MARCOS SANTOS LIMA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
8 resultados
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conferenceObject Does F-18-FDG-PET/MRI Add Metabolic Information to Anatomic Image in Childhood-onset Takayasu's Arteritis Patients? A Multicenter Case Series(2021) CLEMENTE, Gleice; SOUZA, Alexandre; FILHO, Hilton Leao; COELHO, Fernando; BUCHPIGUEL, Carlos; LIMA, Marcos; PIOTO, Daniela Petry; FRAGA, Melissa; SAKAMOTO, Ana Paula; CARNEIRO, Camila; PEREIRA, Rosa; AIKAWA, Nadia; SILVA, Clovis Artur; CAMPOS, Lucia; ASTLEY, Camilla; GUALANO, Bruno; TERRERI, MariaconferenceObject Exercise Improves Arterial Inflammation in Childhood-onset Takayasu Arteritis: A Randomized Controlled Trial(2019) ASTLEY, Camilla; CLEMENTE, Gleice; TERRERI, Maria Teresa; CARNEIRO, Camila; LIMA, Marcos; BUCHPIGUEL, Carlos; LEAO FILHO, Hilton; LIMA, Fernanda; SA-PINTO, Ana Lucia; SILVA, Clovis; AIKAWA, Nadia; GIL, Saulo; ROSCHEL, Hamilton; PEREIRA, Rosa; GUALANO, Bruno- Home-Based Exercise Training in the Recovery of Multisystem Inflammatory Syndrome in Children: A Case Series Study(2023) ASTLEY, Camilla; LEAL, Gabriela Nunes; GIL, Saulo; SUGUITA, Priscila; FINK, Thais; BAIN, Vera; PEREIRA, Maria Fernanda Badue; MARQUES, Heloisa Helena; SIECZKOWSKA, Sofia; PRADO, Danilo; LIMA, Marcos Santos; CARNEIRO, Camila G.; BUCHPIGUEL, Carlos Alberto; SILVA, Clovis Artur; GUALANO, BrunoObjective: To assess the potential therapeutic role of exercise on health-related quality of life, assessed by the Pediatric Outcomes Data Collection Instrument (PODCI), coronary flow reserve (CFR), cardiac function, cardiorespiratory fitness, and inflammatory and cardiac blood markers in multisystemic inflammatory syndrome in children (MIS-C) patients. Methods: This is a case series study of a 12-wk, home-based exercise intervention in children and adolescents after MIS-C diagnosis. From 16 MIS-C patients followed at our clinic, 6 were included (age: 7-16 years; 3 females). Three of them withdrew before the intervention and served as controls. The primary outcome was health-related quality of life, assessed PODCI. Secondary outcomes were CFR assessed by 13N-ammonia PET-CT imaging, cardiac function by echocardiography, cardiorespiratory fitness, and inflammatory and cardiac blood markers. Results: In general, patients showed poor health-related quality of life, which seemed to be improved with exercise. Additionally, exercised patients showed improvements in coronary flow reserve, cardiac function, and aerobic conditioning. Non-exercised patients exhibited a slower pattern of recovery, particularly in relation to health-related quality of life and aerobic conditioning. Conclusions: Our results suggest that exercise may play a therapeutic role in the treatment of post-discharge MIS-C patients. As our design does not allow inferring causality, randomized controlled trials are necessary to confirm these preliminary findings.
- In-depth cardiovascular and pulmonary assessments in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: A case series study(2022) ASTLEY, Camilla; PEREIRA, Maria Fernanda Badue; LIMA, Marcos Santos; BUCHPIGUEL, Carlos Alberto; CARNEIRO, Camila G.; SAPIENZA, Marcelo Tatit; LEAL, Gabriela Nunes; PRADO, Danilo Marcelo Leite do; PECANHA, Tiago; SIECZKOWSKA, Sofia Mendes; MATSUO, Olivia Mari; LINDOSO, Livia; MARQUES, Heloisa Helena; SILVA, Clovis Artur; GUALANO, BrunoWe assessed PET-CT myocardial blood flow (MBF) using N-13 ammonia, brachial flow-mediated dilation, and cardiopulmonary exercise test in five post-discarged MIS-C survivors. None of the patients (median age: 9, range: 7-18 years; 3 females; 2 males) had preexisting pediatric chronic conditions. At the follow-up visit, two patients exhibited severe perfusion defect developed in the left ventricular cavity, suggesting extensive myocardial ischemia (MBF <2.0) and one patient showed persistent mild pericardial effusion. Others two patients demonstrated endothelial dysfunction. Nevertheless, all patients had lower predicted values in the VO2peak, VO2VAT, OUES, and O-2 Pulse (range: 35.2%-64.5%; 15.6%-38.2%; 1.0-1.3 L/min; 4-7 ml/beat), respectively. Our d suggested that previously health MIS-C patients had impaired MBF, endothelial dysfunction and lower cardiopulmonary capacity at follow-up analysis. Multidisciplinary further investigations should be conducted to reinforce these findings.
- Segmental cardiac strain assessment by two-dimensional speckle-tracking echocardiography in surviving MIS-c patients: Correlations with myocardial flow reserve (MFR) by 13 N-ammonia PET-CT(2022) LEAL, Gabriela Nunes; ASTLEY, Camila; LIMA, Marcos Santos; DINIZ, Maria de Fatima Rodrigues; LIANZA, Alessandro Cavalcanti; SAWAMURA, Karen Saori Shiraishi; MENEZES, Carolina Rocha Brito; SILVA, Camila Lino Martins Rodrigues da; BAIN, Vera; IMADA, Rodrigo; CHALELA, William; PEREIRA, Maria Fernanda Badue; MARQUES, Heloisa Helena de Sousa; BUCHPIGUEL, Carlos Alberto; GUALANO, Bruno; SILVA, Clovis ArturBackground Multisystem inflammatory syndrome in children (MIS-c) is associated with severe cardiovascular impairment and eventually death. Pathophysiological mechanisms involved in myocardial injury were scarcely investigated, and cardiovascular outcomes are uncertain. Autopsy studies suggested that microvascular dysfunction may be relevant to LV impairment. Objective We aimed to evaluate segmental LV longitudinal strain by 2DST echocardiography and myocardial flow reserve (MFR) by 13 N-ammonia PET-CT, in six surviving MIS-c patients. Methods Each patient generated 34 LV segments for combined 2DST and MRF analysis. MFR was considered abnormal when <2, borderline when between 2 and 2.5 and normal when >2.5. Results From July 2020 to February 2021, six patients were admitted with MIS-c: three males, aged 9.3 (6.6-15.7) years. Time from admission to the follow-up visit was 6.05 (2-10.3) months. Although all patients were asymptomatic and LV EF was >= 55%, 43/102 (42.1%) LV segments showed MFR r = .36, p = .03 for basal segments; r = .41, p = .022 for mid segments; r = .42, p = .021 for apical segments. Median peak systolic longitudinal strain was different among MRF categories: 18% (12%-24%) for abnormal, 18.5% (11%-35%) for borderline, and 21% (12%-32%) for normal MFR (p = .006). Conclusion We provided preliminary evidence that surviving MIS-c patients may present subclinical impairment of myocardial microcirculation. Segmental cardiac strain assessment 2DST seems useful for MIS-c cardiovascular follow-up, given its good correlation with 13 N-ammonia PET-CT derived MFR.
- Does [18F]F-FDG-PET/MRI add metabolic information to magnetic resonance image in childhood-onset Takayasu's arteritis patients? A multicenter case series(2022) CLEMENTE, Gleice; SOUZA, Alexandre W. de; LEAO FILHO, Hilton; COELHO, Fernando M. A.; BUCHPIGUEL, Carlos; LIMA, Marcos; CARNEIRO, Camila; PEREIRA, Rosa M. R.; AIKAWA, Nadia; SILVA, Clovis A.; CAMPOS, Lucia M. A.; ALVES, Gabriel; ASTLEY, Camilla; GUALANO, Bruno; TERRERI, Maria TeresaBackground The observation that 2-deoxy-2[18F]fluoro-D-glucose-positron emission tomography/magnetic resonance imaging ([18F]F-FDG-PET/MRI) revealed high-grade arterial wall FDG uptake, without arterial wall thickening with contrast-enhancement, in a considerable number of c-TA patients in our previous study, encouraged us to compare patients with both PET and MR angiography (MRA) positives, with those with PET positive but MRA negative. Our aim was to evaluate the relevance of these two imaging modalities together. Methods A three-center cross-sectional study with 17 patients who fulfilled the EULAR/PRINTO/PReS criteria for c-TA and who underwent [18F]F-FDG-PET/MRI was previously performed. Herein we compared patients/vessels with positive PET (arterial wall F-18-FDG uptake higher than liver) and positive MRA (arterial wall thickening with contrast-enhancement)-group 1, with those with positive PET but negative MRA-group 2. Results Median disease duration of 17 c-TA patients was 10.4 years. Nine patients were classified as group 1 and six as group 2. Median of metabolic inflammatory volume (MIV) of all arterial segments was significantly higher in group 1 (2346 vs. 1177 cm(3); p = 0.036). Fifty-four (19%) from 284 available arterial segments presented positive findings in vessel wall in one or both images. Positive findings were concordant between PET and MRA in only 13% arterial segments (group 1); most changes (28-59.6%) that were discordant between both images, were positive in PET and negative in MRA (group 2). Conclusion Our study demonstrated that [18F]F-FDG-PET/MRI added information about inflammation in vessel wall of c-TA patients. Prospective multicenter studies are needed in order to get solid data to guide immunosuppressive tapering and withdrawal.
- Is positron emission tomography/magnetic resonance imaging a reliable tool for detecting vascular activity in treated childhood-onset Takayasu's arteritis? A multicentre study(2022) CLEMENTE, Gleice; PEREIRA, Rosa M. R.; AIKAWA, Nadia; SILVA, Clovis A.; CAMPOS, Lucia M. A.; ALVES, Gabriel; BUCHPIGUEL, Carlos; LIMA, Marcos; CARNEIRO, Camila; FILHO, Hilton L.; MORBECK, Fernando; NETO, Guilherme; FILHO, Vicente O.; SOUZA, Alexandre W. D.; TERRERI, Maria TeresaObjectives Toassess whether F-18-fluordeoxiglucose (F-18-FDG) PET/MRI) with angiographic sequences can contribute to detecting vessel wall inflammation in patients with childhood-onset Takayasu's arteritis (c-TA) under immunosuppressive therapy. Methods A three-centre cross-sectional study was conducted. F-18-FDG PET/MRI scans were performed in c-TA patients and in oncologic patients, who served as the control group. Clinical and laboratory characteristics were also analysed. Results Seventeen c-TA patients (65% females) between the ages of 6 and 21 years with a mean disease duration of 9.4 years were recruited. Only one patient presented clinical disease activity and six (35.6%) had increased ESR and/or CRP levels. The most frequent magnetic resonance angiography (MRA) findings were stenosis and thickening, observed in 82.4 and 70.6% of c-TA patients, respectively. F-18-FDG PET revealed F-18-FDG uptake greater than the liver in at least one arterial segment in 15 (88.2%) patients in a qualitative analysis and a median maximum standardized uptake value (SUVmax) of 3.22 (interquartile range 2.76-3.69) in a semi-quantitative analysis. c-TA patients presented significantly higher SUVmax values than oncologic patients (P < 0.001). A positive correlation between SUVmax and CRP levels (rho = 0.528, P = 0.029) was seen. Conclusion A state-of-the-art imaging modality was used in c-TA patients and revealed a strong arterial FDG uptake even in patients in apparent remission. We suppose that this finding may represent silent activity in the vessel wall; however, we cannot exclude the possibility of arterial remodelling. Importantly, a negative imaging scan may help in immunosuppression withdrawal in daily clinical practice.
- Home-Based Exercise Training in Childhood-Onset Takayasu Arteritis: A Multicenter, Randomized, Controlled Trial(2021) ASTLEY, Camilla; CLEMENTE, Gleice; TERRERI, Maria Teresa; CARNEIRO, Camila G.; LIMA, Marcos S.; BUCHPIGUEL, Carlos Alberto; LEAO FILHO, Hilton; PINTO, Ana Lucia de Sa; SILVA, Clovis Artur; CAMPOS, Lucia Maria Arruda; AIKAWA, Nadia Emi; GIL, Saulo; PEREIRA, Rosa Maria Rodrigues; ROSCHEL, Hamilton; GUALANO, BrunoIntroduction: Childhood-onset Takayasu Arteritis (c-TA) is a rare, large-vessel vasculitis seen in children that could predisposing patients to a high risk of mortality. Exercise has the potential to improve overall health in several diseases, but evidence remains scant in c-TA. The main objective of this study was to investigate the safety and potential therapeutic effects of exercise in c-TA. Methods: This was a 12-week, multicenter, randomized, controlled trial, to test the effects of a home-based, exercise intervention vs. standard of care in c-TA patients in remission. The primary outcomes were arterial inflammation, assessed by [F-18] FDG-PET/MRI and systemic inflammatory markers. Secondary outcomes included, physical activity levels, functionality, body composition, disease-related parameters, and quality of life. Results: Thirty-seven patients were assessed for eligibility, which represents the total number of c-TA patients being followed by the three specialized medical ambulatory services in Sao Paulo. After exclusions, fourteen c-TA patients (71.4% females) aged 12-25 years were randomly allocated into exercised (n=5) and non-exercised groups (n=9). Exercise did not exacerbate arterial inflammation. In fact, exercised patients had a reduction in the frequency of vessel segments with severe inflammation, whereas the non-exercised patients had an opposite response (P=0.007). Greater improvements in visceral fat, steps per day, functionality and physical component SF-36 were observed in the exercised patients (P <= 0.05). Conclusions: Exercise is safe and may improve visceral fat, physical activity levels, functionality, and physical component SF-36 in c-TA patients. Thus, exercise arises as a novel, evidence-based intervention to improve general health in c-TA.