KARINA TAKESAKI MIYAJI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/48 - Laboratório de Imunologia, Hospital das Clínicas, Faculdade de Medicina
LIM/48 - Laboratório de Imunologia, Hospital das Clínicas, Faculdade de Medicina
4 resultados
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- Bites by Philodryas olfersii (Lichtenstein, 1823) and Philodryas aestiva (Dumeril, Bibron and Dumeril, 1854) (serpentes, dipsadidae) in Sao Paulo, Brazil: A retrospective observational study of 155 cases(2021) CASTRO, Felipe Correa; SOUZA, Solange Nogueira de; ALMEIDA-SANTOS, Selma Maria de; MIYAJI, Karina Takesaki; MEDEIROS, Carlos Roberto deDespite the biological relevance and abundance of non-front-fanged colubroid snakes, little is known about the medical significance of the majority these species. Herein, we described bites by two green racer species of colubroid snakes, with respect to clinical, epidemiological, and biological features. We retrospectively analyzed proven cases of Philodryas olfersii and Philodryas aestiva bites. Only cases in which the causative animal was brought and identified by an expert were included. Analysis included variables related to the snake, patient demographics, clinical findings, whole blood clotting time (WBCT20), and treatments. Total 155 medical records were analyzed, of which 141 and 14 patients each were bitten by P. olfersii and P. aestiva, respectively. Most bites occurred in spring and summer seasons, predominantly during daytime. Most snakes were female and adult. Bites by P. olfersii adults were more frequent in summer (p < 0.001) and spring (p < 0.001). The hands were most frequently bitten by P. olfersii (59.6%), while the feet and legs (71.4%) were most bitten by P. aestiva. The most common local signs or symptoms observed were pain, edema, erythema, and transitory local bleeding. Severe pain, extensive edema, ecchymosis, and paresthesia were present only in patients bitten by P. olfersii. Significant association was observed between local bleeding and adult snakes (p = 0.019), as well as between the snout-ventlength and pain (p = 0.018), extensive edema (p = 0.024), and erythema (p = 0.047). WBCT20 was normal in the 35 cases in which it was available. Two patients were wrongly treated with anti-Bothrops antivenom. These results indicated that most accidents caused by P. olfersii and P. aestiva present mild local symptomatology. Some bites of P. olfersii bites may present local symptoms, resembling bites by Bothrops-like snakes. Physicians should be informed about these kinds of accidents, to avoid unnecessary distress to the patient and over prescription of antivenom.
- Adverse events following yellow fever vaccination in immunocompromised persons(2021) LARA, Amanda Nazareth; MIYAJI, Karina Takesaki; IBRAHIM, Karim Yaqub; LOPES, Marta Heloisa; SARTORI, Ana Marli ChristovamThis observational retrospective study conducted during an yellow fever (YF) outbreak in Sao Paulo. Brazil, in 2017-2018, describes adverse events (AE) following YF vaccination of immunocompromised persons. Risks and benefits of vaccination were individually evaluated by physicians. AE were assessed by phone call or electronic mail, 14 to 90 days after vaccination. Three hundred and eighty one immunocompromised persons received a full-dose of YF vaccine. Their age ranged from 1.4 to 89.3 years (median 50.8 years); 53% were women; 178 (46.7%) had chronic kidney disease, 78 (205%) had immune-mediated inflammatory diseases; 94 (24.7%) were using or had recently used immunosuppressive/immunomodulatory drugs. All of them denied previous YF vaccination. We were able to contact 341 (89.5%) vaccinees: 233 (68.3%) of them received the YF vaccine from BioManguinhos and 108 (31.7%) received the vaccine from Sanofi-Pasteur; 130 (38.1%) vaccinees received other vaccines (up to 4) simultaneously with the the YF vaccine, mostly hepatitis B (59 vaccinees), pneumococcal polysaccharide 23-valent (46). influenza (43) and diphtheria-tetanus (dT, 41). One hundred and eleven vaccinees (32.6%) reported at least one AE: 79 (23.2%) presented systemic AE, 44 (12.9%) had local AE and 12 had both, local and systemic AE. The most common AE was pain at the injection site (41 persons, 12%), myalgia (34; 10%). fever (25; 7.3%) and headache (16; 4.7%). There was no statistically significant difference on the AE frequency according to the vaccine producer. There were four severe AE: one hospitalization and three deaths, considered not related to the YF vaccine.
- Bites by Xenodon merremii (Wagler, 1824) and Xenodon neuwiedii (Gunther, 1863) (Dipsadidae: Xenodontini) in Sao Paulo, Brazil: a retrospective observational study of 163 cases(2021) GENDLER, Jose Luiz Pinto Lima; SOUZA, Solange Nogueira de; MARQUES, Otavio Augusto Vuolo; MIYAJI, Karina Takesaki; MEDEIROS, Carlos Roberto deDespite the biological relevance and abundance of non-front-fanged colubroid snakes, little is known about their medical significance. Here, we describe the clinical, epidemiological, and biological aspects of bites by two colubroid species. We retrospectively analyzed cases of Xenodon merremii and Xenodon neuwiedii bites in which the offending snake was clearly identified. Analyses included variables related to the snake and the patient, including demographic data, clinical findings, and treatments. Of the 163 cases, 123 were bites by X. merremii and 40 by X. neuwiedii. Most bites occurred in spring and summer, predominantly during the daytime. Most offending snakes were female. Bites by X. merremii juveniles were more frequent in autumn than in other seasons, whereas those by X. neuwiedii adults were in the summer. Hands and feet were the most frequently affected regions, with no significant difference between upper and lower limbs bitten by either X. merremii or X. neuwiedii. The main clinical findings were pain, transitory bleeding, erythema, and local edema. Local edema was proportionally more frequent with X. neuwiedii bites than with X. merremii bites. No patient had extensive edema or systemic envenomation. A significant association between the snout-vent-length and transitory bleeding in bites by X. merremii, but not in those by X. neuwiedii, was identified. Whole blood clotting tests were normal in all tested patients (62 cases). Sixteen patients were incorrectly treated with anti-Bothrops antivenom. In conclusion, most accidents caused by X. merremii and X. neuwiedii present mild local symptomatology. These snakes can be mistaken for lance-headed vipers, and some bites present symptoms that resemble mild bites by Bothrops sp. Physicians should be aware of X. merremii and X. neuwiedii bites to avoid unnecessary patient distress and overprescription of antivenom.
- Systematic review and meta-analysis of HPV vaccination in women with systemic lupus erythematosus (SLE)(2021) INFANTE, Vanessa; MIYAJI, Karina Takesaki; SOAREZ, Patricia Coelhode; SARTORI, Ana Marli ChristovamObjective We conducted a systematic review and meta-analysis to access HPV vaccines' safety and immunogenicity in Systemic Lupus Erythematosus (SLE) women. Methods The search was conducted in the most relevant databases. Meta-analyses to evaluate seroconversion rates for each HPV vaccine type and SLE flare rates after vaccination were performed. Results We identified 3,467 articles; six papers referring to SLE population were included. Five articles that evaluated vaccine immunogenicity at 7th month after enrollment were included in the meta-analysis. Overall seroconversion rates among SLE participants were 89.3% (95%CI, 0.76-1.00) for HPV6; 92.4% (95%CI, 0.82-1.00) for HPV11; 96.4% (95%CI, 0.93-1.00) for HPV16; and 91.8% (95%CI, 0.85-1.00) for HPV18. Five studies were included in the qualitative analysis of vaccines safety. Pain at the injection site was the most common adverse event (AE). Just one study reported serious AE not related to the vaccine. Flare rate after HPV vaccination was 12,6% (95% CI, 0.04-0.21). Conclusion Few studies, small sample size, evaluated HPV vaccines in SLE women. Seroconversion rates in SLE women were like healthy women, but anti-HPV geometric mean titers (GMT) were slightly lower in SLE women. HPV vaccines were safe in this population.