MARCIA UCHOA DE REZENDE
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
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- Development of a Fresh Osteochondral Allograft Program Outside North America(2016) TIRICO, Luis Eduardo Passarelli; DEMANGE, Marco Kawamura; SANTOS, Luiz Augusto Ubirajara; REZENDE, Marcia Uchoa de; HELITO, Camilo Partezani; GOBBI, Riccardo Gomes; PECORA, Jose Ricardo; CROCI, Alberto Tesconi; BUGBEE, William DickObjective. To standardize and to develop a fresh osteochondral allograft protocol of procurement, processing and surgical utilization in Brazil. This study describes the steps recommended to make fresh osteochondral allografts a viable treatment option in a country without previous fresh allograft availability. Design. The process involves regulatory process modification, developing and establishing procurement, and processing and surgical protocols. Results. Legislation: Fresh osteochondral allografts were not feasible in Brazil until 2009 because the law prohibited preservation of fresh grafts at tissue banks. We approved an amendment that made it legal to preserve fresh grafts for 30 days from 2 degrees C to 6 degrees C in tissue banks. Procurement: We changed the protocol of procurement to decrease tissue contamination. All tissues were procured in an operating room. Processing: Processing of the grafts took place within 12 hours of tissue recovery. A serum-free culture media with antibiotics was developed to store the grafts. Surgeries: We have performed 8 fresh osteochondral allografts on 8 knees obtaining grafts from 5 donors. Mean preoperative International Knee Documentation Committee (IKDC) score was 31.99 +/- 13.4, improving to 81.26 +/- 14.7 at an average of 24 months' follow-up. Preoperative Knee Injury and Oseoarthritis Outcome Score (KOOS) score was 46.8 +/- 20.9 and rose to 85.24 +/- 13.9 after 24 months. Mean preoperative Merle D'Aubigne-Postel score was 8.75 +/- 2.25 rising to 16.1 +/- 2.59 at 24 months' follow-up. Conclusion. To our knowledge, this is the first report of fresh osteochondral allograft transplantation in South America. We believe that this experience may be of value for physicians in countries that are trying to establish an osteochondral allograft transplant program.
- Educational Program Promoting Regular Physical Exercise Does Not Improve Muscular Capacity In Osteoarthritis Knee Patients(2016) SILVA, Jose M. Rodrigues da; RESENDE, Marcia U. de; SPADA, Tania C.; GREVE, Julia M. D'Andrea; CIOLAC, Emmanuel G.
- One-Year Results of an Educational Program on Osteoarthritis: A Prospective Randomized Controlled Trial in Brazil(2016) REZENDE, Marcia Uchoa de; HISSADOMI, Marcelo Issao; CAMPOS, Gustavo Constantino de; FRUCCHI, Renato; PAILO, Alexandre Felicio; PASQUALIN, Thiago; BRITO, Nadia Lucila Rocha; SANTANA, Olga Fugiko Magashima; MOREIRA, Merilu Marins; STRUTZ, Carolina Guimaraes; MATOS, Natalia Beraldo dos Santos; CAMARGO, Olavo Pires de; HERNANDEZ, Arnaldo JoseIntroduction: Knee osteoarthritis (KOA) is the most prevalent form of osteoarthritis. Low socioeconomic level, age, and obesity are directly correlated with the incidence of the disease. Education, exercise, and diet are the core recommendations of all KOA treatment guidelines. Objective: To evaluate the impact of a multiprofessional educational program on patients with KOA. Methods: Of a total of 198 participants, 150 patients with KOA attended 2 days of lectures (at 1- to 3-month intervals) and received educational material on osteoarthritis, and a control group (48 patients) received educational materials only. Body mass index (BMI), frequency, and intensity of physical activity, pain, function, and quality-of-life scores were assessed at baseline and at 4 and 12 months after the educational program. Bimonthly telephone calls were made to half of the participants. Correlations between BMI, level of education, coping skills, functional, and pain results was procured. Results: The groups were similar in terms of race, gender, affected side, and osteoarthritis severity. The results were not affected by the telephone calls or the patients' level of education. At baseline, 25 performed physical activity, whereas 123 performed at 1 year. Seventy-two (36.36%) patients decreased BMI (45 by 1 point and 27 by more than 2 points). There were some weak correlations such as BMI reduction with pain and functional improvements and with coping results. Significant improvements in function and quality of life were found at 4 months. Quality of life remained improved at 1 year. Conclusion: The effect of this educational program in function and quality of life of patients with KOA is very subtle. Interval between classes (1, 2, or 3 months) is not an important issue.
- The OA Trial Bank: meta-analysis of individual patient data from knee and hip osteoarthritis trials show that patients with severe pain exhibit greater benefit from intra-articular glucocorticoids(2016) MIDDELKOOP, M. van; ARDEN, N. K.; ATCHIA, I.; BIRRELL, F.; CHAO, J.; REZENDE, M. U.; LAMBERT, R. G. W.; RAVAUD, P.; BIJLSMA, J. W.; DOHERTY, M.; DZIEDZIC, K. S.; LOHMANDER, L. S.; MCALINDON, T. E.; ZHANG, W.; BIERMA-ZEINSTRA, S. M. A.Objective: To evaluate the efficacy of intra-articular (IA) glucocorticoids for knee or hip osteoarthritis (OA) in specific subgroups of patients with severe pain and inflammatory signs using individual patient data (IPD) from existing trials. Design: Randomized trials evaluating one or more IA glucocorticoid preparation in patients with knee or hip OA, published from 1995 up to June 2012 were selected from the literature. IPD obtained from original trials included patient and disease characteristics and outcomes measured. The primary outcome was pain severity at short-term follow-up (up to 4 weeks). The subgroup factors assessed included severe pain (>= 70 points, 0-100 scale) and signs of inflammation (dichotomized in present or not) at baseline. Multilevel regression analyses were applied to estimate the magnitude of the effects in the subgroups with the individuals nested within each study. Results: Seven out of 43 published randomized clinical trials (n = 620) were included. Patients with severe baseline pain had a significantly larger reduction in short-term pain, but not in mid-and long-term pain, compared to those with less severe pain at baseline (Mean Difference 13.91; 95% Confidence Interval 1.50-26.31) when receiving IA glucocorticoid injection compared to placebo. No statistical significant interaction effects were found between inflammatory signs and IA glucocorticoid injections compared to placebo and to tidal irrigation at all follow-up points. Conclusions: This IPD meta-analysis demonstrates that patients with severe knee pain at baseline derive more benefit from IA glucocorticoid injection at short-term follow-up than those with less severe pain at baseline.