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  • article 17 Citação(ões) na Scopus
    Demographic characteristics and prevalence of serologic markers among blood donors who use confidential unit exclusion (CUE) in Sao Paulo, Brazil: implications for modification of CUE polices in Brazil
    (2011) ALMEIDA-NETO, Cesar de; LIU, Jing; WRIGHT, David J.; MENDRONE-JUNIOR, Alfredo; TAKECIAN, Pedro L.; SUN, Yu; FERREIRA, Joao Eduardo; CHAMONE, Dalton de Alencar Fischer; BUSCH, Michael P.; SABINO, Ester Cerdeira
    BACKGROUND: This study evaluated demographic profiles and prevalence of serologic markers among donors who used confidential unit exclusion (CUE) to assess the effectiveness of CUE and guide public policies regarding the use of CUE for enhancing safety versus jeopardizing the blood supply by dropping CUE. STUDY DESIGN AND METHODS: We conducted a cross-sectional analysis of whole blood donations at a large public blood center in Sao Paulo from July 2007 through June 2009, compared demographic data, and confirmed serologic results among donors who used and who have never used CUE (CUE never). RESULTS: There were 265,550 whole blood units collected from 181,418 donors from July 2007 through June 2009. A total of 9658 (3.6%) units were discarded, 2973 (1.1%) because CUE was used at the current donation (CUE now) and 6685 (2.5%) because CUE was used in the past (CUE past). The CUE rate was highest among donors with less than 8 years of education (odds ratio [OR], 2.78; 95% confidence interval [CI], 2.51-3.08). CUE now donations were associated with higher positive infectious disease marker rates than CUE never donations (OR, 1.41; CI, 1.13-1.77), whereas CUE past donations were not (OR, 1.04; CI, 0.75-1.45). CONCLUSION: The CUE process results in a high rate of unit discard. CUE use on an individual donation appears predictive of a high-risk marker-positive donation and, thus, appears to contribute modestly to blood safety. The policy of discarding units from donors who have previously CUE-positive donations does not improve safety and should be discontinued.
  • article 4 Citação(ões) na Scopus
    Evaluation of a High Throughput Method for the Detection of Mutations Associated with Thrombosis and Hereditary Hemochromatosis in Brazilian Blood Donors
    (2015) NIEWIADONSKI, Vivian Dionisio Tavares; BIANCHI, Juliana Vieira dos Santos; ALMEIDA-NETO, Cesar de; GABURO JR., Nelson; SABINO, Ester Cerdeira
    Background The aim of this study was to evaluate the OpenArray platform for genetic testing of blood donors and to assess the genotype frequencies of nucleotide-polymorphisms (SNPs) associated with venous thrombosis (G1691A and G20210A), hyperhomocysteinemia (C677T, A1298C), and hereditary hemochromatosis (C282Y, H63D and S65C) in blood donors from Sao Paulo, Brazil. Methods We examined 400 blood donor samples collected from October to November 2011. The SNPs were detected using OpenArray technology. The blood samples were also examined using a real-time PCR-FRET system to compare the results and determine the accuracy of the OpenArray method. Results We observed 100% agreement in all assays tested, except HFE C282Y, which showed 99.75% agreement. The HFE C282Y assay was further confirmed through direct sequencing, and the results showed that OpenArray analysis was accurate. The calculated frequencies of each SNP were FV G1691A 98.8% (G/G), 1.2% (G/A); FII G2021A 99.5% (G/G), 0.5% (G/A); MTHFR C677T 45.5%(C/C), 44.8% (C/T), 9.8% (T/T); MTHFR A1298C 60.3% (A/A), 33.6% (A/C), 6.1% (C/C); HFE C282Y 96%(G/G), 4%(G/A), HFE H63D 78.1%(C/C), 20.3% (C/G), 1.6% (G/G); and HFE S65C 98.1%(A/A), 1.9% (A/T). Conclusion Taken together, these results describe the frequencies of SNPs associated with diseases and are important to enhance our current knowledge of the genetic profiles of Brazilian blood donors, although a larger study is needed for a more accurate determination of the frequency of the alleles. Furthermore, the OpenArray platform showed a high concordance rate with standard FRET RT-PCR.
  • article 15 Citação(ões) na Scopus
    Number of recent sexual partners among blood donors in Brazil: associations with donor demographics, donation characteristics, and infectious disease markers
    (2012) PATAVINO, Giuseppina Maria; ALMEIDA-NETO, Cesar de; LIU, Jing; WRIGHT, David J.; MENDRONE-JUNIOR, Alfredo; FERREIRA, Maria Ines Lopes; CARNEIRO, Anna Barbara de Freitas; CUSTER, Brian; FERREIRA, Joao Eduardo; BUSCH, Michael P.; SABINO, Ester Cerdeira
    BACKGROUND: Brazilian blood centers ask candidate blood donors about the number of sexual partners in the past 12 months. Candidates who report a number over the limit are deferred. We studied the implications of this practice on blood safety. STUDY DESIGN AND METHODS: We analyzed demographic characteristics, number of heterosexual partners, and disease marker rates among 689,868 donations from three Brazilian centers between July 2007 and December 2009. Donors were grouped based on maximum number of partners allowed in the past 12 months for each center. Chi-square and logistic regression analysis were conducted to examine associations between demographic characteristics, number of sex partners, and individual and overall positive markers rates for human immunodeficiency virus (HIV), human T-lymphotropic virus Types 1 and 2, hepatitis B virus, hepatitis C virus, and syphilis. RESULTS: First-time, younger, and more educated donors were associated with a higher number of recent sexual partners, as was male sex in Sao Paulo and Recife (p < 0.001). Serologic markers for HIV and syphilis and overall were associated with multiple partners in Sao Paulo and Recife (p < 0.001), but not in Belo Horizonte (p = 0.05, p = 0.94, and p = 0.75, respectively). In logistic regression analysis, number of recent sexual partners was associated with positive serologic markers (adjusted odds ratio [AOR], 1.2-1.5), especially HIV (AOR, 1.9-4.4). CONCLUSIONS: Number of recent heterosexual partners was associated with HIV positivity and overall rates of serologic markers of sexually transmitted infections. The association was not consistent across centers, making it difficult to define the best cutoff value. These findings suggest the use of recent heterosexual contacts as a potentially important deferral criterion to improve blood safety in Brazil.
  • article 8 Citação(ões) na Scopus
    Hepatitis C among blood donors: cascade of care and predictors of loss to follow-up
    (2017) MACHADO, Soraia Mafra; ALMEIDA-NETO, Cesar de; PINHO, Joao Renato Rebello; MALTA, Fernanda de Mello; CAPUANI, Ligia; CAMPOS, Aleia Faustina; ABREU, Fatima Regina Marques; NASTRI, Ana Catharina de Seixas Santos; SANTANA, Rbia Anita Ferraz; SABINO, Ester Cerdeira; MENDES-CORREA, Maria Cassia
    OBJECTIVE: To investigate the HCV cascade of care and to identify the factors associated with loss or absence to follow-up of patients identified as infected with hepatitis C through blood donation. METHODS: Blood donors from 1994 to 2012, identified with positive anti-HCV by enzyme immunoassay and immunoblot tests were invited to participate in the study, through letters or phone calls. Patients who agreed to participate were interviewed and their blood samples were collected for further testing. The following variables were investigated: demographic data, data on comorbidities and history concerning monitoring of hepatitis C. Multiple regression analysis by Poisson regression model was used to investigate the factors associated with non-referral for consultation or loss of follow-up. RESULTS: Of the 2,952 HCV-infected blood donors, 22.8% agreed to participate: 394 (58.2%) male, median age 48 years old and 364 (53.8%) Caucasian. Of the 676 participants, 39.7% did not receive proper follow-up or treatment after diagnosis: 45 patients referred not to be aware they were infected, 61 did not seek medical attention and 163 started a follow-up program, but were non-adherent. The main reasons for inadequate follow-up were not understanding the need for medical care (71%) and health care access difficulties (14%). The variables showing a significant association with inadequate follow-up after multiple regression analysis were male gender (PR = 1.40; 95% CI 1.15-1.71), age under or equal to 50 years (PR = 1.36; 95% CI 1.12-1.65) and non-Caucasians (PR = 1.53; 95% CI 1.27-1.84). CONCLUSIONS: About 40.0% of patients did not receive appropriate follow-up. These data reinforce the need to establish strong links between primary care and reference centers and the need to improve access to specialists and treatments.
  • article 1 Citação(ões) na Scopus
    Factors Associated with Leg Ulcers in Adults with Sickle Cell Disease in Brazil
    (2023) SOUZA, Valquiria Reis de; KELLY, Shannon; SABINO, Ester Cerdeira; OLIVEIRA, Franciane Mendes de; SILVA, Tassila; TEIXEIRA, Carolina Miranda; MAXIMO, Claudia; LOUREIRO, Paula; CARNEIRO-PROIETTI, Anna Barbara de Freitas; GOMES, Isabel; CUSTER, Brian; ALMEIDA-NETO, Cesar de
    OBJECTIVETo define the prevalence of leg ulcers and identify the clinical and laboratory factors associated with leg ulcers in adult participants.METHODSThe authors conducted a cross-sectional study of 1,109 patients who were 18 years or older with SS or S beta(0)-thalassemia genotypes from a Brazilian cohort. Investigators assessed the prevalence of factors associated with leg ulcers from 2013 to 2017.RESULTSThe prevalence of leg ulcers was 21%. Increasing age (odds ratio [OR], 1.07; range, 1.06-1.09), male sex (OR, 2.03; range, 1.44-2.87), treatment with chronic transfusion therapy (OR, 1.88; range, 1.15-3.03), higher indirect bilirubin levels (OR, 1.48; range, 1.02-2.16), and low hemoglobin levels (OR, 2.17; range, 1.52-3.11) were associated with leg ulcers. Participants who self-reported as Black (OR, 6.75; range, 2.63-21.32), mixed (OR, 3.91; range, 1.55-12.20), and other/unknown (OR, 3.84; range, 1.04-15.24) were more likely to have leg ulcers compared with those who self-reported as White.CONCLUSIONSThe prevalence of leg ulcers in this Brazilian cohort was higher than the prevalence reported in developed countries. Known factors such as age and male sex were corroborated. The increased bilirubin level and decreased hemoglobin levels among participants with leg ulcers support the hypothesis that hemolysis is correlated with leg ulcer pathogenesis. Self-reported black skin color was an independent predictor of leg ulcers and warrants further study to understand the etiology and implications of this finding.
  • article 6 Citação(ões) na Scopus
    10-year analysis of human immunodeficiency virus incidence in first-time and repeat donors in Brazil
    (2021) MATEOS, Sheila de Oliveira Garcia; PREISS, Liliana; GONCALEZ, Thelma T.; OLIVEIRA, Claudia Di Lorenzo; GREBE, Eduard; GERMANIO, Clara Di; STONE, Mars; AMORIM FILHO, Luiz; PROIETTI, Anna Barbara Carneiro; BELISARIO, Andre Rolim; ALMEIDA-NETO, Cesar de; MENDRONE-JUNIOR, Alfredo; LOUREIRO, Paula; BUSCH, Michael P.; CUSTER, Brian; SABINO, Ester Cerdeira
    Background and objectives Incidence in first-time and repeat blood donors is an important measure of transfusion-transmitted HIV infection (TT-HIV) risk. This study assessed HIV incidence over time at four large blood centres in Brazil. Materials and methods Donations were screened and confirmed using serological assays for HIV from 2007 to 2016, and additionally screened by nucleic acid testing from 2011 forward. Limiting antigen (LAg) avidity testing was conducted on HIV seroreactive samples from first-time donors to classify whether an infection was recently acquired. We calculated incidence in first-time donors using the mean duration of recent infection and in repeat donors using classical methods. Time and demographic trends were assessed using Poisson regression. Results Over the 10-year period, HIV incidence in first-time donors was highest in Recife (45 center dot 1/100 000 person-years (10(5)py)) followed by Sao Paulo (32 center dot 2/10(5)py) and then Belo Horizonte (23 center dot 3/10(5)py), and in repeat donors was highest in Recife (33 center dot 2/10(5)py), Belo Horizonte (27 center dot 5/10(5)py) and Sao Paulo (17 center dot 0/10(5)py). Results from Rio de Janeiro were available from 2013 to 2016 with incidence in first-time donors of 35 center dot 9/10(5)py and repeat donors from 2011 to 2016 of 29 center dot 2/10(5)py. Incidence varied by other donor demographics. When incidence was considered in 2-year intervals, no significant trend was evident. Overall residual risk of TT-HIV was 5 center dot 46 and 7 center dot 41 per million units of pRBC and FFP transfused, respectively. Conclusion HIV incidence in both first-time and repeat donors varied by region in Brazil. Clear secular trends were not evident.
  • article 6 Citação(ões) na Scopus
    Risk factors for deferral due to low hematocrit and iron depletion among prospective blood donors in a Brazilian center
    (2015) DAUAR, Eloísa Tedeschi; PATAVINO, Giuseppina Maria; MENDRONE JÚNIOR, Alfredo; GUALANDRO, Sandra Fátima Menosi; SABINO, Ester Cerdeira; ALMEIDA-NETO, Cesar de
    OBJECTIVE: Deferral of blood donors due to low hematocrit and iron depletion is commonly reported in blood banks worldwide. This study evaluated the risk factors for low hematocrit and iron depletion among prospective blood donors in a large Brazilian blood center.METHOD: A case-control study of 400 deferred donors due to low hematocrit and 456 eligible whole blood donors was conducted between 2009 and 2011. Participants were interviewed about selected risk factors for anemia, and additional laboratory tests, including serum ferritin, were performed. Bivariate and multivariate analyses were performed to assess the association between predictors and deferral due to low hematocrit in the studied population and iron depletion in women.RESULTS: Donors taking aspirins or iron supplementation, those who reported stomachache, black tarry stools or hematochezia, and women having more than one menstrual period/month were more likely to be deferred. Risk factors for iron depletion were repeat donation and being deferred at the hematocrit screening. Smoking and lack of menstruation were protective against iron depletion.CONCLUSION: This study found some unusual risk factors related to gastrointestinal losses that were associated with deferral of donors due to low hematocrit. Knowledge of the risk factors can help blood banks design algorithms to improve donor notification and referral.
  • article 5 Citação(ões) na Scopus
    Contribution of the Retrovirus Epidemiology Donor Study (REDS) to research on blood transfusion safety in Brazil
    (2014) LOUREIRO, Paula; ALMEIDA-NETO, Cesar de; PROIETTI, Anna Bárbara Carneiro; CAPUANI, Ligia; GONÇALEZ, Thelma Terezinha; OLIVEIRA, Claudia Di Lorenzo de; LEÃO, Silvana Carneiro; LOPES, Maria Inês; SAMPAIO, Divaldo; PATAVINO, Giuseppina Maria; FERREIRA, João Eduardo; BLATYTA, Paula Fraiman; LOPES, Maria Esther Duarte; MENDRONE-JUNIOR, Alfredo; SALLES, Nanci Alves; KING, Melissa; MURPHY, Edward; BUSCH, Michael; CUSTER, Brian; SABINO, Ester Cerdeira
    The Retrovirus Epidemiology Donor Study (REDS) program was established in the United States in 1989 with the purpose of increasing blood transfusion safety in the context of the HIV/AIDS and human T-lymphotropic virus epidemics. REDS and its successor, REDS-II were at first conducted in the US, then expanded in 2006 to include international partnerships with Brazil and China. In 2011, a third wave of REDS renamed the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) was launched. This seven-year research program focuses on both blood banking and transfusion medicine research in the United States of America, Brazil, China, and South Africa. The main goal of the international programs is to reduce and prevent the transmission of HIV/AIDS and other known and emerging infectious agents through transfusion, and to address research questions aimed at understanding global issues related to the availability of safe blood. This article describes the contribution of REDS-II to transfusion safety in Brazil. Articles published from 2010 to 2013 are summarized, including database analyses to characterize blood donors, deferral rates, and prevalence, incidence and residual risk of the main blood-borne infections. Specific studies were developed to understand donor motivation, the impact of the deferral questions, risk factors and molecular surveillance among HIV-positive donors, and the natural history of Chagas disease. The purpose of this review is to disseminate the acquired knowledge and briefly summarize the findings of the REDS-II studies conducted in Brazil as well as to introduce the scope of the REDS-III program that is now in progress and will continue through 2018.
  • article 39 Citação(ões) na Scopus
    Correlation between SARS-COV-2 antibody screening by immunoassay and neutralizing antibody testing
    (2021) MENDRONE-JUNIOR, Alfredo; DINARDO, Carla Luana; FERREIRA, Suzete Cleuza; NISHYA, Anna; SALLES, Nanci Alves; ALMEIDA NETO, Cesar de; HAMASAKI, Debora Toshei; FACINCANI, Tila; ALVES, Lucas Bassolli de Oliveira; MACHADO, Rafael Rahal Guaragna; ARAUJO, Danielle Bastos; DURIGON, Edison Luiz; ROCHA, Vanderson; SABINO, Ester Cerdeira
    Background The efficacy of convalescent plasma (CP), an alternative for the treatment of COVID-19, depends on high titers of neutralizing antibodies (nAbs), but assays for quantifying nAbs are not widely available. Our goal was to develop a strategy to predict high titers of nAbs based on the results of anti-SARS-CoV-2 immunoassays and the clinical characteristics of CP donors. Study Design and Methods A total of 214 CP donors were enrolled and tested for the presence of anti-SARS-CoV-2 antibodies (IgG) using two commercial immunoassays: EUROIMMUN (ELISA) and Abbott (Chemiluminescence). Quantification of nAbs was performed using the Cytopathic Effect-based Virus Neutralization test. Three criteria for identifying donors with nAbs >= 1:160 were tested: - C1: Curve ROC; - C2: Conditional decision tree considering only the IA results and - C3: Conditional decision tree including both the IA results and the clinical variables. Results The performance of the immunoassays was similar referring to both S/CO and predictive value for identifying nAbs titers >= 1:160. Regarding the studied criteria for identifying CP donors with high nAbs titers: (a) C1 showed 76.1% accuracy if S/CO = 4.65, (b) C2 presented 76.1% accuracy if S/CO >= 4.57 and (c) C3 had 71.6% accuracy if S/CO was >= 4.57 or if S/CO was between 2.68-4.57 and the last COVID-19-related symptoms were recent (within 19 days). Conclusion SARS-CoV-2 IgG immunoassays (S/CO) can be used to predict high anti-SARS-CoV-2 nAbs titers. This study has proposed different criteria for identifying donors with >= 1:160 nAbs titers, all with high efficacy.
  • article 0 Citação(ões) na Scopus
    Survival analysis over a 20-year period of a Brazilian cohort of blood donors coinfected HIV-HCV
    (2023) MENEZES FILHO, Helio Ranes de; GRANDI, Giuliano; CARDOSO, Ludimila Paula Vaz; SILVA, Juan Felipe Galvao da; MACHADO, Soraia Mafra; ALMEIDA-NETO, Cesar de; SABINO, Ester Cerdeira; MENDES-CORREA, Maria Cassia
    Among individuals coinfected with HCV and HIV, studies of mortality from non-hepatic causes have shown inconsistent results. The aim of this study was to investigate the contribution of HCV and HIV co-infection to mortality from hepatic and non-hepatic causes in Brazil. This retrospective cohort study included blood donors from Funda & ccedil;& atilde;o Pr & oacute;-Sangue de S & atilde;o Paulo (FPS) who were followed from 1994 to 2016 to compare mortality and its causes between HIV-HCV coinfected individuals versus those seronegative for all tested infections. Records from the FPS database and the Mortality Information System were linked through a probabilistic record Relationship (RL). The Hazard Ratio (HR) was estimated using Cox multiple regression models. HCV-HIV coinfected individuals compared to seronegative individuals had a higher risk of death from all causes (HR = 14.54), non-liver neoplasms (HR = 2.55), infections (HR = 10.37) and liver disease (HR = 7.0). In addition, HCV mono-infected individuals compared to seronegative individuals had a higher risk of death from all causes (HR = 2.23), liver cancer (HR = 32.21), liver disease (HR = 14.92), infection (HR = 3.22), and trauma (HR = 1.68). Individuals coinfected with HCV and HIV have increased overall mortality and death due to infections, liver diseases and non-liver neoplasms as compared to those uninfected with HCV and HIV.