RENATA APARECIDA DE ALMEIDA MONTEIRO

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LIM/05 - Laboratório de Poluição Atmosférica Experimental, Hospital das Clínicas, Faculdade de Medicina

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  • conferenceObject
    Lung ECM composition, its influence factors and transcriptomics in the lungs of severe COVID-19.
    (2023) COSTA, Natalia de Souza Xavier; RIBEIRO JUNIOR, Gabriel; NASCIMENTO, Ellen Toledo Do; BRITO, Jose Mara De; MONTEIRO, Jhonatas Sirino; SETUBAL, Joao Carlos; PINHO, Joao Renato Rebello; PEREIRA, Roberta Verciano; MONTEIRO, Renata Aparecida De Almeida; DUARTE NETO, Amaro Nunes; SALDIVA, Paulo Hilario Nascimento; SILVA, Luiz Fernando Ferraz Da; DOLHNIKOFF, Marisa; MAUAD, Thais
  • conferenceObject
    Dynamics and Heterogeneity of the Lung Immunopathology in Severe COVID-19
    (2022) ERJEFALT, J.; COSTA, N. De Souza Xavier; JONSSON, J.; COZZOLINO, O.; DANTAS, K.; CLAUSSON, C.; SIDDHURAJ, P.; LINDO, C.; LOMBARDI, S. Ferreira Spina; MENDRONI JUNIOR, A.; ANTONANGELO, L.; FARIA, C. Silverio; DUARTE NETO, A. Nunes; MONTEIRO, R. De Almeida; PINHO, J. Rebello; GOMES-GOUVEA, M. Soares; PEREIRA, R. Verciano; MONTEIRO, J. Sirino; SETUBAL, J.; OLIVEIRA, E. Pierre De; THEODORO FILHO, J.; SANDEN, C.; ORENGO, J.; SLEEMAN, M.; SILVA, L. Ferraz Da; SALDIVA, P. Nascimento; DOLHNIKOFF, M.; MAUAD, T.
  • conferenceObject
    Differentially expressed genes in Diffuse Alveolar Damage (DAD) patterns of COVID-19.
    (2022) COSTA, N. de Souza Xavier; MONTEIRO, J. Sirino; ERJEFALT, J.; JONSSON, J.; COZZOLINO, O.; DANTAS, K.; CLAUSSON, C.; SIDDHURAJ, P.; LINDO, C.; LOMBARDI, S. Ferreira Spina; MENDRONI JUNIOR, A.; ANTONANGELO, L.; FARIA, C. Silverio; DUARTE NETO, A. Nunes; MONTEIRO, R. Almeida; PINHO, J. R. Rebello; GOMES-GOUVEA, M. Soares; PEREIRA, R. Verciano; OLIVEIRA, E. Pierre De; THEODORO FILHO, J.; SANDEN, C.; ORENGO, J.; SLEEMAN, M.; SILVA, L. F. Ferraz Da; SALDIVA, P. Nascimento; DOLHNIKOFF, M.; MAUAD, T.; SETUBAL, J. C.
  • article 0 Citação(ões) na Scopus
    Postmortem chest computed tomography in COVID-19: A minimally invasive autopsy method
    (2024) SAVOIA, Paulo; SAWAMURA, Marcio Valente Yamada; MONTEIRO, Renata Aparecida de Almeida; DUARTE-NETO, Amaro Nunes; MARTIN, Maria da Graca Morais; DOLHNIKOFF, Marisa; MAUAD, Thais; SALDIVA, Paulo Hilario Nascimento; LEITE, Claudia da Costa; SILVA, Luiz Fernando Ferraz da; CARDOSO, Ellison Fernando
    Objectives: Performing autopsies in a pandemic scenario is challenging, as the need to understand pathophysiology must be balanced with the contamination risk. A minimally invasive autopsy might be a solution. We present a model that combines radiology and pathology to evaluate postmortem CT lung findings and their correlation with histopathology. Methods: Twenty-nine patients with fatal COVID-19 underwent postmortem chest CT, and multiple lung tissue samples were collected. The chest CT scans were analyzed and quantified according to lung involvement in five categories: normal, ground-glass opacities, crazy-paving, small consolidations, and large or lobar consolidations. The lung tissue samples were examined and quantified in three categories: normal lung, exudative diffuse alveolar damage (DAD), and fibroproliferative DAD. A linear index was used to estimate the global severity of involvement by CT and histopathological analysis. Results: There was a positive correlation between patient mean CT and histopathological severity score indexesPearson correlation coefficient (R) = 0.66 (p = 0.0078). When analyzing the mean lung involvement percentage of each finding, positive correlations were found between the normal lung percentage between postmortem CT and histopathology (R=0.65, p = 0.0082), as well as between ground -glass opacities in postmortem CT and normal lungs in histopathology (R=0.65, p = 0.0086), but negative correlations were observed between groundglass opacities extension and exudative diffuse alveolar damage in histological slides (R=-0.68, p = 0.005). Additionally, it was found is a trend toward a decrease in the percentage of normal lung tissue on the histological slides as the percentage of consolidations in postmortem CT scans increased (R =-0.51, p = 0.055). The analysis of the other correlations between the percentage of each finding did not show any significant correlation or correlation trends (p >= 0.10). Conclusions: A minimally invasive autopsy is valid. As the severity of involvement is increased in CT, more advanced disease is seen on histopathology. However, we cannot state that one specific radiological category represents a specific pathological correspondent. Ground -glass opacities, in the postmortem stage, must be interpreted with caution, as expiratory lungs may overestimate disease.
  • article 27 Citação(ões) na Scopus
    Ultrasound assessment of pulmonary fibroproliferative changes in severe COVID-19: a quantitative correlation study with histopathological findings
    (2021) MONTEIRO, Renata Aparecida de Almeida; DUARTE-NETO, Amaro Nunes; SILVA, Luiz Fernando Ferraz da; OLIVEIRA, Ellen Pierre de; NASCIMENTO, Ellen Caroline Toledo do; MAUAD, Thais; SALDIVA, Paulo Hilario do Nascimento; DOLHNIKOFF, Marisa
    Purpose This study was designed to evaluate the usefulness of lung ultrasound (LUS) imaging to characterize the progression and severity of lung damage in cases of COVID-19. Methods We employed a set of combined ultrasound parameters and histopathological images obtained simultaneously in 28 patients (15 women, 0.6-83 years) with fatal COVID-19 submitted to minimally invasive autopsies, with different times of disease evolution from initial symptoms to death (3-37 days, median 18 days). For each patient, we analysed eight post-mortem LUS parameters and the proportion of three histological patterns (normal lung, exudative diffuse alveolar damage [DAD] and fibroproliferative DAD) in eight different lung regions. The relationship between histopathological and post-mortem ultrasonographic findings was assessed using various statistical approaches. Results Statistically significant positive correlations were observed between fibroproliferative DAD and peripheral consolidation (coefficient 0.43, p = 0.02) and pulmonary consolidation (coefficient 0.51, p = 0.005). A model combining age, time of evolution, sex and ultrasound score predicted reasonably well (r = 0.66) the proportion of pulmonary parenchyma with fibroproliferative DAD. Conclusion The present study adds information to previous studies related to the use of LUS as a tool to assess the severity of acute pulmonary damage. We provide a histological background that supports the concept that LUS can be used to characterize the progression and severity of lung damage in severe COVID-19.
  • article 18 Citação(ões) na Scopus
    Histological-ultrasonographical correlation of pulmonary involvement in severe COVID-19
    (2020) MONTEIRO, Renata Aparecida Almeida; OLIVEIRA, Ellen Pierre de; SALDIVA, Paulo Hilario Nascimento; DOLHNIKOFF, Marisa; DUARTE-NETO, Amaro Nunes
  • article 46 Citação(ões) na Scopus
    Testicular pathology in fatal COVID-19: A descriptive autopsy study
    (2022) DUARTE-NETO, Amaro N.; TEIXEIRA, Thiago A.; CALDINI, Elia G.; KANAMURA, Cristina T.; GOMES-GOUVEA, Michele S.; SANTOS, Angela B. G. dos; MONTEIRO, Renata A. A.; PINHO, Joao R. R.; MAUAD, Thais; SILVA, Luiz F. F. da; SALDIVA, Paulo H. N.; DOLHNIKOFF, Marisa; LEITE, Katia R. M.; HALLAK, Jorge
    Background Multi-organ damage is a common feature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, going beyond the initially observed severe pneumonia. Evidence that the testis is also compromised is growing. Objective To describe the pathological findings in testes from fatal cases of COVID-19, including the detection of viral particles and antigens, and inflammatory cell subsets. Materials and methods Postmortem testicular samples were obtained by percutaneous puncture from 11 deceased men and examined by reverse-transcription polymerase chain reaction (RT-PCR) for RNA detection and by light and electron microscopy (EM) for SARS-CoV-2. Immunohistochemistry (IHC) for the SARS-CoV-2 N-protein and lymphocytic and histiocytic markers was also performed. Results Eight patients had mild interstitial orchitis, composed mainly of CD68+ and TCD8+ cells. Fibrin thrombi were detected in five cases. All cases presented congestion, interstitial edema, thickening of the tubular basal membrane, decreased Leydig and Sertoli cells with reduced spermatogenesis, and strong expression of vascular cell adhesion molecule (VCAM) in vessels. IHC detected SARS-Cov-2 antigen in Leydig cells, Sertoli cells, spermatogonia, and fibroblasts in all cases. EM detected viral particles in the cytoplasm of fibroblasts, endothelium, Sertoli and Leydig cells, spermatids, and epithelial cells of the rete testis in four cases, while RT-PCR detected SARS-CoV-2 RNA in three cases. Discussion and conclusion The COVID-19-associated testicular lesion revealed a combination of orchitis, vascular changes, basal membrane thickening, Leydig and Sertoli cell scarcity, and reduced spermatogenesis associated with SARS-CoV-2 local infection that may impair hormonal function and fertility in men.
  • article 5 Citação(ões) na Scopus
    Use of minimally invasive autopsy during the COVID-19 pandemic and its possibilities in the context of developing countries
    (2021) MELO, Deborah Nunes; COELHO, Tania Mara; LIMA, Giovanna Rolim Pinheiro; FERNANDES, Carolina Gomes; ALVES, Bruno Cavalcante Fales de Brito; ARAUJO, Fernanda Montenegro de Carvalho; MONTEIRO, Renata Aparecida de Almeida; ORDI, Jaume; SALDIVA, Paulo Hilario do Nascimento; CAVALCANTI, Luciano Pamplona de Goes
  • article 0 Citação(ões) na Scopus
    What else in times of COVID-19? The role of minimally invasive autopsy for the differential diagnosis of acute respiratory failure in a case of kala-azar
    (2023) GEBER-JUNIOR, Joao Carlos; MONTEIRO, Renata Aparecida de Almeida; ROCHA, Joao Wilson Pedro da; DUARTE, Edson Luiz Tarsia; NICODEMO, Elizabete; MUNHOZ, Olavo; PAIVA, Edison Ferreira de; MAUAD, Thais; SILVA, Luiz Fernando Ferraz da; SALDIVA, Paulo Hilario Nascimento; DOLHNIKOFF, Marisa; DUARTE-NETO, Amaro Nunes
    Visceral leishmaniasis (VL) is a chronic vector-borne zoonotic disease caused by trypanosomatids, considered endemic in 98 countries, mainly associated with poverty. About 50,000-90,000 cases of VL occur annually worldwide, and Brazil has the second largest number of cases in the world. The clinical picture of VL is fever, hepatosplenomegaly, and pancytopenia, progressing to death in 90% of cases due to secondary infections and multi-organ failure, if left untreated. We describe the case of a 25-year-old female who lived in the metropolitan area of Sao Paulo, who had recently taken touristic trips to several rural areas in Southeastern Brazil and was diagnosed post-mortem. During the hospitalization in a hospital reference for the treatment of COVID-19, the patient developed acute respiratory failure, with chest radiographic changes, and died due to refractory shock. The ultrasound-guided minimally invasive autopsy diagnosed VL (macrophages containing amastigote forms of Leishmania in the spleen, liver and bone marrow), as well as pneumonia and bloodstream infection by gram-negative bacilli.
  • article 42 Citação(ões) na Scopus
    Tracking the time course of pathological patterns of lung injury in severe COVID-19
    (2021) MAUAD, Thais; DUARTE-NETO, Amaro Nunes; SILVA, Luiz Fernando Ferraz da; OLIVEIRA, Ellen Pierre de; BRITO, Jose Mara de; NASCIMENTO, Ellen Caroline Toledo do; MONTEIRO, Renata Aparecida de Almeida; FERREIRA, Juliana Carvalho; CARVALHO, Carlos Roberto Ribeiro de; SALDIVA, Paulo Hilario do Nascimento; DOLHNIKOFF, Marisa
    Background: Pulmonary involvement in COVID-19 is characterized pathologically by diffuse alveolar damage (DAD) and thrombosis, leading to the clinical picture of Acute Respiratory Distress Syndrome. The direct action of SARS-CoV-2 in lung cells and the dysregulated immuno-coagulative pathways activated in ARDS influence pulmonary involvement in severe COVID, that might be modulated by disease duration and individual factors. In this study we assessed the proportions of different lung pathology patterns in severe COVID-19 patients along the disease evolution and individual characteristics. Methods: We analysed lung tissue from 41 COVID-19 patients that died in the period March-June 2020 and were submitted to a minimally invasive autopsy. Eight pulmonary regions were sampled. Pulmonary pathologists analysed the H&E stained slides, performing semiquantitative scores on the following parameters: exudative, intermediate or advanced DAD, bronchopneumonia, alveolar haemorrhage, infarct (%), arteriolar (number) or capillary thrombosis (yes/no). Histopathological data were correlated with demographic-clinical variables and periods of symptoms-hospital stay. Results: Patient ' s age varied from 22 to 88 years (18f/23 m), with hospital admission varying from 0 to 40 days. All patients had different proportions of DAD in their biopsies. Ninety percent of the patients presented pulmonary microthrombosis. The proportion of exudative DAD was higher in the period 0-8 days of hospital admission till death, whereas advanced DAD was higher after 17 days of hospital admission. In the group of patients that died within eight days of hospital admission, elderly patients had less proportion of the exudative pattern and increased proportions of the intermediate patterns. Obese patients had lower proportion of advanced DAD pattern in their biopsies, and lower than patients with overweight. Clustering analysis showed that patterns of vascular lesions (microthrombosis, infarction) clustered together, but not the other patterns. The vascular pattern was not influenced by demographic or clinical parameters, including time of disease progression. Conclusion: Patients with severe COVID-19 present different proportions of DAD patterns over time, with advanced DAD being more prevalent after 17 days, which seems to be influenced by age and weight. Vascular involvement is present in a large proportion of patients, occurs early in disease progression, and does not change over time.