ANA CATHARINA DE SEIXAS SANTOS NASTRI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/07 - Laboratório de Gastroenterologia Clínica e Experimental, Hospital das Clínicas, Faculdade de Medicina
LIM/07 - Laboratório de Gastroenterologia Clínica e Experimental, Hospital das Clínicas, Faculdade de Medicina
7 resultados
Resultados de Busca
Agora exibindo 1 - 7 de 7
- Visceral leishmaniasis caused by Leishmania (Leishmania) amazonensis associated with Hodgkin's lymphoma(2022) PORTO, Victor Bertolo Gomes; CARVALHO, Laina Bubach; BUZO, Bruno Fernando; LITVOC, Marcelo Nobrega; SANTOS, Ana Catharina S.; ROCCI, Rafael Avila; SOARES, Sandra Regina Castro; ZAMPIERI, Ricardo Andrade; DUARTE, Maria Irma Seixas; LINDOSO, Jose Angelo LaulettaVisceral leishmaniasis (VL) is mainly caused by Leishmania (Leishmania) donovani and Leishmania (L.) infantum; however, other Leishmania species have been associated with VL. We report a case of a patient simultaneously diagnosed with VL caused by Leishmania (L.) amazonensis and Hodgkin's lymphoma. After treatment with liposomal amphotericin B and chemotherapy, the patient presented a clinical cure. This case report reinforces the hypothesis that other Leishmania species can cause visceral lesions mainly related to immunosuppression.
- Tegumentary leishmaniasis mimicking visceralization in a cirrhotic patient: atypical cutaneous lesions and local immunological features(2020) VERNAL, Sebastian; CASAL, Yuri; VIEIRA, Lucas T.; AMATO, Valdir S.; DUARTE, Maria Irma S.; NASTRI, Ana Catharina S. S.Tegumentary leislunaniasis (TL) diagnosis is challenging due to the lack of a gold standard diagnostic tool. The diagnosis is significantly harder in regions where visceral leishmaniasis (VL) is also prevalent since immunological tests may present cross-reactivity. A cirrhotic patient from an endemic Brazilian region for TL and VL presented with atypical cutaneous lesions, a usual clinico-laboratory feature of VL (including a positive rk39 test result), but he was diagnosed with TL histopathologically; VL was ruled out by necropsy. Physicians working in co-prevalent areas should be aware of atypical features, unusual clinical course, and unexpected laboratory findings of leishmaniasis.
- Evaluation of eleven immunochromatographic assays for SARS-CoV-2 detection: investigating the dengue cross-reaction(2022) OLIVEIRA, Beatriz Araujo; OLIVEIRA, Lea Campos de; OLIVEIRA, Franciane Mendes de; PEREIRA, Geovana Maria; SOUZA, Regina Maia de; MANULI, Erika Regina; MARCHINI, Fabricio Klerynton; ESPINOZA, Evelyn Patricia Sanchez; PARK, Marcelo; TANIGUCHI, Leandro; MENDES, Pedro Vitale; FRANCO, Lucas Augusto Moyses; NASTRI, Ana Catharina; OLIVEIRA, Maura Salaroli de; VIEIRA JUNIOR, Jose Mauro; KALLAS, Esper Georges; LEVIN, Anna Sara; SABINO, Ester Cerdeira; COSTA, Silvia FigueiredoCOVID-19 disease is spread worldwide and diagnostic techniques have been studied in order to contain the pandemic. Immunochromatographic (IC) assays are feasible and a low-cost alternative especially in low and middle-income countries, which lack structure to perform certain diagnostic techniques. Here we evaluate the sensitivity and specificity of eleven different IC tests in 145 serum samples from confirmed cases of COVID-19 using RT-PCR and 100 negative serum samples from blood donors collected in February 2019. We also evaluated the cross-reactivity with dengue using 20 serum samples from patients with confirmed diagnosis for dengue collected in early 2019 through four different tests. We found high sensitivity (92%), specificity (100%) and an almost perfect agreement (Kappa 0.92) of IC assay, especially when we evaluated IgG and IgM combined after 10 days from the onset of symptoms with RT-PCR. However, we detected cross-reactivity between dengue and COVID-19 mainly with IgM antibodies (5 to 20% of cross-reaction) and demonstrated the need for better studies about diagnostic techniques for these diseases.
- Confronting the Multidimensional Challenges of Research in the Context of Emerging Infectious Diseases in Brazil: The Example of Yellow Fever(2020) AVELINO-SILVA, Vivian I.; FIGUEIREDO-MELLO, Claudia; CASADIO, Luciana V. B.; NASTRI, Ana C. S. S.; MARCILIO, Izabel; RIBEIRO, Ana F.; LEVIN, Anna S.; SABINO, Ester C.In the most recent Brazilian yellow fever (YF) outbreak, a group of clinicians and researchers initiated in mid-January 2018 a considerable effort to develop a multicenter randomized controlled clinical trial to evaluate the effect of sofosbuvir on YF viremia and clinical outcomes (Brazilian Clinical Trials Registry: RBR-93dp9n). The approval of this protocol had urgency given the seasonal/short-lived pattern of YF transmission, large number of human cases, and epidemic transmission at the outskirts of a large urban center. However, many intricacies in the research regulatory and ethical submission systems in Brazil were indomitable even under such pressing conditions. By April 2018, we had enrolled 29 patients for a target sample size of 90 participants. Had enrollment been initiated 3 weeks earlier, an additional 31 patients could have been enrolled, reaching the prespecified sample size for the interim analysis. This recent experience highlights the urgent need to improve local preparedness for research in the setting of explosive outbreaks, as has been seen in the last few years in different countries.
- Staging liver fibrosis after severe yellow fever with ultrasound elastography in Brazil: A six-month follow-up study(2021) NEVES, Yuri Costa Sarno; CASTRO-LIMA, Victor Augusto Camarinha de; SOLLA, Davi Jorge Fontoura; OGATA, Vivian Simone de Medeiros; PEREIRA, Fernando Linhares; ARAUJO, Jordana Machado; NASTRI, Ana Catharina Seixas; HO, Yeh-Li; CHAMMAS, Maria CristinaBackground Yellow fever (YF) is a hemorrhagic disease caused by an arbovirus endemic in South America, with recent outbreaks in the last years. Severe cases exhibit fulminant hepatitis, but there are no studies regarding its late-term effects on liver parenchyma. Thus, the aim of this study was to determine the frequency and grade of liver fibrosis in patients who recovered from severe YF and to point out potential predictors of this outcome. Methodology/Principal findings We followed-up 18 patients who survived severe YF during a recent outbreak (January-April 2018) in Brazil using ultrasound (US) with shear-wave elastography (SWE) at 6 months after symptoms onset. No patient had previous history of liver disease. Median liver stiffness (LS) was 5.3 (4.6-6.4) kPa. 2 (11.1%) patients were classified as Metavir F2, 1 (8.3%) as F3 and 1 (8.3%) as F4; these two last patients had features of cardiogenic liver congestion on Doppler analysis. Age and cardiac failure were associated with increased LS (p = 0.036 and p = 0.024, respectively). SAPS-3 at ICU admission showed a tendency of association with significant fibrosis (>= F2; p = 0.053). 7 patients used sofosbuvir in a research protocol, of which none showed liver fibrosis (p = 0.119). Conclusions/Significance We found a low frequency of liver fibrosis in severe YF survivors. US with SWE may have a role in the follow up of patients of age and / or with comorbidities after hospital discharge in severe YF, a rare but reemergent disease. Author summary Yellow fever (YF) is a viral disease transmitted by mosquitoes and represents an important health problem in countries of South America and Africa, with recent outbreaks in the past few years. Severe cases lead to fulminant hepatitis and death; it has also been reported that surviving patients tend to recover / ""regenerate"" the liver after the acute phase of the disease. However, there are no prior investigations on this matter. Thus, we followed up a group of previously healthy patients who had severe YF 6 months after the initial symptoms, using a non-invasive ultrasound technique of estimating the liver fibrosis (scar tissue) grade, called elastography. In our findings, we report a low frequency of liver fibrosis. Thus, we concluded that patients who had severe YF are not likely to have late-term liver fibrosis or cirrhosis. Nevertheless, there are some specific individuals (older or with chronic diseases) that might need further evaluation.
- Lipase and factor V (but not viral load) are prognostic factors for the evolution of severe yellow fever cases(2019) CASADIO, Luciana Vilas Boas; SALLES, Ana Paula Moreira; MALTA, Fernanda de Mello; LEITE, Gabriel Fialkovitz; HO, Yeh-Li; GOMES-GOUVEA, Michele Soares; MALBOUISSON, Luiz Marcelo Sa; LEVIN, Anna S.; AZEVEDO NETO, Raymundo Soares de; CARRILHO, Flair Jose; NASTRI, Ana Catharina Seixas Santos; PINHO, Joao Renato RebelloBACKGROUND Despite a highly efficacious vaccine, yellow fever (YF) is still a major threat in developing countries and a cause of outbreaks. In 2018, the Brazilian state of Sao Paulo witnessed a new YF outbreak in areas where the virus has not been detected before. OBJECTIVE The aim is to describe the clinical and laboratorial characteristics of severe cases of YF, evaluate viral to determine markers associated with fatal outcome. METHODS Acute severe YF cases (n = 62) were admitted to the Intensive Care Unit of a reference hospital and submitted to routine laboratorial evaluation on admission. YFV-RNA was detected in serum and urine by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and then sequenced. Patients were classified in two groups: survival or death. FINDINGS In the univariate analysis the following variables were associated with outcome: alanin aminotransferase (ALT), aspartat aminotransferase (AST), AST/ALT ratio, total bilirubin (TB), chronic kidney disease epidemiology collaboration (CKD-EPI), ammonia, lipase, factor V, international normalised ratio (INR), lactate and bicarbonate. Logistic regression model showed two independent variables associated with death: lipase [odds ratio (OR) 1.018, 95% confidence interval (CI) 1.007 to 1.030, p = 0.002], and factor V (OR -0.955, 95% CI 0.929 to 0.982, p = 0.001). The estimated lipase and factor V cut-off values that maximised sensitivity and specificity for death prediction were 147.5 U/L [area under the curve (AUC) = 0.879], and 56.5% (AUC = 0.913). MAIN CONCLUSIONS YF acute severe cases show a generalised involvement of different organs (liver, spleen, heart, kidneys, intestines and pancreas), and different parameters were related to outcome. Factor V and lipase are independent variables associated with death, reinforcing the importance of hemorrhagic events due to fulminant liver failure and pointing to pancreatitis as a relevant event in the outcome of the disease.
- Peginterferon still has a place in the treatment of hepatitis C caused by genotype 3 virus(2017) GRANDO, Aline Vitali; FERREIRA, Paulo Roberto Abrao; PESSOA, Mario Guimaraes; MAZO, Daniel Ferraz de Campos; BRANDAO-MELLO, Carlos Eduardo; REUTER, Tania; MARTINELLI, Ana de Lourdes Candolo; GONZALEZ, Mario Peribanez; NASTRI, Ana Catharina Seixas-Santos; CAMPOS, Aleia Faustina; LOPES, Max Igor Banks Ferreira; BRITO, Jose David Urbaez; MENDES-CORREA, Maria CassiaDespite recent advances in therapy for chronic hepatitis C (CHC), the disease caused by genotype 3 virus (GEN3) is still considered a treatment challenge in certain patient subgroups. The aim of this retrospective study was to evaluate the effectiveness and safety of the peginterferon (Peg-IFN) and ribavirin (RBV) combination treatment for GEN3/CHC patients, and to evaluate sustained virological response (SVR) indicators and early treatment interruption due to serious adverse events (SAE). This was a retrospective observational study of GEN3/CHC patients, co-infected or not by HIV and treated with Peg-IFN/RBV in nine Brazilian healthcare centers. The study sample included 184 GEN3/CHC patients; 70 (38%) were co-infected with HIV. The overall SVR rate was 57.1% (95% CI 50-64). Among co-infected and mono-infected patients, the SVR rate was 51.4% (36/70) and 60.5% (69/114), respectively (p=0.241). Thirty-four (18.5%) patients experienced SAE and interrupted treatment. SVR was negatively associated with the use of Peg-IFN alpha 2b (PR 0.75; 95% CI 0.58-0.99; p=0.045) and to early treatment interruption due to SAE (PR 0.36; 95% CI 0.20-0.68; p=0.001). Early treatment interruption due to SAE was associated with age (PR 1.06; 95% CI 1.02-1.10; p<0.001) and occurrence of liver cirrhosis (PR 2.06; 95% CI 1.11-3.83; p=0.022). In conclusion, Peg-IFN/RBV might represent an adequate treatment option, mainly in young patients without advanced liver disease or when the use of direct-action drugs is limited to specific patient groups.