THIAGO BITAR MORAES BARROS
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4
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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
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article 4 Citação(ões) na Scopus Miopatia inflamatória induzida por adalimumab na artrite reumatóide(2012) SOUZA, Fernando Henrique Carlos de; BARROS, Thiago Bitar Morais; LEVY-NETO, Mauricio; SHINJO, Samuel KatsuyukiThe application of immunobiologics for the rheumatoid arthritis treatment may present as a rare complication the development of inflammatory myopathy. Until this moment, there have been described in literature only seven cases of inhibitors of tumor necrosis factor induced-myositis. In this paper, we report the case of the patient with 39 years-old with eight years of arthritis rheumatoid and that due to refractory to various immunosuppressive drugs, the adalimumab was introduced, and evolved to dermatomyositis status.- Adult dermatomyositis: experience of a Brazilian tertiary care center(2012) SOUZA, Fernando Henrique Carlos de; BARROS, Thiago Bitar Moraes; LEVY-NETO, Mauricio; SHINJO, Samuel KatsuyukiObjective: To report the results of a retrospective cohort involving 139 patients with dermatomyositis, conducted from 1991 to 2011. Methods: All patients met at least four of the five Bohan and Peter criteria (1975). Results: The patients' mean age at disease onset was 41.7 +/- 14.1 years, and mean disease duration was 7.2 +/- 5.2 years. The sample comprised 90.2% white patients and 79.9% female patients. Constitutional symptoms occurred in less than half of the patients. Cutaneous and joint involvements occurred in 95.7% and 41.7% of the patients, respectively. Incipient pneumopathy, ground glass opacities and/or pulmonary fibrosis were present in 48.2% of the patients. All patients received prednisone (1 mg/kg/day) and 51.1% also received intravenous methylprednisolone (1 g/day for three days). Several immunosuppressants were used as corticosteroid sparing agents according to tolerance, side effects and/or refractoriness. Although disease relapse (clinical and/or laboratory) occurred in 53.2% of the patients, 76.3% were in disease remission at the end of the study. The rate of severe infection was 35.3%, and herpes zoster predominated. There were 15(10.8%) cases of cancer, 12 within one year after the diagnosis. There were 16 deaths (11.5%), and their major causes were sepsis/septic shock (27.5%), pneumopathy attributed to the disease (31.3%), neoplasms (31.3%), and cardiovascular events (12.5%). Conclusions: In this study, the clinical and laboratory data were similar to those of other population groups described in the literature, with minimal differences regarding the frequency and characteristics of the extramuscular manifestations.
- IgA nephropathy and polymyositis: a rare association(2014) BARROS, Thiago Bitar Moraes; SOUZA, Fernando Henrique Carlos de; MALHEIROS, Denise Maria Auancini Costa; LEUY-NETO, Mauricio; SHINJO, Samuel KatsuyukiPolymyositis is a systemic and idiopathic inflammatory myopathy that, besides muscle manifestation, may occur with respiratory involvement, gastrointestinal tract and rarely renal involvement. In this latter, there are only two cases of IgA nephropathy, but both in dermatomyositis. On the other hand, we reported, for the first time, a case of IgA nephropathy in polymyositis.
article 3 Citação(ões) na Scopus Hepatite autoimune e dermatomiosite: uma rara associação(2012) SOUZA, Fernando Henrique Carlos de; BARROS, Thiago Bitar Moraes; MORAES, Mariana Teichner de; MISSUMI, Larissa Sayuri; LIMA, Fabiana Roberto; LEVY-NETO, Mauricio; SHINJO, Samuel KatsuyukiThe association between autoimmune hepatitis and idiopathic inflammatory myopathies has been rarely described in literature. To our knowledge, there are only five reports of autoimmune hepatitis, all coursing with polymyositis. In the present work, we describe a female patient at the age of 58 with cutaneous lesions (heliotrope), progressive proximal muscle weakness of four limbs and constitutional symptoms for 12 months, and worsened two months ago. She had also been episodes of jaundice for five months. During hospitalization, after intense clinical investigation, the diagnosis of dermatomyositis and autoimmune hepatitis were defined, and the patient had a good clinical and laboratory response to corticosteroids and immunosuppressive.- Analysis of Metabolic Syndrome in Adult Dermatomyositis With a Focus on Cardiovascular Disease(2013) MORAES, Mariana Teichner de; SOUZA, Fernando Henrique Carlos de; BARROS, Thiago Bitar Moraes de; SHINJO, Samuel KatsuyukiObjective To evaluate the frequency of metabolic syndrome in dermatomyositis (DM) patients and to analyze the possible association of metabolic syndrome with traditional cardiovascular disease (CVD) risk factors and DM-related clinical and laboratory features. Methods The present cross-sectional single-center study included 84 DM patients and 105 healthy controls. Metabolic syndrome was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III. Results The median age was similar in both the DM and control groups (41.5 and 42.0 years, respectively; P = 0.378), with a comparable predominance of women (P = 0.904) and white race (P = 0.623). The DM patients had a higher prevalence of metabolic syndrome (41.7% versus 7.0%; P < 0.001), diabetes mellitus (17.9% versus 1.0%; P < 0.001), stroke (4.8% versus 0%; P = 0.024), and family history of CVD (23.8% versus 8.6%; P = 0.004). However, the frequency of sedentarism, hypothyroidism, smoking, and alcohol intake was similar in both groups (P > 0.05). Further analysis of the DM patients with (n = 35) and without (n = 49) metabolic syndrome revealed that the patients with this complication were older (mean +/- SD age 50.0 +/- 14.5 years versus 40.9 +/- 14.6 years; P = 0.006) and had a similar disease duration (P = 0.925) and higher prevalence of systemic arterial hypertension prior to the onset of disease symptoms (54.3% versus 10.2%; P < 0.001). In a multivariate analysis, only hypertension diagnosed prior to the disease was associated with metabolic syndrome (odds ratio 10.47 [95% confidence interval 2.6244.81]). Conclusion Metabolic syndrome is highly prevalent in DM, and prior hypertension seems to be a major determinant of its development, while disease- and therapy-related factors do not appear to play a relevant role.
conferenceObject An Analysis of Metabolic Syndrome in Adult Dermatomyositis with a Focus On Cardiovascular Disease(2012) MORAES, Mariana T.; SOUZA, Fernando H. C.; BARROS, Thiago B. M.; SHINJO, Samuel K.Background/Purpose: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities associated with increased cardiovascular risk. MetS has been systematically evaluated in all systemic autoimmune rheumatic diseases except for dermatomyositis (DM). Hence, we evaluated the frequency of MetS in DM patients and analyzed the possible association of MetS with traditional cardiovascular disease (CVD) risk factors and DM-related clinical and laboratorial features. Methods: The present cross-sectional single center study included 84 consecutive DM patients (Bohan & Peter, 1975) and 105 healthy control individuals. MetS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III. Results: The median age was similar in both the DM and control groups (aged 41.5 vs. aged 42.0, respectively; p=0.378) with a comparable predominance of the female gender (p=0.904) and white race (p=0.654) in both groups. The median disease duration was 4 years (range: 1–7). The DM patients had a higher prevalence of MetS (41.7 vs. 7.0%, p<0.001), diabetes mellitus (17.9 vs. 1.0%, p<0.001), ischemic stroke (4.8 vs. 0%, p=0.024), and a family history of premature CVD (32.8 vs. 8.6%, p=0.004). However, the frequency of sedentarism, hypothyroidism, smoking habit and alcohol intake were similar in both groups (p>0.05). Further analysis of the DM patients with (n=35) and without MetS (n=49) revealed that the patients with this complication were older (50.0±14.5 vs. 40.9±14.6, p=0.006) and had a similar disease duration (p=0.925) and a higher incidence of systemic arterial hypertension prior to the disease (54.3 vs. 10.2%, p=0.001). The frequency of other comorbidities, previously mentioned lifestyle contributing factors, clinical and laboratory disease features, and therapy schemes were similar in both groups (p>0.05). In a multivariate analysis, only hypertension diagnosed prior to the disease was associated with MetS (odds ratio 10.47, 95% confidence interval 2.62–44.81). Conclusion: MetS is highly prevalent in DM and prior hypertension seems to be a major determinant of its development while disease and therapy related factors do not appear to play a relevant role.