MARCELO VIVOLO AUN
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/60 - Laboratório de Imunologia Clínica e Alergia, Hospital das Clínicas, Faculdade de Medicina
LIM/60 - Laboratório de Imunologia Clínica e Alergia, Hospital das Clínicas, Faculdade de Medicina
45 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 45
- Th17/Treg-Related Intracellular Signaling in Patients with Chronic Obstructive Pulmonary Disease: Comparison between Local and Systemic Responses(2021) LOURENCO, Juliana D.; TEODORO, Walcy R.; BARBEIRO, Denise F.; VELOSA, Ana Paula P.; SILVA, Larissa E. F.; KOHLER, Julia B.; MOREIRA, Alyne R.; V, Marcelo Aun; SILVA, Isadora C. da; FERNANDES, Frederico L. A.; NEGRI, Elnara M.; GROSS, Jefferson L.; TIBERIO, Iolanda F. L. C.; ITO, Juliana T.; LOPES, Fernanda D. T. Q. S.Th17/Treg imbalance plays a pivotal role in COPD development and progression. We aimed to assess Th17/Treg-related intracellular signaling at different COPD stages in local and systemic responses. Lung tissue and/or peripheral blood samples were collected and divided into non-obstructed (NOS), COPD stages I and II, and COPD stages III and IV groups. Gene expression of STAT3 and -5, ROR gamma t, Foxp3, interleukin (IL)-6, -17, -10, and TGF-beta was assessed by RT-qPCR. IL-6, -17, -10, and TGF-beta levels were determined by ELISA. We observed increased STAT3, ROR gamma t, Foxp3, IL-6, and TGF-beta gene expression and IL-6 levels in the lungs of COPD I and II patients compared to those of NOS patients. Regarding the systemic response, we observed increased STAT3, ROR gamma t, IL-6, and TGF-beta gene expression in the COPD III and IV group and increased IL-6 levels in the COPD I and II group. STAT5 was increased in COPD III and IV patients, although there was a decrease in Foxp3 expression and IL-10 levels in the COPD I and II and COPD III and IV groups, respectively. We demonstrated that an increase in Th17 intracellular signaling in the lungs precedes this increase in the systemic response, whereas Treg intracellular signaling varies between the compartments analyzed in different COPD stages.
- Drug-induced anaphylaxis: is it an epidemic?(2018) GIAVINA-BIANCHI, Pedro; AUN, Marcelo V.; KALIL, JorgePurpose of reviewThe present review addresses the epidemiology, analyzes the current data and promotes global awareness of drug-induced anaphylaxis.Recent findingsAnaphylaxis is a medical emergency that may cause death! In the last decade, studies have shown an increasing incidence and prevalence of anaphylaxis.SummaryDrug-induced anaphylaxis fatalities have increased, and this syndrome remains underdiagnosed and undertreated.
- Spirometric values in elderly asthmatic patients are not influenced by obesity(2012) AGONDI, R. C.; BISACCIONI, C.; AUN, M. V.; RIBEIRO, M. R.; KALIL, J.; GIAVINA-BIANCHI, P.Background Studies have suggested that asthma in obese individuals differs from the classic asthma phenotype, presenting as a disease that is more difficult to control. Objective The objective of the present study was to determine whether obesity, age or a combination of the two are associated with worse spirometry parameters in patients with asthma. Methods This was an observational cross-sectional study involving patients over 18 years of age who had been diagnosed with asthma (allergic or nonallergic). We evaluated the results of their spirometric tests. The patients were classified in accordance with two criteria: body mass index (BMI) and age. Based on their BMIs, the patients were divided into three groups: normal weight, overweight and obese. Patients were also separated into two categories by age: 18-59 years of age; and >= 60 years of age. Results We evaluated 451 patients with asthma and their spirometry tests. In the present study, the pulmonary function parameters were negatively correlated with BMI and age (P < 0.05). We found that there was a statistically significant correlation between spirometric values and BMI among patients 18-59 years of age (P < 0.001), however, among patients over 60, we did not observe this negative association. Conclusions and Clinical Relevance The spirometric values decreased significantly in proportion to the increase of BMI and age in patients with asthma, especially among young adults. There was no negative correlation between BMI and FEV1 in the group >= 60 years of age, suggesting that perhaps the time of disease is a major factor in the loss of lung function than weight gain in the elderly.
- Is age associated with the development of antibodies against botulinum toxin?(2013) AUN, M. V.; CHUNG, T. M.; SANTOS, K. S.; BATTISTELLA, L. M. R.; RIZZO, L. V.; KALIL, J.; GIAVINA-BIANCHI, P.
- Editorial: The Role of Mast Cells in Immediate Hypersensitivity Reactions(2021) AUN, Marcelo Vivolo; BLANCA-LOPEZ, Natalia; CASTELLS, Mariana C.; GIAVINA-BIANCHI, Pedro
- Vocal cord dysfunction diagnosis may be improved by a screening check list(2016) PINTO, Lucia Helena Eduardo; AUN, Marcelo Vivolo; CUKIER-BLAJ, Sabrina; STELMACH, Rafael; CUKIER, Alberto; KALIL, Jorge; AGONDI, Rosana Camara; GIAVINA-BIANCHI, PedroBackground: Many patients with vocal cord dysfunction (VCD), with or without asthma, receive inappropriate treatment because they are misdiagnosed as having difficult-to-control asthma alone. We developed a clinical screening check list designed to aid the diagnosis of VCD. Methods: A prospective observational study involving 80 patients aged >= 8 years, diagnosed with severe asthma. After anamnesis and physical examination, physicians completed a check list with 6 questions to identify VCD, for which the answer ""yes"" counted one point. Then patients underwent spirometry and laryngoscopy. On the basis of the laryngoscopic findings, we created three patient groups: VCD (vocal cord adduction during inspiration, n = 14); unconfirmed VCD (inconclusive findings, n = 29); and control (normal findings, n = 37). We attempted to determine whether any of those groups were associated with the responses to individual questions or sets of questions on the check list. Results: The proportion of affirmative answers to the question ""Does pulmonary auscultation reveal wheezing, predominantly in the cervical region, and/or stridor?"" was significantly higher for the VCD group than for the other two groups (P = 0.006), notably in elderly patients. The variable ""4 or more affirmative answers"" was more common in VCD and unconfirmed VCD groups in comparison to controls (P = 0.022). Conclusions: A finding of wheezing or stridor on auscultation of the cervical region is suggestive of vocal cord dysfunction, especially in elderly patients, and such dysfunction can be confirmed through laryngoscopy. Our VCD screening check list proved to be useful in the screening of VCD among patients with severe asthma.
- Diagnosis and treatment of systemic mastocytosis in Brazil: Recommendations of a multidisciplinary expert panel(2022) VELLOSO, Elvira D. Rodrigues Pereira; PADULLA, Georgia A.; CERQUEIRA, Ana Maria Mosca de; SOUSA, Adriana Martins de; SANDES, Alex Freire; TRAINA, Fabiola; SEGURO, Fernanda Salles; NOGUEIRA, Frederico Lisboa; PEREIRA, Grazielly de Fathima; BOECHAT, jose Laerte; PAGNANO, Katia Borgia Barbosa; MARCHI, Luan Lima; ENSINA, Luis Felipe; GIAVINA-BIANCHI, Mara; AUN, Marcelo Vivolo; AGONDI, Rosana Camara; SANTOS, Fabio Pires de Souza; GIAVINA-BIANCHI, PedroIntroduction: Systemic Mastocytosis comprises a group of neoplastic diseases character-ized by clonal expansion and infiltration of mast cells into several organs. The diagnosis and treatment of this disease may be challenging for non-specialists. Objective: Make suggestions or recommendations in Systemic Mastocytosis based in a panel of Brazil-ian specialists.Method and results: An online expert panel with 18 multidisciplinary specialists was con-vened to propose recommendations on the diagnosis and treatment of Systemic Mastocy-tosis in Brazil. Recommendations were based on discussions of topics and multiple-choice questions and were graded using the Oxford Centre for Evidence-Based Medicine 2011 Lev-els of Evidence Chart. Conclusion: Twenty-two recommendations or suggestions were proposed based on a litera-ture review and graded according to the findings.(c) 2022 Associacao Brasileira de Hematologia, Hemoterapia e Terapia Celular.
- Drug-induced anaphylaxis in children: Nonsteroidal anti-inflammatory drugs and drug provocation test REPLY(2014) AUN, Marcelo Vivolo; BLANCA, Miguel; GARRO, Laila Sabino; RIBEIRO, Marisa Rosimeire; KALIL, Jorge; MOTTA, Antonio Abilio; CASTELLS, Mariana; GIAVINA-BIANCHI, Pedro
- Specific questionnaire detects a high incidence of intra-operative hypersensitivity reactions(2018) GARRO, Laila S.; V, Marcelo Aun; SOARES, Iracy Silvia C.; RIBEIRO, Marisa R.; MOTTA, Antonio A.; KALIL, Jorge; CASTELLS, Mariana C.; CARMONA, Maria Jose C.; GIAVINA-BIANCHI, PedroOBJECTIVE: To assess the incidence of intra-operative immediate hypersensitivity reactions and anaphylaxis. METHODS: A cross-sectional observational study was conducted at the Department of Anesthesiology, University of Sao Paulo School of Medicine, Hospital das Clinicas, Sao Paulo, Brazil, from January to December 2010. We developed a specific questionnaire to be completed by anesthesiologists. This tool included questions about hypersensitivity reactions during anesthesia and provided treatments. We included patients with clinical signs compatible with immediate hypersensitivity reactions. Hhypersensitivity reactions were categorized according to severity (grades I-V). American Society of Anesthesiologists physical status classification (ASA 1-6) was analyzed and associated with the severity of hypersensitivity reactions. RESULTS: In 2010, 21,464 surgeries were performed under general anesthesia. Anesthesiologists answered questionnaires on 5,414 procedures (25.2%). Sixty cases of intra-operative hypersensitivity reactions were reported. The majority patients (45, 75%) had hypersensitivity reactions grade I reactions (incidence of 27.9:10,000). Fifteen patients (25%) had grade II, III or IV reactions (intra-operative anaphylaxis) (incidence of 7:10,000). No patients had grade V reactions. Thirty patients (50%) were classified as ASA 1. The frequency of cardiovascular shock was higher in patients classified as ASA 3 than in patients classified as ASA 1 or ASA 2. Epinephrine was administered in 20% of patients with grade III hypersensitivity reactions and in 50% of patients with grade II hypersensitivity reactions. CONCLUSIONS: The majority of patients had hypersensitivity reactions grade I reactions; however, the incidence of intra-operative anaphylaxis was higher than that previously reported in the literature. Patients with ASA 3 had more severe anaphylaxis; however, the use of epinephrine was not prescribed in all of these cases. Allergists and anesthesiologists should implement preventive measures to reduce the occurrence of anaphylaxis.
- Algorithm to guide re-exposure to penicillin in allergic pregnant women with syphilis: Efficacy and safety(2021) GARCIA, Juliana Foes Bianchini; AUN, Marcelo Vivolo; MOTTA, Antonio Abilio; CASTELLS, Mariana; KALIL, Jorge; GIAVINA-BIANCHI, PedroResults: Ninety-one patients were enrolled. Allergy to penicillin was confirmed in 7.69% of pregnant women with syphilis and clinical history of allergy to penicillin; in all cases the diagnosis was made through intradermal testing, which predicted 100% of the breakthrough reactions observed during rapid drug desensitization (p < 0.001). Risk stratification based on the initial clinical reaction and skin testing to guide penicillin re-introduction through drug challenge or desensitization was safe (97.8%) and effective (97.8%). Conclusion: We developed and showed the efficacy and safety of an algorithm to guide reexposure to penicillin in pregnant women with syphilis and labeled as allergic to this drug. Intradermal test is an excellent biomarker in the diagnosis of immediate hypersensitivity reaction to penicillin and to predict breakthrough reaction during rapid drug desensitization. Further studies Background: Gestational syphilis is underdiagnosed and undertreated, leading to stillbirth, prematurity, low birthweight, neonatal death, and congenital syphilis. Most patients who label as allergic to penicillin are misdiagnosed. Objective: To assess the efficacy and safety of an algorithm to guide re-exposure to penicillin in pregnant women with syphilis and reporting allergy to the antibiotic. Methods: We performed a prospective study assessing pregnant women with syphilis and labeled as allergic to penicillin. Based on clinical history, patients were divided in two groups: high risk and low-risk to penicillin allergy. Low-risk patients with negative skin testing and negative serum specific IgE to penicillin underwent drug provocation test. The remaining patients underwent desensitization. Results: Ninety-one patients were enrolled. Allergy to penicillin was confirmed in 7.69% of pregnant women with syphilis and clinical history of allergy to penicillin; in all cases the diagnosis was made through intradermal testing, which predicted 100% of the breakthrough reactions observed during rapid drug desensitization (p < 0.001). Risk stratification based on the initial clinical reaction and skin testing to guide penicillin re-introduction through drug challenge or desensitization was safe (97.8%) and effective (97.8%). Conclusion: We developed and showed the efficacy and safety of an algorithm to guide re exposure to penicillin in pregnant women with syphilis and labeled as allergic to this drug. Intradermal test is an excellent biomarker in the diagnosis of immediate hypersensitivity reaction to penicillin and to predict breakthrough reaction during rapid drug desensitization. Further studies may confirm the greater safety of the intravenous protocol compared to the oral protocol.