 (9-88) vs. 16.5 (0-80)%, P = 0.001) and cell class IV (10.5 (3-86) vs. 7 (0-36)%, P = 0.039) in SLE. The sperm DNA fragmentation index was also significantly higher in SLE patients (62 (31-97) vs. 25.5 (0-100)%, P < 0.001). Conventional sperm parameters (including sperm count, motility and morphology) were similar in both groups. In SLE patients no correlations were observed between sperm DNA fragmentation index and age, disease duration, Systemic Lupus Erythematosus Disease Activity Index 2000 and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index scores, and cumulative dose of prednisone, hydroxychloroquine, intravenous cyclophosphamide, methotrexate, azathioprine and mycophenolate mofetil (P > 0.05). Further analysis of SLE patients treated with and without intravenous cyclophosphamide showed that total sperm motility was significantly lower in the former group (64% (15-83) vs. 72% (57-86), P = 0.024). The sperm DNA fragmentation index was alike in both groups (52.5 (31-95) vs. 67.5 (34-97)%, P = 0.185). Conclusions To our knowledge, this is the first demonstration that male non-azoospermic SLE patients have increased sperm DNA fragmentation without evident gonadal dysfunction. Intravenous cyclophosphamide does not seem to be a major determinant for this abnormality. Future prospective study is necessary to determine the impact of this alteration in these patients' fertility.
  • conferenceObject
    Prospective Evaluation of American Academy of Ophthalmology Low Dose Hydroxychloroquine Recommendation in Stable Lupus Nephritis with High-Risk Retinopathy: Lipid Profile and Flare Rates
    (2019) PEDROSA, Tatiana; PASOTO, Sandra G.; YUKI, Emily; AIKAWA, Nadia; BORBA, Eduardo; FERREIRA FILHO, Julio; CARRICONDO, Pedro; ZANETTI, Caio; CONDE, Paola; FONTOURA, Nicole; ROMANO, Paschoalina; CARVALHO, Valdemir; SILVA, Clovis; BONFA, Eloisa