CARLA BALEEIRO RODRIGUES SILVA

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3
Projetos de Pesquisa
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LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina

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Agora exibindo 1 - 5 de 5
  • article 0 Citação(ões) na Scopus
    Distinct features of youth-onset primary antiphospholipid syndrome
    (2021) SILVA, Carla Baleeiro; DURAN, Camila S. C.; SIGNORELLI, Flavio; BALBI, Gustavo G. M.; BONFA, Eloisa; ANDRADE, Danieli C. O.
    Background Characteristics of primary APS (PAPS) in the youth population have never been studied. In contrast with children, pregnancy is genuinely relevant in the youth age, and understanding clinical characteristics of PAPS patients within this specific age stratum may also provide insights regarding the well-known risk of poor obstetric outcomes during the adolescence. Objective To evaluate clinical and laboratory characteristics of patients with youth-onset PAPS (15-24 years) and compare them with adult-onset PAPS (over 24 years old). Methods This was a cross-sectional study derived from two rheumatology outpatient clinics. Patients who fulfilled Sidney criteria and who were 15 years of age or older at disease onset were included. Secondary APS patients were excluded. We subdivided patients into two groups: youth- (15-24 years) and adult-onset (over 24 years) and compared them regarding demographic characteristics, criteria and non-criteria manifestations, cardiovascular risk factors, and aPL status. For the pregnancy outcomes analysis, ever-pregnant patients were divided in three groups: youth-onset, early adult-onset (25-34 years), and late adult-onset (35-49 years). Results A total of 250 consecutive PAPS patients were included. Groups had a comparable female and Caucasian distribution. We found a similar disease duration (14.0 +/- 7.9 vs 17.0 +/- 10.1 years, p = 0.079) and similar rates of thrombotic arterial (34.2% vs. 42.0%, p = 0.250) and venous events (69.7% vs. 69.5%, p = 0.975) between them. Skin ulcers were more frequent in the youth-onset group (17.1% vs. 4.0%, p = 0.001), whereas nephropathy was less common (1.3% vs. 8.0%, p = 0.039). No differences were observed for the other criteria and non-criteria manifestations. The adult-onset group presented more frequently with hypertension (p = 0.002), hyperlipidemia (p = 0.008), and smoking (p = 0.003). The youth-onset group presented a higher frequency of obstetric events as the first manifestation of PAPS (30.3% vs. 21.7%, p = 0.005), with worse pregnancy outcomes, namely, fetal death (58.5% vs. 46.4% vs. 24.1%, p = 0.012) and premature delivery (35.8% vs. 19.0% vs. 10.3%, p = 0.016). Of note, all groups had a comparable number of pregnancies (2.81 +/- 2.52 vs 2.74 +/- 2.07, p = 0.899). Conclusion This study provides novel evidence that youth-onset PAPS presents a higher frequency of obstetric complications as its first manifestation, with an increased risk of fetal death and preterm delivery. Early recognition of this condition by obstetricians is essential to improve prognosis.
  • article 1 Citação(ões) na Scopus
    Successful endovascular correction of common carotid pseudoaneurysm secondary to Behcet's disease: case report and review of the literature
    (2020) SILVA, C. B. R.; REBOUCAS, J. C.; NUNES, S. L. O.; LUCCIA, N. de; PEREIRA, R. M. R.
    Behcet's disease (BD) is a chronic, multisystemic, inflammatory disease characterised by recurrent mucocutaneous, ocular, musculoskeletal, central nervous system, gastrointestinal and vascular manifestations, which may affect blood vessels of any size (1). Venous involvement is more common, but arterial involvement accounts for the major cause of mortality (2, 3). Choosing the adequate technique for correcting aneurysms in BD and the timing to do it is still challenging. The authors report a case of 37-year-old male patient with common carotid pseudoaneurysm at the time of diagnosis, which was successfully treated by an endovascular stent placement after adequate immunosuppression. A review of the literature about this issue was also done.
  • article 25 Citação(ões) na Scopus
    Influence of vitamin D status on hospital length of stay and prognosis in hospitalized patients with moderate to severe COVID-19: a multicenter prospective cohort study
    (2021) REIS, Bruna Z.; FERNANDES, Alan L.; SALES, Lucas P.; SANTOS, Mayara D.; SANTOS, Caroline C. Dos; PINTO, Ana J.; GOESSLER, Karla F.; FRANCO, Andre S.; DURAN, Camila S. C.; SILVA, Carla B. R.; MACEDO, Marina B.; DALMOLIN, Henrique H. H.; BAGGIO, Janaina; BALBI, Guilherme G. M.; ANTONANGELO, Leila; CAPARBO, Valeria F.; GUALANO, Bruno; MURAI, Igor H.; PEREIRA, Rosa M. R.
    Background: Vitamin D acts as a mediator in the immune system regulating antiviral mechanisms and inflammatory processes. Vitamin D insufficiency has been suggested as a potential risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, although its impact on the prognosis of hospitalized patients with coronavirus disease 2019 (COVID-19) remains unclear. Objective: This multicenter prospective cohort study was designed to investigate whether serum 25-hydroxyvitamin D [25(OH)D] concentration is associated with hospital length of stay and prognosis in hospitalized patients with COVID-19. Methods: Patients with moderate to severe COVID-19 (n = 220) were recruited from 2 hospitals in Sao Paulo, Brazil. Serum 25(OH)D concentrations were categorized as follows: <10 ng/mL, 10 to <20 ng/mL, 20 to <30 ng/mL, and >= 30 ng/mL, and <10 ng/mL and >= 10 ng/mL. The primary outcome was hospital length of stay and the secondary outcomes were the rate of patients who required invasive mechanical ventilation and mortality. Results: There were no significant differences in hospital length of stay when the 4 25(OH)D categories were compared (P = 0.120). Patients exhibiting 25(OH)D<10 ng/mL showed a trend (P = 0.057) for longer hospital length of stay compared with those with 25(OH)D >= 10 ng/mL [9.0 d (95% CI: 6.4, 11.6 d) vs. 7.0 d (95% CI: 6.6, 7.4 d)]. The multivariable Cox proportional hazard models showed no significant associations between 25(OH)D and primary or secondary outcomes. Conclusions: Among hospitalized patients with moderate to severe COVID-19, those with severe 25(OH)D deficiency (<10 ng/mL) exhibited a trend for longer hospital length of stay compared with patients with higher 25(OH)D concentrations. This association was not significant in the multivariable Cox regression model. Prospective studies should test whether correcting severe 25(OH)D deficiency could improve the prognosis of patients with COVID-19.
  • article 27 Citação(ões) na Scopus
    Effect of a single high dose of vitamin D-3 on cytokines, chemokines, and growth factor in patients with moderate to severe COVID-19
    (2022) FERNANDES, Alan L.; MURAI, Igor H.; REIS, Bruna Z.; SALES, Lucas P.; SANTOS, Mayara D.; PINTO, Ana J.; GOESSLER, Karla F.; DURAN, Camila S. C.; SILVA, Carla B. R.; FRANCO, Andre S.; MACEDO, Marina B.; DALMOLIN, Henrique H. H.; BAGGIO, Janaina; BALBI, Guilherme G. M.; ANTONANGELO, Leila; CAPARBO, Valeria F.; GUALANO, Bruno; PEREIRA, Rosa M. R.
    Background: The modulating effect of vitamin D on cytokine concentrations in severe coronavirus disease 2019 (COVID-19) remains unknown. Objectives: We aimed to investigate the effect of a single high dose of vitamin D-3 on cytokincs, chemokines, and growth factor in hospitalized patients with moderate to severe COVID-19. Methods: This is a post hoc, ancillary, and exploratory analysis from a multicenter, double-blind. placebo-controlled, randomized clinical trial. Patients with moderate to severe COVID-19 were recruited from 2 hospitals in Sao Paulo. Brazil. Of 240 randomly assigned patients, 200 were assessed in this study and randomly assigned to receive a single oral dose of 200,000 IU vitamin D-3 (n = 101) or placebo (n = 99). The primary outcome was hospital length of stay, which has been published in our previous study. The prespecified secondary outcomes were serum concentrations of IL-1 beta, IL-6, IL-10. INF-alpha. and 25-hydroxyvitamin D. The post hoc exploratory secondary outcomes were IL-4, IL-12p70. IL-17A, IFN-gamma. granulocyte-macrophage colony-stimulating factor (GM-CSF), IL-8, IFN-inducible protein-10 (IP-10), macrophage inflammatory protein-1 beta (MIP-1 beta), monocyte chemoattractant protein-1 (MCP-1), vascular endothelial growth factor (VEGF), and leukocyte count. Generalized estimating equations for repeated measures, with Bonferroni's adjustment, were used for testing all outcomes. Results: The study included 200 patients with a mean +/- SD age of 55.5 +/- 14.3 y and BMI of 32.2 +/- 7.1 kg/m(2), of which 109 (54.5%) were male. GM-CSF concentrations showed a significant group-by-time interaction effect (P = 0.04). although the between-group difference at postintervention after Bonferroni's adjustment was not significant. No significant effects were observed for the other outcomes. Conclusions: The findings do not support the use of a single dose of 200,000 IU vitamin D-3, compared with placebo, for the improvement of cytokines, chemokines, and growth factor in hospitalized patients with moderate to severe COVID-19.
  • article 360 Citação(ões) na Scopus
    Effect of a Single High Dose of Vitamin D-3 on Hospital Length of Stay in Patients With Moderate to Severe COVID-19 A Randomized Clinical Trial
    (2021) MURAI, Igor H.; FERNANDES, Alan L.; SALES, Lucas P.; PINTO, Ana J.; GOESSLER, Karla F.; DURAN, Camila S. C.; SILVA, Carla B. R.; FRANCO, Andre S.; MACEDO, Marina B.; DALMOLIN, Henrique H. H.; BAGGIO, Janaina; BALBI, Guilherme G. M.; REIS, Bruna Z.; ANTONANGELO, Leila; CAPARBO, Valeria F.; GUALANO, Bruno; PEREIRA, Rosa M. R.
    IMPORTANCE The efficacy of vitamin D-3 supplementation in coronavirus disease 2019 (COVID-19) remains unclear. OBJECTIVE To investigate the effect of a single high dose of vitamin D-3 on hospital length of stay in patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS This was a multicenter, double-blind, randomized, placebo-controlled trial conducted in 2 sites in Sao Paulo, Brazil. The study included 240 hospitalized patients with COVID-19 who were moderately to severely ill at the time of enrollment from June 2, 2020, to August 27, 2020. The final follow-up was on October 7, 2020. INTERVENTIONS Patients were randomly assigned to receive a single oral dose of 200 000 IU of vitamin D-3 (n = 120) or placebo (n = 120). MAIN OUTCOMES AND MEASURES The primary outcome was length of stay, defined as the time from the date of randomization to hospital discharge. Prespecified secondary outcomes included mortality during hospitalization; the number of patients admitted to the intensive care unit; the number of patients who required mechanical ventilation and the duration of mechanical ventilation; and serum levels of 25-hydroxyvitamin D, total calcium, creatinine, and C-reactive protein. RESULTS Of 240 randomized patients, 237 were included in the primary analysis (mean [SD] age, 56.2 [14.4] years; 104 [43.9%] women; mean [SD] baseline 25-hydroxyvitamin D level, 20.9 [9.2] ng/mL). Median (interquartile range) length of stay was not significantly different between the vitamin D-3 (7.0 [4.0-10.0] days) and placebo groups (7.0 [5.0-13.0] days) (log-rank P = .59; unadjusted hazard ratio for hospital discharge, 1.07 [95% CI, 0.82-1.39]; P = .62). The difference between the vitamin D-3 group and the placebo group was not significant for in-hospital mortality (7.6% vs 5.1%; difference, 2.5% [95% CI, -4.1% to 9.2%]; P = .43), admission to the intensive care unit (16.0% vs 21.2%; difference, -5.2% [95% CI, -15.1% to 4.7%]; P = .30), or need for mechanical ventilation (7.6% vs 14.4%; difference, -6.8% [95% CI, -15.1% to 1.2%]; P = .09). Mean serum levels of 25-hydroxyvitamin D significantly increased after a single dose of vitamin D-3 vs placebo (44.4 ng/mL vs 19.8 ng/mL; difference, 24.1 ng/mL [95% CI, 19.5-28.7]; P < .001). There were no adverse events, but an episode of vomiting was associated with the intervention. CONCLUSIONS AND RELEVANCE Among hospitalized patients with COVID-19, a single high dose of vitamin D-3, compared with placebo, did not significantly reduce hospital length of stay. The findings do not support the use of a high dose of vitamin D-3 for treatment of moderate to severe COVID-19.