ANA PAOLA NAVARRETTE LOTITO
Projetos de Pesquisa
Unidades Organizacionais
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina
5 resultados
Resultados de Busca
Agora exibindo 1 - 5 de 5
- Invasive aspergillosis: a severe infection in juvenile systemic lupus erythematosus patients(2012) SILVA, M. F.; RIBEIRO, A. S.; FIOROT, F. J.; AIKAWA, N. E.; LOTITO, A. P.; CAMPOS, L. M.; MAUAD, T.; SILVA, C. A.Infections are an important cause of morbidity and mortality in juvenile systemic lupus erythematosus (JSLE). Among them, invasive aspergillosis (IA), which is usually related to immunosuppressed patients, has been rarely reported in JSLE. From 1983 to 2011, 5604 patients were followed at our institution and 283 (5%) met the American College of Rheumatology (ACR) classification criteria for SLE. Six (2.1%) of our JSLE patients had IA. One of them was previously reported and five will be described herein. Four of them were female. The median age at JSLE diagnosis was 12 years (8-16) and the median interval between diagnosis of JSLE and IA was 6 months (1-38). All had pulmonary involvement and three of them had systemic involvement. The median Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) was 19 (7-22). Diagnosis of IA was performed by isolation of Aspergillus spp., two in bronchoalveolar lavage culture and by way of autopsy in the others. All of them were treated with corticosteroids and/or immunosuppressive drugs at IA diagnosis (azathioprine and/or intravenous cyclophosphamide). They all required treatment in the pediatric intensive care unit with mechanical ventilation and antifungal therapy (fluconazole, amphotericin B, itraconazole and/or voriconazole); nonetheless, none of them survived. In conclusion, this was the first report that evaluated the prevalence of IA in a large population of JSLE patients from a tertiary pediatric hospital, and clearly showed the severity of the outcome, especially in patients with active disease and treated with immunosuppressive agents. This study reinforces the importance of early diagnosis and treatment with certain antifungals, especially in critically ill patients. Lupus (2012) 21, 1011-1016.
conferenceObject INVASIVE ASPERGILLOSIS: A SEVERE INFECTION IN JUVENILE SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS(2012) SILVA, M. F. C.; RIBEIRO, A. S. M.; FIOROT, F. J.; AIKAWA, N. E.; LOTITO, A. P. N.; CAMPOS, L. M. A.; MAUAD, T.; SILVA, C. A.- Acupuntura em adolescentes com fibromialgia juvenil(2012) DIAS, Marialda Höfling P.; AMARAL, Elisabete; PAI, Hong Jin; TSAI, Daniela Terumi Y.; LOTITO, Ana Paola N.; LEONE, Claudio; SILVA, Clovis ArturOBJECTIVE: To describe the use of acupuncture in the treatment of adolescents with juvenile fibromyalgia. METHODS: Retrospective study of patients with juvenile fibromyalgia (American College of Rheumatology criteria) submitted at least to 11 weekly sections of acupuncture. The evaluations before and after acupuncture included: demographic data, musculoskeletal pain findings, pain visual analog scale (VAS), algometry, and myalgic index (MI). These patients could be treated with analgesics, amitriptyline and aerobic physical activity. The results before and after acupuncture were compared by non-parametric Wilcoxon test. RESULTS: 38 patients had juvenile fibromyalgia in eight consecutive years, 13 had all information in their medical and acupuncture records. Seven of the 13 patients improved in three parameters (number of tender points, pain VAS and MI). The median number of tender points and VAS was significantly higher before than after treatment with acupuncture sections [14 (11-18) vs. 10 (0-15), p=0.005; 6 (2-10) vs. 3 (0-10), p=0.045; respectively]. In contrast, the median MI was significantly lower before treatment [3.4 (2.49-4.39) vs. 4.2 (2.71-5.99), p=0.02]. None of the patients with juvenile fibromyalgia had adverse events associated with acupuncture. CONCLUSIONS: Acupuncture is a traditional chinese medicine modality that can be used in pediatric patients with fibromyalgia. Future controlled studies are necessary.
- Profile of paediatric rheumatology specialists and services in the state of Sao Paulo(2013) TERRERI, Maria Teresa; CAMPOS, Lucia M. A.; OKUDA, Eunice M.; SILVA, Clovis A.; SACCHETTI, Silvana B.; MARINI, Roberto; FERRIANI, Virginia P.; VENTURA, Maria Heloiza; FERNANDES, Taciana; SATO, Juliana O.; FERNANDES, Elizabeth C.; LEN, Claudio; BARBOSA, Cassia; LOTITO, Ana Paola; SANTOS, Maria Carolina dos; AIKAWA, Nadia E.; FACO, Mercia; PIOTTO, Daniela; BUGNI, Vanessa; KOZU, Katia T.; ROMANELLI, Paulo R.; SALLUM, Adriana M. E.; FEBRONIO, Marilia; FRAGA, Melissa; MAGALHAES, Claudia S.Introduction: Paediatric rheumatology (PR) is an emerging specialty, practised by a limited number of specialists. Currently, there is neither a record of the profile of rheumatology patients being treated in Brazil nor data on the training of qualified rheumatology professionals in the country. Objective: To investigate the profile of PR specialists and services, as well as the characteristics of paediatric patients with rheumatic diseases, for estimating the current state of rheumatology in the state of Sao Paulo. Patients and methods: In 2010, the scientific department of PR of the Paediatric Society of Sao Paulo administered a questionnaire that was answered by 24/31 accredited specialists in PR practising in state of Sao Paulo and by 8/21 institutions that provide PR care. Results: Most (91%) of the surveyed professionals practise in public institutions. Private clinics (28.6%) and public institutions (37.5%) reported not having access to nailfold capillaroscopy, and 50% of the private clinics reported not having access to acupuncture. The average duration of professional practise in PR was 9.4 years, and 67% of the physicians had attended postgraduate programmes. Seven (87.5%) public institutions perform teaching activities, in which new paediatric rheumatologists are trained, and five (62.5%) offer post-graduate programmes. Two-thirds of the surveyed specialists use immunosuppressants and biological agents classified as ""restricted use"" by the Health Secretariat. The disease most frequently reported was juvenile idiopathic arthritis (29.1-34.5%), followed by juvenile systemic lupus erythematosus (JSLE) (11.6-12.3%) and rheumatic fever (9.1-15.9%). The incidence of vasculitis (including Henoch-Schonlein purpura, Wegener's granulomatosis, and Takayasu's arteritis) and autoinflammatory syndromes was higher in public institutions compared to other institutions (P = 0.03, P = 0.04, P = 0.002, and P < 0.0001, respectively). Patients with JSLE had the highest mortality rate (68% of deaths), mainly due to infection. Conclusion: The field of PR in the state of Sao Paulo has a significant number of specialists with postgraduate degrees who mostly practise at teaching institutions with infrastructures appropriate for the care of high-complexity patients.
- Childhood-onset systemic polyarteritis nodosa and systemic lupus erythematosus: an overlap syndrome?(2016) MARQUES, Victor L. S.; GUARIENTO, Andressa; SIMOES, Marlise S. M.; BLAY, Gabriela; LOTITO, Ana Paola N.; SILVA, Clovis A.