EUCLIDES AYRES DE CASTILHO

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Departamento de Medicina Preventiva, Faculdade de Medicina - Docente
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina

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  • article 26 Citação(ões) na Scopus
    The effectiveness of maternal pertussis vaccination in protecting newborn infants in Brazil: A case-control study
    (2019) FERNANDES, Eder Gatti; SATO, Ana Paula S.; VAZ-DE-LIMA, Lourdes R. A.; RODRIGUES, Marcela; LEITE, Daniela; BRITO, Cyro A. de; LUNA, Expedito J. A.; CARVALHANAS, Telma Regina M. P.; RAMOS, Maria Ligia Bacciote Nerger; SATO, Helena Keico; CASTILHO, Euclides A. de; SOUZA, Edna M. de; ATOBE, Jane H.; OLIVEIRA, Carmem A. F.; MORAES, Jose Cassio de; GASPAR, Jaqueline Correia; OLIVEIRA, Silvia Silva de
    Introduction: In 2014, the Brazilian Ministry of Health (MoH) recommended Tdap to pregnant women in response to a significant increase in the incidence of pertussis among infants. The present study assessed the effectiveness of maternal immunization in preventing pertussis in infants. Methods: An unmatched case-control study was undertaken in Sao Paulo State, Brazil from February 2015 to July 2016. Cases were infants aged <8 weeks at onset of pertussis reported to the Surveillance System and confirmed by real-time polymerase chain reaction or culture. Four to six healthy infants were selected as controls per case from birth certificates in the Information System on Live Births database. General characteristics and mother's vaccination status were compared between cases and controls. The vaccine effectiveness (VE) was calculated as 1 - odds ratio (OR). For the adjusted VE, the OR was calculated using logistic regression analysis. Results: Forty-two cases and 248 controls were enrolled in the study. Mothers of 8 cases (19.1%) and 143 controls (57.4%) were vaccinated during pregnancy, resulting in an unadjusted VE of 82.6% (95% confidence interval [CI], 60.8-92.3%). The VE was unchanged after adjusting for maternal age and monthly household income. Conclusion: Maternal pertussis vaccination during pregnancy was effective in protecting infants aged <8 weeks from pertussis.
  • article 8 Citação(ões) na Scopus
    HIV/AIDS epidemic in Brazil: three decades
    (2011) SZWARCWALD, Celia Landmann; CASTILHO, Euclides Ayres de
  • article 6 Citação(ões) na Scopus
    Effect of maternal Tdap on infant antibody response to a primary vaccination series with whole cell pertussis vaccine in Sao Paulo, Brazil
    (2021) VAZ-DE-LIMA, Lourdes R. A.; SATO, Ana Paula S.; PAWLOSKI, Lucia C.; FERNANDES, Eder G.; RAJAM, Gowrisankar; SATO, Helena K.; PATEL, Divya; LI, Han; CASTILHO, Euclides A. de; TONDELLA, Maria Lucia; SCHIFFER, Jarad
    Background: Maternal Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination provides antibody transfer to newborn infants and may affect their antibody response to the primary vaccination series. This study aimed to assess the effect of Tdap vaccination during pregnancy on infant antibody response to the whole cell pertussis (DTwP) primary series. Methods: Plasma from 318 pregnant women (243 Tdap-vaccinated and 75 unvaccinated) and their infants (cord blood) was collected at delivery; infant blood was again collected at 2 and 7 months, before and after their primary DTwP series. Anti-pertussis toxin (PT), pertactin (PRN), filamentous hemagglutinin (FHA), fimbriae 2/3 (FIM) and adenylate cyclase toxin (ACT) IgG antibodies were quantified by a microsphere-based multiplex antibody capture assay and anti-PT neutralizing antibodies by the Real Time Cell analysis system. Results: Infant geometric mean concentrations (GMCs) of IgG anti-Tdap antigens were significantly higher (p < 0.001) among the Tdap-vaccinated (PT: 57.22 IU/mL; PRN: 464.86 IU/mL; FHA: 424.0 IU/ mL), versus the unvaccinated group (4 IU/mL, 15.43 IU/mL, 31.99 IU/mL, respectively) at delivery. Anti-FIM and ACT GMCs were similar between the two groups. At 2 months of age, anti-PT, PRN, and FHA GMCs remained higher (p < 0.001) in the Tdap-vaccinated group (12.64 IU/mL; 108.76 IU/mL; 87.41 IU/mL, respectively) than the unvaccinated group (1.02 IU/mL; 4.46 IU/mL; 6.89 IU/mL). However, at 7 months, after receiving the third DTwP dose, the anti-PT GMC was higher (p = 0.016) in the unvaccinated group (7.91 IU/mL) compared to the vaccinated group (2.27 IU/mL), but without differences for anti-PRN, FHA, FIM and ACT GMCs. Conclusion: Elevated antibody levels suggest that maternal Tdap vaccination might protect infants until 2 months of age. Reduced anti-PT levels at 7 months indicate potential blunting of immune response in infants. Surveillance would help determine if blunting alters vaccine immunity and impacts pertussis prevention in infants. (C) 2021 The Authors.
  • article 25 Citação(ões) na Scopus
    The HIV-Brazil Cohort Study: Design, Methods and Participant Characteristics
    (2014) GRANGEIRO, Alexandre; ESCUDER, Maria Mercedes; CASSANOTE, Alex Jones Flores; SOUZA, Rosa Alencar; KALICHMAN, Artur O.; VELOSO, Valdilea; IKEDA, Maria Leticia Rodrigues; BARCELLOS, Nemora Tregnago; BRITES, Carlos; TUPINANBAS, Unai; LUCENA, Noaldo O.; SILVA, Carlos Lima da; LACERDA, Heloisa Ramos; GRINSZTEJN, Beatriz; CASTILHO, Euclides Ayres
    Background: The HIV-Brazil Cohort Study was established to analyze the effectiveness of combination antiretroviral therapy (cART) and the impact of this treatment on morbidity, quality of life (QOL) and mortality. The study design, patients' profiles and characteristics of cART initiation between 2003 and 2010 were described. Methodology/Principal Findings: Since 2003, the HIV-Brazil Cohort has been following HIV-infected adults receiving cART at 26 public health care facilities, using routine clinical care data and self-reported QOL questionnaires. When not otherwise available, data are obtained from national information systems. The main outcomes of interest are diseases related or unrelated to HIV; suppression of viral replication; adverse events; virological, clinical and immunological failures; changes in the cART; and mortality. For the 5,061 patients who started cART between 2003 and 2010, the median follow-up time was 4.1 years (IQR 2.2-5.9 years) with an 83.4% retention rate. Patient profiles were characterized by a predominance of men (male/female ratio 1.7:1), with a mean age of 36.9 years (SD 9.9 years); 55.2% had been infected with HIV via heterosexual contact. The majority of patients (53.4%) initiated cART with a CD4(+) T-cell count <= 200 cells/mm(3). The medications most often used in the various treatment regimens were efavirenz (59.7%) and lopinavir/ritonavir (18.2%). The proportion of individuals achieving viral suppression within the first 12 months of cART use was 77.4% (95% CI 76.1-78.6). Nearly half (45.4%) of the patients presented HIV-related clinical manifestations after starting cART, and the AIDS mortality rate was 13.9 per 1,000 person-years. Conclusions/Significance: Results from cART use in the daily practice of health services remain relatively unknown in low- and middle-income countries, and studies with the characteristics of the HIV-Brazil Cohort contribute to minimizing these shortcomings, given its scope and patient profile, which is similar to that of the AIDS epidemic in the country.
  • article 0 Citação(ões) na Scopus
    Ethical considerations in collective health
    (2011) SANTANA, Vilma Souza; CASTILHO, Euclides Ayres de
  • conferenceObject
    Antiretroviral Therapy at Public Health Care Facilities in Brazil: HIV/AIDS Cohort-Brazil.
    (2015) ESCUDER, M. M. L.; GRANGEIRO, A. M.; CASSENOTE, A. J. F.; KALICHMAN, A. O.; SOUZA, R. A.; TUPINAMBA, U.; VELOSO, V.; BARCELLOS, N.; GRINSZTEJN, B.; CASTILHO, E. A.
  • article 10 Citação(ões) na Scopus
    Temporal Trends and Molecular Epidemiology of HIV Type 1 Infection in Rio de Janeiro, Brazil
    (2013) PIMENTEL, Victor F.; MORGADO, Mariza G.; BELLO, Gonzalo; GUIMARAES, Mark D. C.; CASTILHO, Euclides A.; VELOSO, Valdilea G.; GUIMARAES, Monick L.
    HIV-1 molecular epidemiology studies carried out in Rio de Janeiro, Brazil have identified the prevalence of subtypes B, F1 and BF1 recombinants. A high percentage of HIV-1 subtype B isolates in Rio de Janeiro harbor the GWG motif at the V3 tip (B variant) instead of the canonical GPG motif (B variant). To trace the dynamics of the HIV-1 variants over time in different exposure categories in Rio de Janeiro, the HIV-1 proviral DNA from heterosexual men (HET) and men who have sex with men (MSM) from two distinct time periods (1990-1992 and 2008-2010) were extracted, and the env-gp120 region was amplified. Neighbor-joining phylogenetic analysis was performed to determine the viral subtype, and Bayesian analysis was used to trace the HIV-1 transmission networks. A predominance of subtype B was observed in both study periods, independent of the exposure risk category. An increase of non-B subtypes was observed in the HET group, but these subtypes were maintained among the MSM group. The distribution of HIV-1 subtype B signatures in the first and second periods studied were, respectively, HET (GPG) [44.8-51.5%], (GWG) [13.8-33.3%], and (GXG) [41.4-15.2%] and MSM (GPG) [34-50%], (GWG) [55.3-30.6%], and (GXG) [10.7-19.4%]. In the first period, an association between GWG and MSM was verified while a significant reduction of this association was observed during the second period. The phylogenetic tree and the BaTS program detected the clustering of isolates only according to the B signatures but not by exposure risk category. Our findings indicate a stable prevalence of HIV-1 subtypes B and F over time in Rio de Janeiro and further suggest that the B subclade of subtype B was possibly introduced into the MSM group in this area of Brazil.
  • article 4 Citação(ões) na Scopus
    Homeopathic Treatment of Overweight and Obesity in Pregnant Women With Mental Disorders: A Double-blind, Controlled Clinical Trial
    (2016) VILHENA, Edgard Costa de; CASTILHO, Euclides Ayres de
    Context Worldwide, 35 million people suffer from obesity. Mental disorders have been associated with being overweight or obese. Considerable evidence has shown a correlation between stress and the use of homeopathy and stress and obesity. However, few studies have examined the relationship between weight loss and homeopathic treatment of obesity. Objective The study intended to evaluate the efficacy of a homeopathic treatment in preventing excessive weight gain during pregnancy in overweight or obese women who were suspected of having a common mental disorder. Design The study was a randomized, controlled, double-blinded clinical trial. Setting The study took place at the Center for the Social Support of Motherhood (Sao Paulo, Brazil). Participants Participants were pregnant women who were enrolled at the center. Intervention For the homeopathic group, 9 drugs were preselected, including (1) Pulsatilla nigricans, (2) Sepia succus, (3) Lycopodium clavatum, (4) sulphur, (5) Lachesis trigonocephalus, (6) Nux vomica, (7) Calcarea carbonica, (8) phosphorus; and (9) Conium maculatum. From those 9 drugs, 1 was prioritized for administration for each participant. After the first appointment, a reselection or selection of a new, more appropriate drug occurred, using the list of preselected drugs. The dosage was 6 drops orally 2 x/d, in the morning and at night, on 4 consecutive days each wk, with an interval of 3 d between doses, up until the next appointment medical appointment. The control group received the equivalent placebo drug. Both groups also received a diet orientation. Outcome Measures We evaluated pregnant women who were overweight or had class 1 or 2 obesity and were suspected of having a common mental disorder, with no concomitant diseases, in 2 groups: those receiving a placebo (control group, n = 72); and those receiving homeopathic treatment (homeopathy group, n = 62). Weight change during pregnancy was defined as the difference between the body mass index (BMI) at the initial evaluation and that recorded at the final evaluation, adjusted for 40 wk of gestation. In addition, the APGAR index in the newborn was evaluated as a possible complication. Results The mean variation between baseline BMI and BMI at week 40 of gestation was + 4.95 kg/m(2) in the control group and + 5.05 kg/m(2) in the homeopathy group. The difference between the 2 groups was not significant (P = .815; 95% confidence interval [CI], -0.916 to 0.722). APGAR 10 at 5 min (59.6% in homeopathy group and 36.4% among control) was statistically significant (P = .016). Conclusions Homeopathy does not appear to prevent excessive body mass gain in pregnant women who are overweight or obese and suspected of having a common mental disorder. Homeopathy did not change the APGAR score to modified clinical attention at delivery room. However, the evidence observed at APGAR 10 at minute 5 suggests that homeopathy had a modulating effect on the vitality of newborns, warranting further studies designed to investigate it.
  • article 19 Citação(ões) na Scopus
    Pre-exposure and postexposure prophylaxes and the combination HIV prevention methods (The Combine! Study): protocol for a pragmatic clinical trial at public healthcare clinics in Brazil
    (2015) GRANGEIRO, Alexandre; COUTO, Marcia Thereza; PERES, Maria Fernanda; LUIZ, Olinda; ZUCCHI, Eliana Miura; CASTILHO, Euclides Ayres de; ESTEVAM, Denize Lotufo; ALENCAR, Rosa; WOLFFENBUETTEL, Karina; ESCUDER, Maria Mercedes; CALAZANS, Gabriela; FERRAZ, Dulce; ARRUDA, Erico; CORREA, Maria da Gloria; AMARAL, Fabiana Rezende; SANTOS, Juliane Cardoso Villela; ALVAREZ, Vivian Salles; KIETZMANN, Tiago
    Introduction: Few results from programmes based on combination prevention methods are available. We propose to analyse the degree of protection provided by postexposure prophylaxis (PEP) for consensual sexual activity at healthcare clinics, its compensatory effects on sexual behaviour; and the effectiveness of combination prevention methods and pre-exposure prophylaxis (PrEP), compared with exclusively using traditional methods. Methods and analysis: A total of 3200 individuals aged 16 years or older presenting for PEP at 5 sexually transmitted disease (STD)/HIV clinics in 3 regions of Brazil will be allocated to one of two groups: the PEP group-individuals who come to the clinic within 72 h after a sexual exposure and start PEP; and the non-PEP group-individuals who come after 72 h but within 30 days of exposure and do not start PEP. Clinical follow-up will be conducted initially for 6 months and comprise educational interventions based on information and counselling for using prevention methods, including PrEP. In the second study phase, individuals who remain HIV negative will be regrouped according to the reported use of prevention methods and observed for 18 months: only traditional methods; combined methods; and PrEP. Effectiveness will be analysed according to the incidence of HIV, syphilis and hepatitis B and C and protected sexual behaviour. A structured questionnaire will be administered to participants at baseline and every 6 months thereafter. Qualitative methods will be employed to provide a comprehensive understanding of PEP-seeking behaviour, preventive choices and exposure to HIV. Ethics and dissemination: This study will be conducted in accordance with the resolution of the School of Medicine Research Ethics Commission of Universidade de Sao Paulo (protocol no. 251/14). The databases will be available for specific studies, after management committee approval. Findings will be presented to researchers, health managers and civil society members by means of newspapers, electronic media and scientific journals and meetings.
  • article 12 Citação(ões) na Scopus
    Association between the timing of maternal vaccination and newborns' anti-pertussis toxin antibody levels
    (2019) VAZ-DE-LIMA, Lourdes R. A.; SATO, Helena Keico; FERNANDES, Eder Gatti; SATO, Ana Paula Sayuri; PAWLOSKI, Lucia C.; TONDELLA, Maria Lucia; BRITO, Cyro A. de; LUNA, Expedito J. A.; CARVALHANAS, Telma Regina M. P.; CASTILHO, Euclides A. de; SOUZA, Edna M. de; ATOBE, Jane H.; OLIVEIRA, Carmem A. F.; LEITE, Daniela; SILVA, Marcela R.; MARIANI-NETO, Corintio; BERSUSA, Ana; CALABRESI, Rita de Cassia S.; SANTOS, Rosemary A. dos; TESSER, Diva T.; RAMOS, Maria Ligia Bacciotte
    Background: Pertussis remains an important global public health concern, despite the presence of extensive immunization programs. Incidence and severity of pertussis are typically higher in neonates and young infants. As a strategy to protect these young infants, maternal vaccination with Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) has been recommended in Brazil. The objective of this study was to evaluate the effects of Tdap vaccination during pregnancy on the anti-pertussis toxin (PT) IgG response in mothers and their infants at birth. Material and methods: Maternal and cord blood samples were collected from vaccinated (n = 243) and unvaccinated (n = 75) pregnant women, at the time of delivery, from July 2015 to August 2016 in Sao Paulo, Brazil. Anti-PT IgG antibodies were quantified by Enzyme-Linked Immunosorbent Assay (ELISA) and geometric mean concentrations (GMC) were calculated. Relationship between timing of vaccination and antibody concentrations were evaluated. Results: Maternal and cord blood GMCs among the vaccinated group were 5.4 and 5.6 fold higher [66.5 International Units (IU)/mL and 89.8 IU/mL] compared to the unvaccinated group (12.4 IU/mL and 16.1 IU/mL), respectively (p < 0.001). Higher anti-PT IgG GMCs were observed when vaccination occurred >= 60 days before delivery compared to <60 days, suggesting that vaccination early in the third trimester may be more effective than later in pregnancy. Conclusion: Tdap maternal vaccination results in significantly higher anti-FT IgG in newborn infants and supports the current recommendation of the Brazilian Immunization Program.