ANTONIO GOMES DE AMORIM FILHO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina
19 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 19
- Sorting pain out of salience: assessment of pain facial expressions in the human fetus(2021) BERNARDES, Lisandra S.; CARVALHO, Mariana A.; HARNIK, Simone B.; TEIXEIRA, Manoel J.; OTTOLIA, Juliana; CASTRO, Daniella; VELLOSO, Adriano; FRANCISCO, Rossana; LISTIK, Clarice; GALHARDONI, Ricardo; SILVA, Valquiria Aparecida da; MOREIRA, Larissa I.; FILHO, Antonio G. de Amorim; FERNANDES, Ana M.; ANDRADE, Daniel Ciampi deIntroduction:The question of whether the human fetus experiences pain has received substantial attention in recent times. With the advent of high-definition 4-dimensional ultrasound (4D-US), it is possible to record fetal body and facial expressions.Objective:To determine whether human fetuses demonstrate discriminative acute behavioral responses to nociceptive input.Methods:This cross-sectional study included 5 fetuses with diaphragmatic hernia with indication of intrauterine surgery (fetoscopic endoluminal tracheal occlusion) and 8 healthy fetuses, who were scanned with 4D-US in 1 of 3 conditions: (1) acute pain group: Fetuses undergoing intrauterine surgery were assessed in the preoperative period during the anesthetic injection into the thigh; (2) control group at rest: Facial expressions at rest were recorded during scheduled ultrasound examinations; and (3) control group acoustic startle: Fetal facial expressions were recorded during acoustic stimulus (500-4000 Hz; 60-115 dB).Results:Raters blinded to the fetuses' groups scored 65 pictures of fetal facial expressions based on the presence of 12 items (facial movements). Analyses of redundancy and usefulness excluded 5 items for being of low discrimination capacity (P>0.2). The final version of the pain assessment tool consisted of a total of 7 items: brow lowering/eyes squeezed shut/deepening of the nasolabial furrow/open lips/horizontal mouth stretch/vertical mouth stretch/neck deflection. Odd ratios for a facial expression to be detected in acute pain compared with control conditions ranged from 11 (neck deflection) to 1,400 (horizontal mouth stretch). Using the seven-item final tool, we showed that 5 is the cutoff value discriminating pain from nonpainful startle and rest.Conclusions:This study inaugurates the possibility to study pain responses during the intrauterine life, which may have implications for the postoperative management of pain after intrauterine surgical interventions
- COL1A1, COL4A3, TIMP2 and TGFB1 polymorphisms in cervical insufficiency(2021) ALVES, Ana Paula V. D.; FREITAS, Amanda B.; LEVI, Jose Eduardo; AMORIM FILHO, Antonio G.; FRANCO, Lucas A. M.; HOSHIDA, Mara Sandra; PATINO, Elizabeth G.; V, Rossana P. Francisco; CARVALHO, Mario Henrique B.Objectives: To investigate the association between selected single nucleotide polymorphisms (SNPs) with cervical insufficiency and its relationship with obstetric history. Methods: Twenty-eight women with cervical insufficiency (case group) and 29 non-pregnant women (control group) were included. The SNPs sequenced included rs2586490 in collagen type I alpha 1 chain (COL1A1), rs1882435 in collagen type IV alpha 3 chain (COL4A3), rs2277698 in metallopeptidase inhibitor 2 (TIMP2), and rs1800468 in transforming growth factor beta 1 (TGFB1). Results: We found a higher frequency of the normal allele in the control group (65.5%) and the homozygous mutated genotype in the case group (64.3%) for rs2586490 in COL1A1 (p=0.023). An unplanned finding in the cervical insufficiency group was a higher gestational age of delivery (median >= 38 weeks) in the mutated allele than in the wildtype genotype (median of 28.2 weeks) for rs2857396, which is also in the COL1A1 gene (p=0.011). Conclusions: The findings of the present study corroborate the hypothesis that cervical insufficiency has a genetic component and probably involves genes encoding proteins in the extracellular matrix, in addition to inflammatory processes.
- Emergency cerclage: gestational and neonatal outcomes(2019) COSTA, Maira Marinho Freire; AMORIM FILHO, Antonio Gomes de; BARROS, Monica Fairbanks de; RODRIGUES, Agatha Sacramento; ZUGAIB, Marcelo; FRANCISCO, Rossana Pulcineli Vieira; CARVALHO, Mario Henrique Burlacchini deBACKGROUND: The gestational and neonatal outcomes of women with early cervical dilatation undergoing emergency cerclage were evaluated and compared with women treated with expectant management and bed rest. METHODS: Retrospective analysis of pregnant women admitted between 2001 and 2017 with a diagnosis of early cervical dilatation and/or bulging membranes. Patients with a singleton pregnancy of a fetus without malformations, between 16 and 25 weeks and 6 days, with cervical dilatation of 1 to 3 cm were included; patients who delivered or miscarried within 2 days after admission were excluded. RESULTS: The study enrolled 30 patients: 19 in the cerclage group and 11 in the rest group. There was a significant difference, with the cerclage group showing better results concerning gestational age at delivery (28.7 vs. 23.3 weeks; p= 0.031) and latency between hospital admission and delivery (48.6 vs. 16 days; p= 0.016). The fetal death rate was lower in the cerclage group (5.3% vs. 54.5%, p= 0.004). Considering gestational age at delivery of live newborns, no difference was observed between the cerclage and rest groups (29.13 vs. 27.4 weeks; p= 0.857). CONCLUSIONS: Emergency cerclage was associated with longer latency, a significant impact on gestational age at delivery and reduction in the fetal death rate.
- Performance of a Multiplex Nested Polymerase Chain Reaction in Detecting 7 Pathogens Containing DNA in Their Genomes Associated With Congenital Infections(2020) YAMAMOTO, Lidia; AMORIM FILHO, Antonio G.; QUEIROZ, Joelma A.; CARVALHO, Mario H. B. de; RODRIGUES, Jonatas C.; KANUNFRE, Kelly A.; V, Rossana P. Francisco; OKAY, Thelma SuelyContext.-Infections are the leading cause of perinatal and infant mortality in low-income and low-resource countries, which have a higher prevalence of infections. Definitive diagnosis of congenital and perinatal infections is largely dependent upon the results of laboratory tests. Objective.-To develop a multiplex nested polymerase chain reaction (PCR) technique for the simultaneous detection of 7 pathogens containing DNA in their genomes in suspected cases of congenital infection. Design.-Eligible participants were pregnant women with positive immunoglobulin M antibodies raised to one of the pathogens in the prenatal serologic screening, associated or not with fetal ultrasound abnormalities or positive fetal serology. Neonates whose mothers did not attend prenatal care were included when they presented with symptomatology and laboratory parameters suggestive of infection. The detection rate of the multiplex nested PCR was compared with maternal, fetal, and neonatal serology, as well as placental immunohistochemistry and noncommercial amplifications. Results.-Of 161 suspected cases, the multiplex nested PCR detected 60 (37.3%), whereas the tests available in hospital laboratories detected 13 of 60 (21.7%) of the cases detected by the multiplex nested PCR, demonstrating a 4.6 times higher detection rate for the multiplex nested PCR (Fisher exact test, P < .001). Positive amplifications were to Toxoplasma gondii (32 cases), cytomegalovirus (14 cases), parvovirus B19 (5 cases), and adenovirus (5 cases). In 4 cases, 2 pathogens were simultaneously detected. All types of biological matrices were suitable for amplification. Sequencing of multiplex nested PCR products confirmed the molecular findings. Conclusions.-The multiplex nested PCR significantly increased the number of diagnosed congenital infections. Given the scarcity of DNA recovered from amniotic fluid and some neonatal samples, this multiplex nested PCR allows the simultaneous detection of 7 pathogens associated with congenital infections in a reliable, faster, cost-effective, and more sensitive way.
conferenceObject GENETIC POLYMORPHISMS RELATED TO HEMOSTASIS AND THEIR ASSOCIATION WITH PRIMARY RECURRENT PREGNANCY LOSS(2013) GUERRA-SHINOHARA, E.; BERTINATO, J.; GOMES, G.; BOACNIN, M. do Rosario; AMORIM-FILHO, A.; CARVALHO, M. Burlacchini de; ZUGAIB, Marcelo- Validation of QF-PCR for prenatal diagnoses in a Brazilian population(2017) MORAES, Renata Wendel de; CARVALHO, Mario Henrique Burlacchini de; AMORIM-FILHO, Antonio Gomes de; FRANCISCO, Rossana Pulcineli Vieira; ROMAO, Renata Moscolini; LEVI, Jose Eduardo; ZUGAIB, MarceloOBJECTIVES: Quantitative fluorescence polymerase chain reaction (QF-PCR) is a rapid and reliable method for screening aneuploidies, but in Brazil, it is not used in public services. We investigated the accuracy of QF-PCR for the prenatal recognition of common aneuploidies and compared these results with cytogenetic results in our laboratory. METHOD: A ChromoQuant QF-PCR kit containing 24 primer pairs targeting loci on chromosomes 21, 13, 18, X and Y was employed to identify aneuploidies of the referred chromosomes. RESULTS: A total of 162 amniotic fluid samples analyzed using multiplex QF-PCR were compared with karyotyping analysis. The QF-PCR results were consistent with the results of cytogenetic analysis in 95.4% of all samples. CONCLUSION: QF-PCR was demonstrated to be efficient and reliable for prenatal aneuploidy screening. This study suggests that QF-PCR can be used as a rapid diagnostic method. However, rearrangements and some mosaic samples cannot be detected with this test; thus, those exceptions must undergo cytogenetic analysis.
bookPart Abortamento habitual(2013) AMORIM FILHO, Antonio Gomes de; CARVALHO, Mário Henrique Burlacchin de; ZUGAIB, Marcelo- Open fetal myelomeningocele repair at a university hospital: surgery and pregnancy outcomes(2021) ROCHA, Luana Sarmento Neves da; BUNDUKI, Victor; AMORIM FILHO, Antonio Gomes de; CARDEAL, Daniel Dante; MATUSHITA, Hamilton; FERNANDES, Hermann Santos; NANI, Fernando Souza; FRANCISCO, Rossana Pulcineli Vieira de; CARVALHO, Mario Henrique Burlacchini dePurpose Myelomeningocele (MMC) is an open neural tube defect that causes great morbidity. Prenatal open repair is the standard treatment; however, there are many complications related to the procedure. This study reports preliminary findings of open in utero repair of MMC in a public tertiary hospital in Brazil and describes factors that could be associated with increased surgical morbidity. Methods Thirty-nine patients underwent open in utero repair of MMC from October 2015 to August 2019. The Clavien-Dindo classification of surgical complications and a classification system with the preterm definitions of the World Health Organization were used, respectively, for maternal and fetal complications. Results A total of 28 mothers (71.8%) and 31 fetuses (79.5%) experienced at least one minor to major complication. Three mothers (7.7%) had a severe grade 4 complication. Fetal complications grades 3 to 5 occurred in 13 fetuses (33.3%). Gestational age at surgery and at birth were 24.88 +/- 1.16 weeks and 33.23 +/- 3.68 weeks, respectively. Preterm delivery occurred in 30 patients (76.9%), membrane rupture in 18 patients (46.2%) and chorioamnionitis in 13 patients (33.3%). Conclusion Open fetal surgery for MMC was performed at a Brazilian public tertiary care center, resulting in three grade 4 maternal complications. Relevant fetal complications were also present. The use of a standard classification system for complications renders studies more comparable and data more useful for counseling patients. Adjustments of perioperative procedures and long-term follow-up are needed to determine the real benefit of open in utero repair of MMC at our hospital.
- On the feasibility of accessing acute pain-related facial expressions in the human fetus and its potential implications: A case report(2018) BERNARDES, L. S.; OTTOLIA, J. F.; CECCHINI, M.; FILHO, A. G. D. A.; TEIXEIRA, M. J.; FRANCISCO, R. P. V.; ANDRADE, D. C. DeIntroduction: Although pain facial assessment is routinely performed in term and preterm newborns by the use of facial expression-based tools such as the Neonatal Facial Coding System, the assessment of pain during the intrauterine life has not been extensively explored. Objective: Describe for the first time, an experimental model to assess and quantify responses due to acute pain in fetuses undergoing anaesthesia for intrauterine surgery recorded by high-resolution 4D ultrasound machines. Methods/results-case report: A 33-year-old pregnant woman had congenital left diaphragmatic hernia of poor prognosis diagnosed, and her fetus was treated by fetoscopic endotracheal occlusion. Later, during the removal of the fetal endotracheal balloon by ultrasound-guided puncture, we have recorded facial expressions of the foetus before and after the anaesthetic puncture by the use of 4D ultrasound recordings, which were presented to 3 blinded coders instructed to use the Neonatal Facial Coding System for acute pain facial coding. The procedure was safe and feasible. Conclusion: This is the first description of a recordable acute pain model in the human fetus by the use of a facial expression-based tool. The possibility to assess pain-related intrauterine behaviours would allow not only for the monitoring of the efficacy of anaesthetic procedures in the fetus but would also open the way to explore the evolution of pain-related facial responses during the fetal neurodevelopment. This method may pave the way for objective assessments of pain in fetuses, should it endure the steps of formal validation studies. © Copyright © 2018 The Author(s).
- Análise dos resultados maternos e fetais dos procedimentos invasivos genéticos fetais: um estudo exploratório em Hospital Universitário(2012) KOHATSU, Mario; CARVALHO, Mario Henrique Burlacchini de; FRANCISCO, Rossana Pulcineli Vieira; AMORIM FILHO, Antonio Gomes de; ZUGAIB, MarceloAnalysis of fetal and maternal results from fetal genetic invasive procedures: an exploratory study at a University Hospital Objective: To characterize the indications of pregnant women who sought the Fetal Medicine Services of the Hospital das Clinicas, at the Medical School of the Universidade de Sao Paulo for performing invasive diagnostic procedures, and to evaluate the results of fetal karyotypes and their pregnancies. Methods: A retrospective and observational study on pregnant women who underwent chorionic villus sampling (CVS), amniocentesis, and cordocentesis in the period from February, 2005 to December, 2009. Other diagnostic or therapeutic procedures were not included. The result of pregnancy was obtained by consulting patient electronic records, medical records, and/or telephone call. Results: 713 procedures were performed (113 CVS, 340 amniocenteses, and 260 cordocenteses). The main indication for performing invasive procedures was the presence of structural changes in fetuses, followed by increased values of nuchal translucency, and advanced maternal age. Fetal karyotype was altered in 186 cases (26.1%). The 18 trisomy was the commonest aneuploidy followed by the 21 trisomy, X monosomy, and 13 trisomy. There were 4.9% cases of miscarriage, 25.7% cases of stillborn infants, and 13% cases of neonatal deaths. Eight pregnant women opted for legally induced abortion. 99% of pregnant women whose fetuses did not present abnormalities and presented normal fetal karyotype had infants who were born alive.