SYLVIA COSTA LIMA FARHAT
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
LIM/05 - Laboratório de Poluição Atmosférica Experimental, Hospital das Clínicas, Faculdade de Medicina
LIM/05 - Laboratório de Poluição Atmosférica Experimental, Hospital das Clínicas, Faculdade de Medicina
73 resultados
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- O ozônio diminui a qualidade do sêmen em pacientes com lúpus eritematoso sistêmico(2016) FARHAT, Juliana; FARHAT, Sylvia Costa Lima; BRAGA, Alfesio Luis Ferreira; COCUZZA, Marcello; BORBA, Eduardo Ferreira; BONFA, Eloisa; SILVA, Clovis ArturObjective: To investigate the deleterious effects of air pollutants exposure in the Sao Paulo metropolitan region on semen quality in systemic lupus erythematosus (SLE). Methods: A seven-years longitudinal repeated-measures panel study was performed at the Laboratory of Experimental Air Pollution and Rheumatology Division. Two semen samples from 28 post-pubertal SLE patients were analyzed. Daily concentrations of air pollutants exposure: PM10, SO2, NO2, ozone, CO, and meteorological variables were evaluated on 90 days before each semen collection dates using generalized estimating equation models. Results: Intravenous cyclophosphamide (IVCYC) and ozone had an association with a decrease in sperm quality of SLE patients. IVCYC was associated with decreases of 64.3 million of spermatozoa/mL (95% CI 39.01-89.65; p = 0.0001) and 149.14 million of spermatozoa/ejaculate (95% CI 81.93-216.38; p = 0.017). With regard to ozone, the most relevant adverse effects were observed from lags 80-88, when the exposure to an interquartile range increase in ozone 9-day moving average concentration led to decreases of 22.9 million of spermatozoa/mL (95% CI 5.8-40.0; p = 0.009) and 70.5 million of spermatozoa/ejaculate (95% CI 12.3-128.7; p = 0.016). Further analysis of 17 patients that never used IVCYC showed association between exposure to ozone (80-88 days) and decrease of 30.0 million of spermatozoa/mL (95% CI 7.0-53.0; p = 0.011) and 79.0 million of spermatozoa/ejaculate (95% CI 2.1-155.9; p = 0.044). Conclusion: Ozone and IVCYC had a consistent adverse effect on semen quality of SLE patients during spermatogenesis. Minimizing exposure to air pollution should be taken into account, especially for patients with chronic systemic inflammatory diseases living in large cities.
- Point-of-care lung ultrasound score for predicting escalated care in children with respiratory distress(2023) GIORNO, Eliana P. C.; FORONDA, Flavia K.; PAULIS, Milena De; GHOSN, Danielle S. N. Bou; COUTO, Thomaz B.; SA, Fernanda V. M.; FRAGA, Andrea M. A.; FARHAT, Sylvia C. L.; PRETO-ZAMPERLINI, Marcela; SCHVARTSMAN, ClaudioPurpose: Respiratory distress due to lower respiratory illnesses is a leading cause of death in children. Early rec-ognition of high-risk populations is critical for the allocation of adequate resources. Our goal was to assess whether the lung ultrasound (US) score obtained at admission in children with respiratory distress predicts the need for escalated care. Methods: This prospective study included 0-18-year-old patients with respiratory distress admitted to three emergency departments in the state of Sao Paulo, Brazil, between July 2019 and September 2021. The enrolled patients underwent lung US performed by a pediatric emergency physician within two hours of arrival. Lung ul-trasound scores ranging from 0 to 36 were computed. The primary outcome was the need for high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), or mechanical ventilation within 24 h. Results: A total of 103 patients were included. The diagnoses included wheezing (33%), bronchiolitis (27%), pneu-monia (16%), asthma (9%), and miscellaneous (16%). Thirty-five patients (34%) required escalated care and had a higher lung ultrasound score: median 13 (0-34) vs 2 (0-21), p < 0.0001; area under the curve (AUC): 0.81 (95% confidence interval [CI]: 0.71-0.90). The best cut-off score derived from Youden's index was seven (sensitivity: 71.4%; specificity: 79.4%; odds ratio (OR): 9.6 [95% CI: 3.8-24.7]). A lung US score above 12 was highly specific and had a positive likelihood ratio of 8.74 (95% CI:3.21-23.86). Conclusion: An elevated lung US score measured in the first assessment of children with any type of respiratory distress was predictive of severity as defined by the need for escalated care with HFNC, NIV, or mechanical ventilation.
conferenceObject EXPOSURE TO ENVIRONMENTAL FACTORS DURING PREGNANCY AND AFTER BIRTH TO THE BEGINNING OF JUVENILE IDIOPATHIC ARTHRITIS(2015) FRANCA, C. M. P.; SALLUM, A. M. E.; SILVA, C. A.; AIKAWA, N. E.; BRAGA, A. L. F.; FARHAT, S. C. L.- Risk Factors Associated with Juvenile Idiopathic Arthritis: Exposure to Cigarette Smoke and Air Pollution from Pregnancy to Disease Diagnosis(2018) FRANCA, Camila Maria Paiva; SALLUM, Adriana Maluf Elias; BRAGA, Alfesio Luis Ferreira; STRUFALDI, Fernando Louzada; SILVA, Clovis Artur Almeida; FARHAT, Sylvia Costa LimaObjective. To evaluate exposure to environmental factors inhaled during pregnancy and after birth until juvenile idiopathic arthritis (JIA) diagnosis among residents of a large city. Methods. This is an exploratory case-control study that consists of 66 patients with JIA and 124 healthy controls matched by age and sex, living in the Sao Paulo, Brazil, metropolitan area until JIA diagnosis, and whose mothers had resided in this region during pregnancy. A structured and reliable questionnaire (k index for test-retest was 0.80) assessed demographic data, gestational and perinatal-related factors, and exposure to inhalable environmental elements during pregnancy and after birth (occupational exposure to inhalable particles and/or volatile vapor, exposure to cigarette smoke, and the presence of industrial activities or gas stations near the home, work, daycare, or school). Tropospheric pollutants included particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O-3), and carbon monoxide (CO). Results. During pregnancy, intrauterine cigarette smoke exposure (OR 3.43, 95% CI 1.45-8.12, p = 0.005) and maternal occupational exposure (OR 13.69, 95% CI 4.4-42.3, p < 0.001) were significant independent risk factors for JIA diagnosis. In contrast, maternal employment (OR 0.06, 95% CI 0.02-0.2, p < 0.001) and ideal maternal weight gain (OR 0.36, 95% CI 0.2-0.8, p = 0.017) presented negative associations. Secondhand smoke exposure from birth to JIA diagnosis (OR 3.6, 95% CI 1.8-7.3, p < 0.001) and exposure to O-3 during the second year of life (OR 2.76, 95% CI 1.20-6.37, p = 0.017) were independent and significant risk factors for the pathogenesis of JIA. Conclusion. In our study, cigarette smoke exposure (intrauterine and after birth), exposure to O-3 in the second year of life, and maternal occupational exposure were identified as potential risk factors for JIA, warranting further study.
- Point-Of-Care Ultrasound for Lung Assessment in Patients With Severe Scoliosis and Chest Deformities: An Emergency Department Case Series(2020) GIORNO, Eliana Paes de Castro; PRETO-ZAMPERLINI, Marcela; WEERDENBURG, Kirstin; FERRAZ, Isabel de Siqueira; LEITE, Marcia Marques; FARHAT, Sylvia Costa Lima; SCHVARTSMAN, Claudio
- Exposure to Air Pollutants and Disease Activity in Juvenile-Onset Systemic Lupus Erythematosus Patients(2015) FERNANDES, Elisabeth C.; SILVA, Clovis A.; BRAGA, Alfesio L. F.; SALLUM, Adriana M. E.; CAMPOS, Lucia M. A.; FARHAT, Sylvia C. L.ObjectiveTo investigate the association between exposure to air pollutants in the Sao Paulo metropolitan area and disease activity in juvenile-onset systemic lupus erythematosus (SLE) patients. MethodsA longitudinal panel study based on 409 consecutive visits of juvenile-onset SLE patients living in the Sao Paulo metropolitan area was carried out. Disease activity was evaluated in accordance with the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), and the patients were divided into 2 groups: those with SLEDAI scores 8 and those with SLEDAI scores >8. Daily concentrations of inhaled particulate matter (PM10), sulfur dioxide, nitrogen dioxide (NO2), ozone, and carbon monoxide (CO) were evaluated on the 21 days preceding the medical visits. A generalized estimation equation model was used to assess the impact of these measurements on SLEDAI-2K scores, considering the fixed effects for repetitive measurements. The models were adjusted for erythrocyte sedimentation rate, corticosteroid use (daily and cumulative doses), antimalarial use, the use of immunosuppressive agents, the presence of infection 20 days preceding the medical appointment, and the minimum temperature and relative humidity outdoors. ResultsPM(10), NO2, and CO were risk factors for juvenile-onset SLE disease activity (SLEDAI-2K score >8) approximately 2 weeks after exposure. A 13.4 g/m(3) increase in the PM10 moving average (from lag 12 to lag 15) was associated with a 34% increase (95% confidence interval 7.0-68.0) in the risk of a SLEDAI-2K score >8. ConclusionThis is the first study to show that exposure to inhaled pollutants may increase the risk of disease activity in children with juvenile-onset SLE in a large urban center.
- Teaching medical students to choose wisely through simulation(2022) MORATO, Thayza Marcelly Rodrigues; MENDES, Pedro Henrique Magalhaes; GHOSN, Danielle Saad Nemer Bou; COUTO, Thomaz Bittencourt; MAI, Paulo Victor Ferreira; FARHAT, Sylvia Costa Lima; SCHVARTSMAN, Claudio; CAVALCANTI, Nara VasconcelosThe Choosing Wisely (CW) campaign aims to encourage dialog among physicians and patients about the costs and benefits of medical care. The purpose of the present study was to describe the implementation of the CW campaign among medical students in the pediatrics clerkship using different teaching strategies and to evaluate the students' perception and performance. A prospective, interventionist, open study with a control group was conducted. All sixth-year undergraduate medical students that were on their pediatric clerkship at the Emergency Department during the study period were invited to participate. The study consisted of two strategies: a remote video class about the CW initiative and in situ simulation training. By the end of the rotation, all participants were evaluated through an Objective Structured Clinical Examination (OSCE). A total of 50 students were included, of which 24 watched only the online video (control group) and 26 were exposed to both the online video and the simulation scenarios (intervention group). Students in the intervention group had a significantly higher total score in the OSCE compared to students in the control group (median 90 vs 90; range 78-100 vs 50-100; p: 0.047). Median scores of behavioral items of the OSCE grouped together were significantly higher in the intervention group compared to the control group (median 60 vs 50; range 40-60 vs 20-60; p: 0.002). Conclusion: Simulation training about principles of the CW campaign had a greater impact on behavioral aspects of undergraduate students. This learning strategy was well accepted by participants.
- PERSONAL EXPOSURE TO AIR POLLUTION INFLUENCED DISEASE ACTIVITY AND EXHALED BREATH BIOMARKERS: A PROSPECTIVE STUDY IN A CHILDHOOD-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS POPULATION(2016) GOULART, M. F. G.; ALVES, A. G. F.; BRAGA, A. L. F.; SALUM, A. M. E.; PEREIRA, L. A. A.; COIMBRA, A. J. F.; CARVALHO, T. D. S.; NAKAGAWA, N. K.; SILVA, C. A.; FARHAT, S. C. L.
- Inhaled ultrafine particles, epigenetics and systemic autoimmune rheumatic diseases(2020) FARHAT, Sylvia Costa Lima; YARIWAKE, Victor Yuji; VERAS, Mariana Matera; BRAGA, Alfesio Luis Ferreira; MALUF, Adriana Elias; SILVA, Clovis Artur
bookPart Arboviroses(2018) FARHAT, Sylvia Costa Lima; CARVALHO, Vitor Emanoel de Lemos