HELOISA HELENA DE SOUSA MARQUES
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 - Líder
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina - Líder
3 resultados
Resultados de Busca
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- Presentation and Outcomes of Kawasaki Disease in Latin American Infants Younger Than 6 Months of Age: A Multinational Multicenter Study of the REKAMLATINA Network(2020) MORENO, Elizabeth; GARCIA, S. Diana; BAINTO, Emelia; SALGADO, Andrea P.; PARISH, Austin; ROSELLINI, Benjamin D.; ULLOA-GUTIERREZ, Rolando; GARRIDO-GARCIA, Luis M.; DUENAS, Lourdes; ESTRIPEAUT, Dora; LUCIANI, Kathia; RODRIGUEZ-QUIROZ, Francisco J.; AGUILA, Olguita del; CAMACHO-MORENO, German; GOMEZ, Virgen; VIVIANI, Tamara; I, Martha Alvarez-Olmos; MARQUES, Heloisa Helena de Souza; FAUGIER-FUENTES, Enrique; SALTIGERAL-SIMENTAL, Patricia; LOPEZ-MEDINA, Eduardo; MINO-LEON, Greta; BELTRAN, Sandra; MARTINEZ-MEDINA, Lucila; PIREZ, Maria C.; COFRE, Fernanda; TREMOULET, Adriana H.Objective:To characterize the clinical presentation and outcomes of Kawasaki disease (KD) in infants Methods:We evaluated 36 infants <6 months old and 940 infants >= 6 months old diagnosed with KD in Latin America. We compared differences in laboratory data, clinical presentation, treatment response, and coronary artery outcomes between the two cohorts. Results:The majority (78.1%) of infants and children >= 6 months of age were initially diagnosed with KD, as compared to only 38.2% of infants <6 months. Clinical features of KD were more commonly observed in the older cohort: oral changes (92 vs. 75%,P= 0.0023), extremity changes (74.6 vs. 57.1%,P= 0.029), and cervical lymphadenopathy (67.6 vs. 37.1%,P= 0.0004). Whether treated in the first 10 days of illness or after the 10th day, infants <6 months were at greater risk of developing a coronary artery aneurysm compared to KD patients >= 6 months treated at the same point in the course of illness [ <= 10 days (53.8 vs. 9.4%,P= 0.00012); >10 days (50 vs. 7.4%,P= 0.043)]. Conclusion:Our data show that despite treatment in the first 10 days of illness, infants <6 months of age in Latin America have a higher risk of developing a coronary artery aneurysm. Delay in the diagnosis leads to larger coronary artery aneurysms disproportionately in these infants. Thus, suspicion for KD should be high in this vulnerable population.
- Use of Adjunctive Therapy in Acute Kawasaki Disease in Latin America(2020) FORTUNA-REYNA, Brenda; BAINTO, Emelia V.; ULLOA-GUTIERREZ, Rolando; GARRIDO-GARCIA, Luis M.; ESTRIPEAUT, Dora; AGUILA, Olguita del; GOMEZ, Virgen; FAUGIER-FUENTES, Enrique; MINO-LEON, Greta; BELTRAN, Sandra; COFRE, Fernanda; CHACON-CRUZ, Enrique; SALTIGERAL-SIMENTAL, Patricia; MARTINEZ-MEDINA, Lucila; DUENAS, Lourdes; LUCIANI, Kathia; RODRIGUEZ-QUIROZ, Francisco J.; CAMACHO-MORENO, German; VIVIANI, Tamara; ALVAREZ-OLMOS, Martha I.; MARQUES, Heloisa Helena de Sousa; LOPEZ-MEDINA, Eduardo; PIREZ, Maria C.; TREMOULET, Adriana H.Objective: To characterize the use of adjunctive therapy in Kawasaki disease (KD) in Latin America. Methods: The study included 1,418 patients from the Latin American KD Network (REKAMLATINA) treated for KD between January 1, 2009, and May 31, 2017. Results: Of these patients, 1,152 received only a single dose of IVIG, and 266 received additional treatment. Age at onset was similar in both groups (median 2 vs. 2.2 years, respectively). The majority of patients were male (58 vs. 63.9%) and were hospitalized with the first 10 days of fever (85.1 vs. 84.2%). The most common adjunctive therapy administered was steroids for IVIG-resistance, followed by additional doses of IVIG. The use of biologics such as infliximab was limited. KD patients who received adjunctive therapy were more likely to have a lower platelet count and albumin level as well as a higher Z score of the coronary arteries. Conclusion: This is the first report of adjunctive therapies for KD across Latin America. IVIG continues to be the initial and resistance treatment, however, steroids are also used and to a lesser extent, biological therapy such as infliximab. Future studies should address the barriers to therapy in children with acute KD throughout Latin America.
- Clinical Presentation and Outcomes of Kawasaki Disease in Children from Latin America: A Multicenter Observational Study from the REKAMLATINA Network(2023) NARAYAN, Hari K.; LIZCANO, Anel; LAM-HINE, Tracy; ULLOA-GUTIERREZ, Rolando; BAINTO, Emelia V.; GARRIDO-GARCIA, Luis M.; ESTRIPEAUT, Dora; AGUILA, Olguita del; GOMEZ, Virgen; FAUGIER-FUENTES, Enrique; MINO-LEON, Greta; BELTRAN, Sandra; COFRE, Fernanda; CHACON-CRUZ, Enrique; SALTIGERAL-SIMENTAL, Patricia; MARTINEZ-MEDINA, Lucila; DUENAS, Lourdes; LUCIANI, Kathia; RODRIGUEZ-QUIROZ, Francisco J.; MORENO, German Camacho; VIVIANI, Tamara; ALVAREZ-OLMOS, Martha I.; MARQUES, Heloisa Helena de Sousa; LOPEZ-MEDINA, Eduardo; PIREZ, Maria C.; TREMOULET, Adriana H.Objectives To describe the clinical presentation, management, and outcomes of Kawasaki disease (KD) in Latin America and to evaluate early prognostic indicators of coronary artery aneurysm (CAA). Study design An observational KD registry-based study was conducted in 64 participating pediatric centers across 19 Latin American countries retrospectively between January 1, 2009, and December 31, 2013, and prospectively from June 1, 2014, to May 31, 2017. Demographic and initial clinical and laboratory data were collected. Logistic regression incorporating clinical factors and maximum coronary artery z-score at initial presentation (between 10 days before and 5 days after intravenous immunoglobulin [IVIG]) was used to develop a prognostic model for CAA during follow-up (>5 days after IVIG). Results Of 1853 patients with KD, delayed admission (>10 days after fever onset) occurred in 16%, 25% had incomplete KD, and 11% were resistant to IVIG. Among 671 subjects with reported coronary artery z-score during follow-up (median: 79 days; IQR: 36, 186), 21% had CAA, including 4% with giant aneurysms. A simple prognostic model utilizing only a maximum coronary artery z-score >= 2.5 at initial presentation was optimal to predict CAA during follow-up (area under the curve: 0.84; 95% CI: 0.80, 0.88). Conclusion From our Latin American population, coronary artery z-score >= 2.5 at initial presentation was the most important prognostic factor preceding CAA during follow-up. These results highlight the importance of early echocardiography during the initial presentation of KD. (J Pediatr 2023;263:113346).