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article 0 Citação(ões) na Scopus
Renal denervation by radiofrequency in patients with hypertension: systematic review and meta-analysis
(2024) SILVINATO, Antonio; FLORIANO, Idevaldo; BERNARDO, Wanderley Marques
The Guidelines Project, which is an initiative of the Brazilian Medical Association, aims to combine information from the medical field to standardize how to conduct and assist in the reasoning and decision-making of doctors. The information provided by this project must be critically evaluated by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical condition of each patient. Brazilian Medical Association.
article 12 Citação(ões) na Scopus
Online continuing interprofessional education on hospital-acquired infections for Latin America
(2017) MEDINA-PRESENTADO, Julio C.; MARGOLIS, Alvaro; TEIXEIRA, Lucia; LORIER, Leticia; GALES, Ana C.; PEREZ-SARTORI, Graciela; OLIVEIRA, Maura S.; SEIJA, Veronica; PACIEL, Daniela; VIGNOLI, Rafael; GUERRA, Silvia; ALBORNOZ, Henry; ARTETA, Zaida; LOPEZ-ARREDONDO, Antonio; GARCIA, Sofia
IntroductionLatin America is a large and diverse region, comprising more than 600 million inhabitants and one million physicians in over 20 countries. Resistance to antibacterial drugs is particularly important in the region. This paper describes the design, implementation and results of an international bi-lingual (Spanish and Portuguese) online continuing interprofessional interactive educational program on hospital-acquired infections and antimicrobial resistance for Latin America, supported by the American Society for Microbiology. MethodsParticipation, satisfaction and knowledge gain (through pre and post tests) were used. Moreover, commitment to change statements were requested from participants at the end of the course and three months later. ResultsThere were 1169 participants from 19 Latin American countries who registered: 57% were physicians and 43% were other health care professionals. Of those, 1126 participated in the course, 46% received a certificate of completion and 54% a certificate of participation. There was a significant increase in knowledge between before and after the course. Of 535 participants who took both tests, the grade increased from 59 to 81%. Commitments to change were aligned with course objectives. DiscussionImplementation of this educational program showed the feasibility of a continent-wide interprofessional massive course on hospital acquired-infections in Latin America, in the two main languages spoken in the region. Next steps included a new edition of this course and a New Challenges course on hospital-acquired infections, which were successfully implemented in the second semester of 2015 by the same institutions. (C) 2016 Sociedade Brasileira de Infectologia.
article 0 Citação(ões) na Scopus
The FOXP3+ Pro-Inflammatory T Cell: A Potential Therapeutic Target in Crohn's Disease
(2024) KOSINSKY, Robyn Laura; GONZALEZ, Michelle M.; SAUL, Dominik; BARROS, Luisa Leite; SAGSTETTER, Mary R.; FEDYSHYN, Yaroslav; NAIR, Asha; SUN, Zhifu; HAMDAN, Feda H.; GIBBONS, Hunter R.; PACHON, Mauricio E. Perez; DRULINER, Brooke R.; JOHNSEN, Steven A.; FAUBION, William A.
BACKGROUND & AIMS: The incidence of Crohn ' s disease (CD) continues to increase worldwide. The contribution of CD4 + cell populations remains to be elucidated. We aimed to provide an indepth transcriptional assessment of CD4 + T cells driving chronic in flammation in CD. METHODS: We performed single -cell RNAsequencing in CD4 + T cells isolated from ileal biopsies of patients with CD compared with healthy individuals. Cells underwent clustering analysis, followed by analysis of gene signaling networks. We overlapped our differentially expressed genes with publicly available microarray data sets and performed functional in vitro studies, including an in vitro suppression assay and organoid systems, to model gene expression changes observed in CD regulatory T (Treg) cells and to test predicted therapeutics. RESULTS: We identi fied 5 distinct FOXP3 + regulatory Treg subpopulations. Tregs isolated from healthy controls represent the origin of pseudotemporal development into in flammation - associated subtypes. These proin flammatory Tregs displayed a unique responsiveness to tumor necrosis factor -a signaling with impaired suppressive activity in vitro and an elevated cytokine response in an organoid coculture system. As predicted in silico, the histone deacetylase inhibitor vorinostat normalized gene expression patterns, rescuing the suppressive function of FOXP3 + cells in vitro. CONCLUSIONS: We identified a novel, proinflammatory FOXP3 + T cell subpopulation in patients with CD and developed a pipeline to specifically target these cells using the US Food and Drug Administration - approved drug vorinostat. samples, the contribution of individual cell populations remains largely unknown. To identify these cell types, as well as gene expression changes relevant to CD, recent investigations used single -cell RNA sequencing (scRNA-seq) approaches. Interestingly, Jaeger et al 2 detected an increased T helper 17 (Th17) over regulatory T (Treg) cell to T follicular helper cell ratio from single -cell suspensions of lamina propria isolated from CD lesions. 2 In general, CD4 + T cells develop in the thymus and na & iuml;ve CD4 + T cells encounter polarizing cytokines in the periphery, inducing the expression of specific transcription factors underlying the differentiation into specialized functional subsets. 3 The inflamed mucosa of patients with IBD displays a substantial infiltration of Th17 cells. 4 In agreement with this finding, the levels of Th17excreted cytokines were elevated in inflamed lesions, suggesting a proinflammatory function of these cells. 5,6 The X -chromosome -encoded FOXP3 transcription factor represents the master Treg lineage factor and is critical for Treg development, maintenance, and function. 7 -10 We and others have also documented a predominant infiltration of CD4 + FOXP3 + cells in the Crohn 's inflammatory lesion. 11,12 FOXP3 + Treg cells are critical to the maintenance of immune self -tolerance and are key players in the regulation of inflammatory signals in many immune -mediated disorders; yet, emerging evidence suggests altered function within the inflammatory milieu. The notion of a proinflammatory Treg is supported by single -cell sequencing technology suggesting distinct proinflammatory phenotypes resembling those
article 0 Citação(ões) na Scopus
Cryotherapy versus radiofrequency ablation in the treatment of dysplastic Barrett's esophagus with or without early esophageal neoplasia: a systematic review and meta-analysis
(2024) GOMES, Igor Logetto Caetite; MOURA, Diogo Turiani Hourneaux de; RIBEIRO, Igor Braga; MARQUES, Sergio Barbosa; CARLOS, Alexandre de Sousa; NUNES, Beanie Conceicao Medeiros; HIRSCH, Bruno Salomao; OLIVEIRA, Guilherme Henrique Peixoto de; TRASOLINI, Roberto Paolo; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux de
Background/Aims: Radiofrequency ablation (RFA) is the first-line therapy for dysplastic Barrett's esophagus (BE). Therefore, cryotherapy has emerged as an alternative treatment option. This study aimed to compare the efficacies of these two techniques based on the rates of complete eradication of intestinal metaplasia (CE-IM) and dysplasia (CE-D). Adverse events and recurrence have also been reported. Methods: An electronic search was conducted using the Medline (PubMed), Embase, LILACS, and Google Scholar databases until December 2022. Studies were included comparing cryotherapy and RFA for treating dysplastic BE with or without early esophageal neoplasia. This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideResults: Three retrospective cohort studies involving 627 patients were included. Of these, 399 patients underwent RFA, and 228 were treated with cryotherapy. There was no difference in CE-IM (risk difference [RD], -0.03; 95% confidence interval [CI], -0.25 to 0.19; p=0.78; I2=86%) as well as in CE-D (RD, -0.03; 95% CI, -0.15 to 0.09; p=0.64; I2=70%) between the groups. The absolute number of adverse events was low, and there was no difference in the recurrence rate. Conclusions: Cryotherapy and RFA were equally effective in treating dysplastic BE, with or without early esophageal neoplasia.
article
Conventional Versus Traction-Assisted Endoscopic Submucosal Dissection for Esophageal, Gastric, and Colorectal Neoplasms: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
(2024) NUNES, Felipe Giacobo; GOMES, Igor Logetto Caetite; MOURA, Diogo Turiani Hourneaux De; DOMINGUEZ, Juan Eduardo G.; FORNARI, Fernando; RIBEIRO, Igor Braga; OLIVEIRA, Guilherme Henrique Peixoto de; FIGUEIREDO, Sergio Mazzola P. de; BERNARDO, Wanderley Marques; MOURA, Eduardo G. Hourneaux de
Endoscopic submucosal dissection (ESD) is increasingly being utilized for the resection of superficial gastrointestinal neoplasms. However, the long procedure time poses a technical challenge for conventional ESD (C-ESD). Traction-assisted ESD (T-ESD) was developed to facilitate the procedure by reducing its duration. This study compares the efficacy and safety of C-ESD versus T-ESD in the treatment of esophageal, gastric, and colorectal neoplasms. Nine randomized controlled trials (RCTs) were analyzed. Tractionassisted ESD exhibited shorter mean dissection times for the esophagus and colorectal regions and lower perforation rates in colorectal cases. No significant differences were observed in en bloc resection or bleeding rates. Traction-assisted ESD proves to be more efficient in mean procedure time for esophageal and colorectal cases and safer in perforation rates for colorectal cases, but similar rates are noted for en bloc resection or bleeding.
article 0 Citação(ões) na Scopus
article 0 Citação(ões) na Scopus
Pitfalls in the Diagnostic Evaluation of Pheochromocytomas
(2024) FAGUNDES, Gustavo F. C.; ALMEIDA, Madson Q.
Pheochromocytomas and paragangliomas (PPGLs), rare neuroendocrine tumors arising from chromaffin cells, present a significant diagnostic challenge due to their clinical rarity and polymorphic symptomatology. The clinical cases demonstrate the importance of an integrated approach that combines clinical assessment, biochemical testing, and imaging to distinguish PPGLs from mimicking conditions, such as obstructive sleep apnea and interfering medication effects, which can lead to false-positive biochemical results. Although a rare condition, false-negative metanephrine levels can occur in pheochromocytomas, but imaging findings can give some clues and increase suspicion for a pheochromocytoma diagnosis. This expert endocrine consult underscores the critical role of evaluating preanalytical conditions and pretest probability in the biochemical diagnosis of PPGLs. Moreover, a careful differentiation of PPGLs from similar conditions and careful selection and interpretation of diagnostic tests, with focus on understanding and reducing false positives to enhance diagnostic accuracy and patient outcomes, is crucial.
bookPart 1 Citação(ões) na Scopus
Alzheimer’s Disease and the Volume of Hippocampal Subfields: Cluster Analysis Using Neuroimaging Data
(2019) PACHI, C. G. Fonseca; TORRALBO, L.; YAMAMOTO, J. F.
This study analyzes the presence of volumetric changes in subfields of the hippocampus using structural MR image from a large database of volunteers, selected and screened in three distinct groups of elderly subjects: Diagnosed with Alzheimer’s disease (AD) or cognitive impairment mild (MCI) and control group (CG). Images were processed using the FreeSurfer (FS) software methodology specifically developed for automated segmentation of these hippocampal subfields and this selected dataset has based a dissertation research about aging. Statistical tools allowed evaluating the presence of correlation between age and volumetric changes of hippocampal subfields in the advancing age. In addition, clustering analysis showed important similarities between the volumes of the hippocampal subfields of these subjects. © Springer Nature Switzerland AG 2019.
bookPart
Pronto-socorro digital
(2023) NANBU, Danilo Yamamoto; COUTO, Thomaz Bittencourt
bookPart
Monitorização ambulatorial da pressão arterial
(2016) NOBRE, Fernando; JúNIOR, Décio Mion; LOPES, Paulo César; COLOMBO, Fernanda M. C.