VERA HERMINA KALIKA KOCH
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
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
6 resultados
Resultados de Busca
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- First-year profile of biomarkers for early detection of renal injury in infants with congenital urinary tract obstruction(2019) KOSTIC, Dusan; BEOZZO, Glenda Priscila Neves dos Santos; COUTO, Saulo Brasil do; KATO, Andre Henrique Teruaki; LIMA, Laila; PALMEIRA, Patricia; KREBS, Vera Lucia Jornada; BUNDUKI, Victor; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, Marcelo; CARVALHO, Werther Brunow de; KOCH, Vera Hermina KalikaBackground Diagnosis of renal function impairment and deterioration in congenital urinary tract obstruction (UTO) continues to be extremely challenging. Use of renal biomarkers in this setting may favor early renal injury detection, allowing for a reliable choice of optimal therapeutic options and prevention or minimization of definitive renal damage. Methods This longitudinal, prospective study analyzed the first-year profile of two serum renal biomarkers: creatinine (sCr) and cystatin C (sCyC); and six urinary renal biomarkers: neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), transforming growth factor beta-1 (TGF-beta 1), retinol-binding protein (RBP), cystatin C (mu CyC), and microalbuminuria (ALB) in a cohort of 37 infants with UTO divided into three subgroups: 14/37 with unilateral hydro(uretero)nephrosis, 13/37 with bilateral hydro(uretero)nephrosis, and 10/37 patients with lower urinary tract obstruction (LUTO), compared with 24 healthy infants matched by gestational age and birth weight. Results All urine biomarkers showed significantly higher values at the first month of life (p <= 0.009), while NGAL (p = 0.005), TGF-beta 1 (p<0.001), and mu ALB (p<0.001) were high since birth compared to controls. Best single biomarker performances were RBP in bilateral hydronephrosis and LUTO subgroups and KIM-1 in unilateral hydronephrosis subgroup. Best biomarker combination results for all subgroups were obtained by matching RBP with TGF-beta 1 or KIM-1 and NGAL with CyC ([AUC] <= 0.934; sensitivity <= 92.4%; specificity <= 92.8%). Conclusions RBP, NGAL, KIM-1, TGF-beta 1, and CyC, alone and especially in combination, are relatively efficient in identifying surgically amenable congenital UTO and could be of practical use in indicating on-time surgery.
- The role of renal biomarkers to predict the need of surgery in congenital urinary tract obstruction in infants(2019) KOSTIC, D.; BEOZZO, G. P. N. S.; COUTO, S. B. do; KATO, A. H. T.; LIMA, L.; PALMEIRA, P.; KREBS, V. L. J.; BUNDUKI, V; V, R. P. Francisco; ZUGAIB, M.; DENES, F. T.; CARVALHO, W. B. de; KOCH, V. H. K.Introduction The diagnosis of renal function impairment and deterioration in congenital urinary tract obstruction (UTO) continues to be extremely challenging. The use of new renal biomarkers in this setting may favor early renal injury detection, allowing for a reliable choice of optimal therapeutic options and the prevention or minimization of definitive renal damage. Objective The aim of the study was to investigate a selection of promising biomarkers of renal injury with the intention of evaluating and comparing their profile with clinically based decisions for surgical intervention of infants with congenital obstructive uropathies. Study design The first-year profile of renal biomarkers, serum creatinine (sCr), serum and urine cystatin C (CyC), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), transforming growth factor beta-1 (TGF-beta 1), retinolbinding protein (RBP), and microalbuminuria (mu ALB), was analyzed in a cohort of 37 infants with congenital UTO, divided into three subgroups, 14 cases with grade III unilateral hydro (uretero)nephrosis, 13 cases with grade III bilateral hydro (uretero)nephrosis, and 10 cases with low urinary tract obstruction (LUTO), compared with 24 healthy infants matched by gestational age and birth weight. Serum and urine samples were stored at -70 degrees C and thereafter analyzed by quantitative enzymatic immunoassay. Results Compared with the control group (Figure), all renal biomarker values were significantly increased in patients (P <= 0.02). In the unilateral hydronephrosis and LUTO group, RBP (P <= 0.043), NGAL (P <= 0.043), KIM-1 (P <= 0.03), and TGF-beta 1 (P <= 0.034) values dropped significantly after surgery. Neutrophil gelatinase-associated lipocalin alone and in combination with urine and serum CyC demonstrated the best performance in determining the need for surgery (area under the curve, 0.801 and 0.881, respectively). Biomarker profile analysis was suggestive of surgical intervention in 55.4% (7/13) of non-operated cases, and most of the biomarker values were above the cutoff levels within at least 3 months before the clinically based surgical decision in 58% (14/24) of all operated patients. Discussion To the best of the authors' knowledge, this is the first study to present the clinical use of selected group of serum and urinary biomarkers in the setting of UTO to distinguish between patients who would benefit from surgery intervention. The most promising results were obtained using NGAL, RBP, TGF-beta 1, and KIM-1, especially in the unilateral hydro(uretero)nephrosis and LUTO subgroups when compared with the control group. Conclusions Urine biomarkers, alone and in combination, demonstrated high potential as a non-invasive diagnostic tool for identifying infants who may benefit from earlier surgical intervention. [GRAPHICS] .
- The effects of obesity on kidney function: a challenge for nephrologists(2019) KOCH, Vera H.
- Prevalence and correlates of depression, anxiety, and stress in medical residents of a Brazilian academic health system(2019) PASQUALUCCI, Paula Lage; DAMASO, Luciana Luccas Mendes; DANILA, Arthur Hirschfeld; FATORI, Daniel; NETO, Francisco Lotufo; KOCH, Vera Hermina KalikaBackgroundSeveral studies correlate medical residency with the occurrence of mental health disorders, Burnout Syndrome and quality of life impairment. It has been demonstrated that mental health disorders increase medical errors and lead to less effective patient care. Considering such context, this study aimed to evaluate the prevalence of anxiety, depression, stress and to identify its correlates with Burnout Syndrome and quality of life in a sample of medical residents and fellow physicians of the largest Brazilian academic health system.MethodsIn 2017, 1648 participants were voluntarily and anonymously surveyed online about demographic characteristics, Burnout Syndrome, mental symptoms, and quality of life measured by validated questionnaires. Responses were captured through REDCap platform and multivariate statistical analyses were performed with STATA 15.ResultsA total of 606 (36.8%) residents/fellows physicians completed the survey. Depression symptoms were present in 19%, anxiety symptoms in 16% and stress symptoms in 17.7% of the sample.Burnout Syndrome was present in 63% of the sample. Multivariate analysis showed a statistical significant positive correlation between Burnout Syndrome and depression, anxiety and stress symptoms and a negative correlation between mental symptoms and quality of life scores.ConclusionsMental health symptoms prevalence in this study is similar to other studies and their occurrence is positively correlated with Burnout Syndrome among medical residents/fellow physicians of the largest Brazilian academic health system. These results are relevant and must be confirmed by multicentric longitudinal studies. This study reinforces the importance of debating interventions to improve mental health among doctors in training.
- Study of the profile of behavioral problems and quality of life indexes in a pediatric cohort of monosymptomatic enuresis(2019) SILVA, Guilherme Jorge Sousa e; SAMMOUR, Simone Nascimento Fagundes; FERRARO, Alexandre Archanjo; KOCH, Vera Hermina KalikaObjective: To evaluate and correlate, before and after the therapeutic intervention, the behavioral problem scores evaluated by the CBCL/6-18 questionnaire and the quality of life indexes evaluated by the PedsQL (TM) 4.0 in patients with monosymptomatic nocturnal enuresis. Method: After the initial evaluation and completion of the CBCL/6-18 questionnaire, a multidisciplinary evaluation and completion of the PedsQL (TM) 4.0 questionnaire was performed. Of the initially evaluated 140 children and adolescents aged 6-16 years, 58 were excluded due to nonmonosymptomatic enuresis or associated comorbidities. Of the initially included 82 patients, who were randomized to three treatment groups, 59 completed the CBCL/6-18 and PedsQL (TM) 4.0 questionnaires at the end of the treatment and were included in this study. The alpha error was set at 5% for ruling out the null hypothesis. Results: Of the total of 59 participants, 45.8% responded with total success, 23.7% were partially successful, 23.7% did not reach the improvement criteria, and 6.8% gave up the treatment. There was a significant increase in quality of life indexes and a reduction of post-intervention behavioral problem scores, in the three proposed modalities, in patients who had a total or partial response to treatment. There was no correlation between higher scores of pre-treatment behavior problems and therapeutic failure. Conclusions: Only the participants who successfully responded to interventions showed improvement in quality of life and behavioral problems, which indicates that enuresis is a primary problem that has a negative impact on these parameters. The authors suggest that it is possible to achieve success in the treatment of monosymptomatic enuresis, even in patients with high pre-intervention behavioral problem scores. (C) 2018 Sociedade Brasileira de Pediatria.
- Global Variation of Nutritional Status in Children Undergoing Chronic Peritoneal Dialysis: A Longitudinal Study of the International Pediatric Peritoneal Dialysis Network(2019) SCHAEFER, Franz; BENNER, Laura; BORZYCH-DUZALKA, Dagmara; ZARITSKY, Joshua; XU, Hong; REES, Lesley; ANTONIO, Zenaida L.; SERDAROGLU, Erkin; HOOMAN, Nakysa; PATEL, Hiren; SEVER, Lale; VONDRAK, Karel; FLYNN, Joseph; REBORI, Anabella; WONG, William; HOLTTA, Tuula; YILDIRIM, Zeynep Yuruk; RANCHIN, Bruno; GRENDA, Ryszard; TESTA, Sara; DROZDZ, Dorota; SZABO, Attila J.; EID, Loai; BASU, Biswanath; VITKEVIC, Renate; WONG, Cynthia; POTTOORE, Stephen J.; MUELLER, Dominik; DUSUNSEL, Ruhan; CELEDON, Claudia Gonzalez; FILA, Marc; SARTZ, Lisa; SANDER, Anja; WARADY, Bradley A.; ADRAGNA, M.; COCCIA, P. A.; SUAREZ, A.; VALLES, P. G.; SALIM, R.; ALCONCHER, L.; ARBEITER, K.; HOECK, K. van; KOCH, V; FEBER, J.; HARVEY, E.; WHITE, C.; VALENZUELA, M.; VILLAGRA, J.; CANO, F.; CONTRERAS, M. A.; VOGEL, A.; ZAMBRANO, P.; HEVIA, P.; CHIU, M. C.; DING, Jie; VANEGAS, J. J.; HIGUITA, L. M.; ROUSSEY, G.; ULINSKI, T.; KRID, S.; FISCHBACH, M.; HARAMBAT, J.; SAMAILLE, Ch; BUESCHER, R.; OH, J.; PAPE, L.; JOHN, U.; KLAUS, G.; BILLING, H.; STAFANIDIS, C.; PAPACHRISTOU, F.; BAGGA, A.; KANITKAR, M.; SINHA, R.; SETHI, S.; VERRINAM, E.; VIDAL, E.; LEOZAPPA, G.; LANDAU, D.; Ha; PAIK, K. H.; BILAL, A.; SAHPAZOVA, E.; LIM, Y. N.; BARBOSA, L. Sanchez; GROOTHOFF, J. W.; KONIJENBERG, Y.; SILVA, Y.; RYAMI, M. Al; MUNARRIZ, R. Loza; LESZEPANSKA, B.; SZCZEPANSKA, M.; BRUMARIU, O.; KARI, J.; KRUSCIC, D.; YAP, H. K.; ARICETA, G.; AGUIRRE, M.; SANTOS, F.; NIWHISKA-FARYNA, B.; BAYAZIT, A.; BAKKALOGLU, C. A. S.; BAKKALOGLU, S.; BILGE, I; YAVASCAN, O.; MIR, S.; SIMKOVA, Eva; CHRISTIAN, M.; GREENBAUM, L.; NEU, A.; ASKENAZI, D.; AL-AKASH, A.; SWARTZ, S.; BROPHY, P.; RHEAULT, M.; PRADHAN, M.While children approaching end-stage kidney disease (ESKD) are considered at risk of uremic anorexia and underweight they are also exposed to the global obesity epidemic. We sought to investigate the variation of nutritional status in children undergoing chronic peritoneal dialysis (CPD) around the globe. The distribution and course of body mass index (BMI) standard deviation score over time was examined prospectively in 1001 children and adolescents from 35 countries starting CPD who were followed in the International Pediatric PD Network (IPPN) Registry. The overall prevalence of underweight, and overweight/obesity at start of CPD was 8.9% and 19.7%, respectively. Underweight was most prevalent in South and Southeast Asia (20%), Central Europe (16.7%) and Turkey (15.2%), whereas overweight and obesity were most common in the Middle East (40%) and the US (33%). BMI SDS at PD initiation was associated positively with current eGFR and gastrostomy feeding prior to PD start. Over the course of PD BMI SDS tended to increase on CPD in underweight and normal weight children, whereas it decreased in initially overweight patients. In infancy, mortality risk was amplified by obesity, whereas in older children mortality was markedly increased in association with underweight. Both underweight and overweight are prevalent in pediatric ESKD, with the prevalence varying across the globe. Late dialysis start is associated with underweight, while enteral feeding can lead to obesity. Nutritional abnormalities tend to attenuate with time on dialysis. Mortality risk appears increased with obesity in infants and with underweight in older children.