MARIA RITA POLO GASCON
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- Neuropsychological profile of patients with infectious disease: characterization and comparison of patients with HIV, HTLV, and HCV(2023) GASCON, Maria Rita Polo; OLIVEIRA, Giovana S. de; LAURENCE, Paulo Guirro; GUALQUI, Carolina Fernandes; OLIVEIRA, Augusto Cesar Penalva de; SMID, Jerusa; FONSECA, Luiz A. M.; CASSEB, Jorge; MACEDO, Elizeu CoutinhoUnderstanding the effect of the HIV, HTLV-1, and HCV viruses on cognitive aspects can help in the better characterization of dementia, as well as the best conducts to be suitable for rehabilitation. Thus, the present study aimed to characterize and compare the neuropsychological profile of 3 groups of patients with infectious diseases: HIV, HTLV, and HCV. The results of neuropsychological assessments and depression assessment of 325 people treated at a referral hospital for infectious dis-eases were analyzed, being 120 HIV carriers (74 (61.7%) men) with an average age of 47.5 years (SD = 10.3), 65 patients with HTLV-1 (16 (24.6%) men) with a mean age of 49.9 years (SD = 12.9), and 87 HCV patients (47 (54%) men) with a mean age of 55.5 years (SD = 11.2). In addition, 54 people (26 (48.1%) men) with negative serology who made up the con-trol group were evaluated. The results of the statistical evaluation of the sociodemographic factors of the four groups (HIV, HTLV-1, HCV, and control) showed that in addition to age, schooling was a significant factor among them and may have a strong influence on the performance of cognitive tests. The HTLV-1 group had the lowest neurocognitive performance and also the highest rate of depressive symptoms.
- Prevalence of cognitive impairment in HIV patients: vertical and horizontal transmission(2022) GASCÓN, Maria Rita Polo; TERRA, Cauê Peter da Cruz; GUERRA, Hestela de Lima; GUALQUI, Carolina Fernandes; LUCIA, Mara Cristina Souza De; BENUTE, Glaucia Rosana Guerra; FONSECA, Luiz Augusto Marcondes; CASSEB, Jorge; VIDAL, Jose Ernesto; OLIVEIRA, Augusto César Penalva deABSTRACT. Antiretroviral treatment has significantly increased the survival of patients infected with HIV-1. However, with increased survival, cognitive changes associated with HIV are frequently observed in this population. The clinical manifestations of HIV changes can vary as a result of several aspects, including the virus transmission route. Several studies have pointed out premature neurological changes in vertically infected patients, while the manifestation of cognitive damage in adults may take a longer time. Objective: The aim of this study was to verify the prevalence of cognitive changes in patients with HIV via vertical transmission after the highly active antiretroviral therapy and the cognitive performance of these patients compared to a group of sexually infected patients. Methods: A total of 48 patients were evaluated, 25 with vertical transmission and 23 with sexual transmission, between May 2013 and February 2015 at the Institute of infectology Emilio Ribas. Neuropsychological tests were applied to assess cognitive performance, scales to assess symptoms of anxiety and depression, and sociodemographic questionnaire. Results: The results demonstrate that the frequency of cognitive impairment in vertically transmitted patients was higher than in sexually transmitted patients. Conclusions: These findings suggest that the deleterious effects of the HIV virus on the development of the central nervous system reverberate more strongly than in patients who acquire it after adulthood.
- Prevalence of depression and anxiety disorders in hospitalized patients at the dermatology clinical ward of a university hospital(2012) GASCON, Maria Rita Polo; RIBEIRO, Cristiana Mara; BUENO, Livia Maria de Araujo; BENUTE, Glaucia Rosana Guerra; LUCIA, Mara Cristina Souza de; RIVITTI, Evandro Ararigboia; FESTA NETO, CyroBACKGROUND: The objective of this study was to estimate the prevalence of depression and anxiety disorders in hospitalized patients at the dermatology ward at a university hospital in Sao Paulo, Brazil. OBJECTIVE: To assess the prevalence of mood and anxiety disorders in hospitalized patients at the dermatology ward at a university hospital in Sao Paulo. METHOD: A total of 75 patients, men and women, aged between 18 and 76 years, took part in the research. The study employed a descriptive, cross sectional and correlational method. The data was collected by means of a social demographic questionnaire and the PRIME-MD. RESULTS: It was found that 45.3 percent of the subjects presented with depressive symptoms, and 52 percent presented with symptoms of anxiety and that this survey showed moderate and high significant correlations (p<0,01; r= 0,616) for depression and anxiety. CONCLUSION: These facts could evidence the relationship between physical and psyche, just as the literature presents.
- Prevalence of Antiretroviral Drug Resistance Mutations in HIV Seropositive Patients from an Outpatient Clinic of a Large University Hospital from Sao Paulo, Brazil(2020) CONSTANTINOV, Ericka Oliveira; BRIGIDO, Luis Fernando de Macedo; FONSECA, Luiz Augusto M.; CASSEB, Jorge; VEIGA, Ana Paula R.; MAGRI, Marcello M. C.; MONTEIRO, Mariana A.; ROCHA, Rosana C.; GASCON, Maria R. P.; FERREIRA, Mauricio D.; POLIS, Thales J. B.; NASCIMENTO, Najara A. de Lima; LIMONGELLI, Isadora Id; OLIVEIRA, Caro S.; FONSECA, Luiz A. M.; DUARTE, Alberto J. S.Drug resistance mutations (DRMs) can affect the success of the therapy and compromise new prevention strategies. Increasing rates of resistance to antiretroviral (ARV) drugs have been reported in some areas. This study evaluated the DRMs prevalence among patients at Hospital das Clinicas (Sao Paulo). Among treatment-naive patients, the prevalence of transmitted DRMs (Stanford Calibrated Population Resistance) was 8.4% (21/249), with 69% (75/109) of acquired resistance among treatment-experienced patients. Rates of transmitted DRM showed an increase (6.6% in 2002-2009 vs. 15.1% in 2010-2015, p = .05), from the first to the second decade, mainly due to mutations to the NNRTI (non-nucleoside reverse transcriptase inhibitor) class. Among treatment-experienced cases, a nonsignificant decrease overall, significant for the protease inhibitors (PIs) class, was documented. Subtype B predominated in both groups (78%), followed by subtype F, BF recombinants, and subtype C. Our results add to the growing evidence of an increase in transmitted DRM, document extensive DRM among experienced patients, and a decrease in resistance to PIs class that may reflect the increased use of boosted PIs and newer ARV classes in more recent years.
- Memory impairment: an intermediate clinical syndrome symptom in HTLV-1-infected patients?(2019) GASCON, Maria Rita; HAZIOT, Michel E.; ASSONE, Tatiane; FONSECA, Luiz Augusto M.; SMID, Jerusa; OLIVEIRA, Augusto Cesar Penalva de; CASSEB, JorgeBackground: Although classical human T-cell lymphocyte virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis syndrome is the most frequent HTLV-1-associated neurological disorder, some ""minor"" neurological disorders can be seen in ""asymptomatic"" carriers. These disorders, including cognitive alterations already described in clinical cases and studies, may constitute an intermediate syndrome (IMS) between the asymptomatic state and myelopathy. The aim of this study was to investigate the presence of cognitive deficits in patients with HTLV-1 virus, who usually are diagnosed as asymptomatic. Methods: A total of 54 HTLV-1-infected patients were evaluated, 35 asymptomatic and 19 with minor neurological alterations (evaluated by a neurologist); 25 HTLV-1-seronegative individuals served as controls. The instruments used were: Beck's Depression Inventory, Lawton's Daily Life Activity Scale, and a complete neuropsychological battery. The application of these evaluation instruments was performed blindly, with the evaluator neuropsychologist not knowing the clinical condition of the patient. Results: Most of the participants in this cohort, including seronegative controls, were female (n = 57, 72.21%), their mean age was 52.34 years (SD = 14.29) and their average schooling was 9.70 years (SD = 4.11). Discussion: Participants classified with IMS had lower gross scores when compared with both the patients classified as asymptomatic and with the control group, and when tested for auditory episodic memory of immediate (p < 0.01), and late (p = 0.01), recall. Conclusion: Patients with IMS presented with memory impairment when compared with asymptomatic patients and seronegative individuals; this is one of the symptoms that aids in the classification of the syndrome.
article 4 Citação(ões) na Scopus Alcohol consumption in adolescence: A literature review(2017) VALIM, G. G.; SIMIONATO, P.; GASCON, M. R. P.Objective: The main goal of the present study was to analyze the scientific production about teenage alcohol consumption. Data sources: Literature review conducted in September 2016 by searching the SciELO (Scientific Electronic Library Online) and LILACS (Latin American and Caribbean Health Sciences) database, through the keywords: teenager and alcoholism; adolescence and alcoholism; teenager and alcohol; adolescence and alcohol. The inclusion criteria adopted for sample selection were: scientific papers that addressed alcohol consumption in adolescence, as well as abusive use of the substance, fully available electronically, written in Portuguese and published in Brazil between 2006 and September 2016. The exclusion criteria adopted were: scientific papers at odds with the topic of investigation, published in another language and countries, other life phases rather than adolescence, and papers about the use of another substances. Data synthesis: 24 articles that fit the inclusion criteria were found. Conclusion: Alcohol consumption is occurring more and more precocious and has negative consequences and risk behavior. As an attempt to stop this abusive consumption in this population, the present study suggests more parental control, awareness campaigns, more efficient public policy regarding control and supervision of publicity and sale of alcohol. © 2017, Nucleo de Estudos da Saude do Adolescente. All rights reserved.- SARS-CoV-2/COVID-19: Clinical Course Among Subjects HIV-1-Infected in Sao Paulo(2022) MONTEIRO, Mariana A. A.; PRATES, Gabriela S. S.; NASCIMENTO, Najara A. A. de Lima; VEIGA, Ana Paula R.; MAGRI, Marcello M. C.; POLIS, Thales J. B.; GASCON, Maria R. P.; FERREIRA, Mauricio D. D.; TIBERTO, Larissa; PEREIRA, Luisa O. O.; ALVES, Wagner; FONSECA, Luiz A. M.; DUARTE, Alberto J. S.; CASSEB, JorgeIntroduction: People living with Human Immunodeficiency Virus (HIV) are under risk for co-infection with SARS-CoV-2. This population may be more prone to complications from COVID-19 due to persistent inflammation caused by HIV and higher incidence of metabolic syndromes, cardiovascular diseases, and malignancies, as well as being considered elderly at 50 years of age. The objective of this study was to report SARS-CoV-2 infection frequency, clinical evolution, and mortality in HIV-positive patients on antiretroviral therapy. Methods: The period of inquiry ranged from January to September 2020. Due to the social distance and the suspension of in-person medical care during the time of the investigation, we sent electronic questions about demographic, epidemiological, and clinical data to 403 HIV-infected patients. Results: Among 260 patients who answered the questionnaire, thirty-nine patients (15%) had suggestive symptoms and were tested for SARS-CoV-2 infection. Of this, 11 had positive results (32.4%) and no patient died of COVID-19 complications. Nine were male (3.4%), and the mean age of the patients with positive results was 43.2 years (+/- 9.6). 107 patients (41.1%) were over 50 years of age and their mean T-CD4(+) cell count was 768. Eleven patients (4.2%) had a detectable HIV RNA viral load and 127 (48.8%) had comorbidities. These variables were not associated with an increased risk for infection. Conclusion: The frequency of SARS-COV2 infection among HIV-infected is similar to the general population, and the clinical course is associated with the presence of comorbidities and not due to the HIV infection. However, new studies should be done to assess if this vulnerable population could answer the vaccine anti-SARS-Cov2.
- Neuropsychological Assessment of 412 HIV-Infected Individuals in Sao Paulo, Brazil(2018) GASCON, Maria Rita Polo; VIDAL, Jose Ernesto; MAZZARO, Yolanda Marques; SMID, Jerusa; MARCUSSO, Rosa Maria Nascimento; CAPITAO, Claudio Garcia; COUTINHO, Elizeu Macedo; BENUTE, Glaucia Rosana Guerra; LUCIA, Mara Cristina Souza De; OLIVEIRA, Augusto Cesar Penalva deHIV-associated neurocognitive disorders (HAND) remain frequent even among individuals receiving combined antiretroviral therapy (cART). In addition, HAND may adversely affect the quality of life and adherence to cART. There is scarce epidemiological information about HAND in Latin America. This cross-sectional study recruited HIV-infected patients from a tertiary teaching institution in Sao Paulo, Brazil, between May 2013 and February 2015. The patients were adults with at least 4 years of education and patients with current neurological or psychiatric diseases were excluded. HAND remain frequent even among individuals receiving cART, use of psychoactive substance, or inability to understand the content for neuropsychological evaluation. We used standardized tools to evaluate depression, use of psychoactive substances, and daily life activities, and we performed a comprehensive neuropsychological examination. HAND was classified using the Frascati criteria. Prevalence of HAND was estimated, and an associated variable of symptomatic HAND was identified by logistic regression. Four-hundred twelve HIV-infected patients were included [male: 281 (68%), mean age of 45.3 years]. Most of them [n = 340 (83.7%)] had an undetectable viral load. The prevalence of HAND was 73.6% (n = 303): 210 (50.9%) had asymptomatic neurocognitive involvement (ANI), 67 (16.2%) had mild neurocognitive disorder (MND), and 26 (6.3%) had HIV-associated dementia (HAD). The univariate logistic regression analysis showed that female gender, age older than 50 years, <11 years of schooling, CD4 count below 200 cells/mm(3), presence of previous illnesses (e.g., diabetes, hypertension), opportunistic disease history, and a Beck Depression Inventory (BDI) score between 13 and 19 points were factors associated with symptomatic HAND (MND and HAD). However, a BDI score between 13 and 19 points was the single independent variable associated with symptomatic HAND. HAND was highly prevalent in Sao Paulo, Brazil, and ANI was the more frequent category of HAND. However, 22.5% of participants had symptomatic HAND. This finding constitutes a challenge in clinical practice. A BDI score between 13 and 19 points was the single independent variable associated with symptomatic HAND.
- Cognitive assessment in patients with Hepatitis C submitted to treatment with Sofosbuvir and Simeprevir or Daclatasvir(2020) GASCON, Maria Rita Polo; BENUTE, Glaucia Rosana Guerra; MACEDO, Elizeu Coutinho; CAPITAO, Claudio Garcia; VIDAL, Jose Ernesto; SMID, Jerusa; MARCUSSO, Rosa Maria Nascimento; LUCIA, Mara Cristina Souza de; PENALVA-DE-OLIVEIRA, Augusto Cesar; DIAMENT, DecioBackground:Hepatitis C can be defined as an infectious disease that develops an inflammatory activity, which may cause an impairment in the central nervous system, may cause cognitive impairments and symptoms of depression.Objective:The objective of this study was to verify the cognitive performance of patients with chronic hepatitis C before and after treatment with simeprevir, sofosbuvir, and daclatasvir. Methods:A prospective study was carried out in three stages: before, right after treatment, and six months after. Fifty-eight patients under clinical follow-up were evaluated at the Emilio Ribas Infectology Institute, in Sao Paulo, Brazil. The following instruments were used: sociodemographic questionnaire, Lawton's Scale, Beck's Depression Inventory, and a battery of neuropsychological tests that evaluated: intellectual function, memory, attention, executive function, and motor and processing speed). For statistical analysis, the analyses described (mean, frequency, and standard deviation), chi-square, and ANOVA were used. Results:Most of the participants were male (n=30, 51.7%), with a mean of 58.23 +/- 8.79 years, mean schooling of 9.75 +/- 4.43 years. Comparing the results of neuropsychological evaluations (before, just after completion of drugs, and six months), a significant improvement was observed in relation to the acquisition of new knowledge (p=0.03), late visual memory (p=0.01), and tendency towards alternate attention (p=0.07). Conclusion:The treatment of the hepatitis C virus improved cognitive performance, especially in relation to memory.
- Cognitive Effects of Intentional Weight Loss in Elderly Obese Individuals With Mild Cognitive Impairment(2016) HORIE, Nidia Celeste; SERRAO, Valeria T.; SIMON, Sharon Sanz; GASCON, Maria Rita Polo; SANTOS, Alessandra Xavier dos; ZAMBONE, Maria Aquimara; FREITAS, Marta Merenciana del Bigio de; CUNHA-NETO, Edecio; MARQUES, Emerson Leonildo; HALPERN, Alfredo; MELO, Maria Edna de; MANCINI, Marcio C.; CERCATO, CintiaContext: Obesity in midlife is a risk factor for dementia, but it is unknown if caloric restriction-induced weight loss could prevent cognitive decline and therefore dementia in elderly patients with cognitive impairment. Objective: To evaluate the cognitive effect of intentional weight loss in obese elderly patients with mild cognitive impairment (MCI), considering the influence of age, apolipoprotein E (APOE) genotype, physical activity, biochemical markers, and diet. Design: Single-center, prospective controlled trial. Setting: Academic medical center. Participants: Eighty obese patients with MCI, aged 60 or older (68.1 +/- 4.9 y, body mass index [BMI] 35.5 +/- 4.4 kg/m(2), 83.7% women, 26.3% APOE allele epsilon 4 carriers). Intervention: Random allocation to conventional medical care alone (n = 40) or together with nutritional counselling (n = 40) in group meetings aiming to promote weight loss through caloric restriction for 12 months. Outcome Measurements: clinical data, body composition, neuropsychological tests (main outcome), serum biomarkers, APOE genotype, physical performance, dietary recalls. Results: Seventy-five patients completed the follow-up. BMI, on average, decreased 1.7 +/- 1.8kg/m(2) (P = .021), and most of the cognitive tests improved, without difference between the groups. In analysis with linear generalized models, the BMI decrease was associated with improvements in verbal memory, verbal fluency, executive function, and global cognition, after adjustment for education, gender, physical activity, and baseline tests. This association was strongest in younger seniors (for memory and fluency) and in APOE allele epsilon 4 carriers (for executive function). Changes in homeostasis model assessment-estimated insulin resistance, C-reactive protein, leptin and intake of energy, carbohydrates, and fats were associated with improvement in cognitive tests. Conclusions: Intentional weight loss through diet was associated with cognitive improvement in patients with MCI.