29 results on '"Machado LG"'
Search Results
2. Towards an update on the antimicrobial use in Adult Care Units in Brazil: insights from multi-hospital prevalence study.
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Machado LG, Resende DS, de Campos PA, Ferreira ML, Rossi I, Braga IA, Aires CAM, Freitas Tenório MT, Queiroz LL, de Almeida VF, Gontijo-Filho PP, and Ribas RM
- Subjects
- Humans, Brazil epidemiology, Male, Adult, Female, Middle Aged, Aged, Prevalence, Prospective Studies, Drug Utilization statistics & numerical data, Antimicrobial Stewardship, Young Adult, Hospitals statistics & numerical data, Aged, 80 and over, Intensive Care Units statistics & numerical data, Anti-Bacterial Agents therapeutic use
- Abstract
Introduction. Efforts to understand the burden of antibiotic use in low- and middle-income countries such as Brazil are essential for developing strategies that are effective and appropriate in the context of endemic multidrug-resistant organisms. Aim. This study aims to determine antimicrobial-prescribing practices among patients hospitalized in intensive care units (ICUs) for adults in Brazil. Methodology. A 1-day point prevalence multicentre survey was conducted in 58 adult ICUs across the five regions of Brazil. The institutions were categorized according to their type and size. Detailed antimicrobial prescription data were prospectively provided to all patients hospitalized on the day of data collection. Results. A total of 620 patients were included in the study, of whom 63.9% were receiving at least one antimicrobial. Of these, 34.6% were treated for an infection, but only 39.9% of the cases were based on microbiological criteria. Empirical treatment was applied to 72.3% of the patients. Significant differences in antibiotic usage were observed across the different hospitals included in the study. Overall, treatment was most commonly directed towards pneumonia (51.8%) and bloodstream infections (29.6%). Glycopeptides (19.4%) and carbapenems (18.5%) were the most prescribed in teaching hospitals, while in non-teaching hospitals, carbapenems (17.8%) and broad-spectrum cephalosporins (16.8%) were most frequently used. Conclusion. Our study reveals alarming data on antibiotic use in adult ICUs in Brazil, with high frequencies of severe healthcare-associated infections acquired in these units, where patients are frequently subjected to empirical treatment.
- Published
- 2024
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3. Performance of the Brazilian Fracture Assessment Risk Tool (FRAX) model and the age-dependent intervention thresholds according to National Osteoporosis Guideline Group (NOGG) guidelines on fracture prediction in community-dwelling older adults: the São Paulo Ageing and Health (SPAH) Study.
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Freitas TQ, Olalla LFG, Machado LG, Figueiredo CP, Takayama L, de Falco Caparbo V, Domiciano DS, and Pereira RMR
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- Humans, Male, Female, Aged, Brazil epidemiology, Risk Assessment methods, Aged, 80 and over, Prospective Studies, Osteoporosis epidemiology, Osteoporosis complications, Independent Living statistics & numerical data, Risk Factors, Practice Guidelines as Topic, Age Factors, Osteoporotic Fractures epidemiology, Bone Density
- Abstract
The SPAH study is a population-based prospective cohort of Brazilian community-dwelling elderlies with higher fracture risk than observed in the studies used to construct the Brazilian FRAX model. In this study, the FRAX tool was a good fracture predictor within this high-risk elderly cohort, especially when calculated without bone density., Purpose: To determine the performances of FRAX and age-dependent intervention thresholds according to National Osteoporosis Guideline Group (NOGG) guidelines with and without bone mineral density (BMD) regarding fracture prediction in community-dwelling elderly Brazilians., Methods: Seven hundred and five older adults (447 women; 258 men) were followed for 4.3 ± 0.8 years. FRAX risk for hip and major osteoporotic fractures with and without BMD was calculated at baseline. The bivariate analysis investigated the associations between the absolute probability of fracture (FRAX), as well as the age-dependent intervention thresholds (NOGG), and the incidence of vertebral fracture (VF), non-vertebral fracture (NVF), and major osteoporotic fractures (MOF), segregated by sex. Age-adjusted Poisson's multiple regression and ROC curves were constructed to determine FRAX and NOGG's accuracies as fracture predictors., Results: Fractures occurred in 22% of women and 15% of men. FRAX with and without BMD was higher in women with all types of fractures (p < 0.001). Only NOGG risk classification without BMD was associated with NVF (p = 0.047) and MOF (p = 0.024). FRAX was associated with NVF in the multiple regression, regardless of BMD. ROC curves of FRAX with and without BMD had AUCs of 0.74, 0.64, and 0.61 for NVF, VF, and MOF, respectively. The most accurate risk cutoffs for FRAX were 8% for MOF and 3% for hip fractures. No statistically significant associations were found in men., Conclusion: FRAX predicted NVF more accurately than VF or MOF in elderlies, regardless of BMD. These results reiterate that FRAX may be used without BMD, even considering that Brazilian elderlies have known higher fracture risk., (© 2024. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)
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- 2024
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4. Incidence and risk factors for osteoporotic non-vertebral fracture in low-income community-dwelling elderly: a population-based prospective cohort study in Brazil. The São Paulo Ageing and Health (SPAH) study.
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Domiciano DS, Machado LG, Figueiredo CP, Caparbo VF, Oliveira RM, Menezes PR, and Pereira RMR
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- Aged, Aging, Brazil epidemiology, Cohort Studies, Female, Humans, Incidence, Male, Prospective Studies, Risk Factors, Bone Density, Independent Living
- Abstract
We ascertained the incidence of non-vertebral fracture in a low-income Brazilian elderly cohort. To the best of our knowledge, this is the first population-based study to demonstrate the frequency of non-vertebral fracture in elderly Latin Americans. Age, prior fracture, and bone mineral density (BMD) at hip were predictors of fracture., Introduction: No data on incidence of osteoporotic non-vertebral fracture have been reported in low-income countries where the population's aging has been faster. Even in developed countries, currently available prospective data on major fracture rates beyond hip are scarce. The aim of this study is to describe the incidence and risk factors for non-vertebral fracture in a longitudinal prospective Brazilian population-based elderly cohort., Methods: Seven hundred seven older adults (449 women, 258 men) were evaluated at baseline and after a mean follow-up of 4.3 ± 0.8 years. Clinical questionnaire, bone mineral density (BMD), and laboratory tests were performed at baseline. New non-vertebral fracture (hip, proximal humerus, rib, forearm) was determined during the follow-up. Multivariate Poisson regression models were used to identify independent predictors of fracture., Results: The age-standardized incidence of non-vertebral fracture was 1562.3/100,000 (1085.7-2248.1/100,000) person-years (pyr) in women and 632.8/100,000 (301.7-1327.3/100,000) in men. Concerning to hip fractures, the incidence was 421.2/100,000 (210.7-842.3/100,000) pyr in women and 89.9/100,000 (12.7-638.5/100,000) in men. In a multivariate analysis, age (RR 2.07, 95% CI 1.13-3.82, p = 0.019, each 10-year increase), prior non-vertebral fracture (RR 3.08, 95% CI 1.36-6.95, p = 0.007), and total hip BMD (RR 1.68, 95% CI 1.11-2.56, p = 0.015, each 1 SD decrease) were predictors of new non-vertebral fracture. In men, fitting a model of risk factors for fracture was prevented by the limited number of events in male sample., Conclusion: This is the first population-based study to ascertain the incidence of major non-vertebral fractures in elderly Latin Americans, confirming the high frequency of the disorder. Age, prior fracture, and hip BMD were predictors of the short-term incidence of fracture.
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- 2021
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5. Neonatal bed status in Brazilian maternity hospitals: an exploratory analysis.
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Miranda ECS, Rodrigues CB, Machado LG, Gomes MASM, Augusto LCR, Simões VMF, Magluta C, and Lamy-Filho F
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- Brazil, Critical Care, Female, Humans, Infant, Newborn, Pregnancy, Surveys and Questionnaires, Hospitals, Maternity, Intensive Care Units, Neonatal
- Abstract
Neonatal units should be organized as a progressive care line, with intermediate and intensive care beds (conventional and kangaroo). The aim of this study was to evaluate the status and adequacy of neonatal beds in maternity hospitals linked to the 'Stork Network' ("Rede Cegonha"). A descriptive study was conducted in 606 maternity hospitals in all regions of Brazil. The databases used belonged to the Stork Network Evaluation Survey and the National Live Birth System. To assess the distribution of neonatal beds by typology, the parameters proposed in Ordinance N. 930/2012 of the Ministry of Health were used. Most neonatal units are not organized as a progressive care line with the three types of bed planned. Kangaroo intermediate care beds comprise the minority of implanted beds. There is a concentration of intensive and intermediate beds in the Southeast and South regions, which show a kangaroo intermediate care bed deficit. Analyzing the adequacy of beds by the number of live births, one can observe an inadequacy of Kangaroo care beds in all regions of Brazil, as well as intensive bed deficit in the North and Northeast regions, and adequacy of conventional intermediate care beds in all regions.
- Published
- 2021
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6. Risk Factors for Low Muscle Mass in a Population-based Prospective Cohort of Brazilian Community-dwelling Older Women: The São Paulo Ageing & Health (SPAH) Study.
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Machado KLLL, Domiciano DS, Machado LG, Lopes JB, Figueiredo CP, Caparbo VF, Takayama L, Menezes PR, and Pereira RMR
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- Aged, Body Composition, Body Mass Index, Brazil epidemiology, Cohort Studies, Female, Humans, Independent Living, Logistic Models, Multivariate Analysis, Prospective Studies, Risk Factors, Accidental Falls statistics & numerical data, Creatinine blood, Intra-Abdominal Fat, Sarcopenia epidemiology, Thyrotropin blood
- Abstract
Introduction: Sarcopenia is characterized by progressive loss of skeletal muscle mass, which results in decreased muscle strength, functional impairment, and increased risk of death. Few studies have performed a concomitant evaluation of clinical, laboratory, and body composition variables to accurately determine the contribution of each parameter to low muscle mass (LMM) in older subjects. This study aimed to identify risk factors (clinical, laboratory parameters, BMD, and body composition by DXA including visceral fat) for LMM in a prospective cohort of older Brazilian women., Methods: A total of 408 women aged ≥65 yr from the São Paulo Ageing & Health study were evaluated with clinical data, laboratory bone tests, BMD, and body composition by DXA using Hologic QDR 4500A equipment. Risk factors were measured at baseline (2005-2007). After a follow-up of 4.3 ± 0.8 yr, subjects were classified according to the LMM definition of the Foundation for the National Institutes of Health criteria. LMM was defined when appendicular lean mass divided by body mass index was less than 0.512. Multivariate logistic regression models were used to identify independent risk factors for LMM., Results: At the end of follow-up, 116 women (28.4%) had LMM. Age averages were 73.3 ± 4.9 yr in the LMM group and 72.5 ± 4.5 yr in the normal group (p = 0.11). Mean BMI was 30.6 ± 5.2 kg/m
2 in the LMM group and 28.1 ± 4.7 kg/m2 in the normal group (p < 0.001). In multivariate analyses, predictors of LMM were: falls (OR = 1.14, p = 0.016), TSH levels (OR = 1.08, p = 0.018, per 1 μUI/L-increase), serum creatinine levels (OR = 11.11, p < 0.001, per 1 mg/dL-decrease), and visceral adipose tissue (VAT) mass (OR = 1.17, p < 0.001, per 100 g increase)., Conclusions: Falls, high TSH, low creatinine, and high VAT were risk factors for LMM in older women. More attention should be paid to these factors, since they are potentially reversible with adequate intervention., (Copyright © 2019 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.)- Published
- 2020
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7. Infections and antimicrobial resistance in an adult intensive care unit in a Brazilian hospital and the influence of drug resistance on the thirty-day mortality among patients with bloodstream infections.
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Sabino SS, Lima CA, Machado LG, Campos PA, Fontes AMS, Gontijo-Filho PP, and Ribas RM
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- Adult, Bacteremia mortality, Female, Gram-Negative Bacteria classification, Gram-Negative Bacteria isolation & purification, Gram-Positive Bacteria classification, Gram-Positive Bacteria isolation & purification, Hospital Mortality, Humans, Incidence, Intensive Care Units, Male, Microbial Sensitivity Tests, Middle Aged, Retrospective Studies, Time Factors, Anti-Bacterial Agents pharmacology, Bacteremia microbiology, Drug Resistance, Bacterial, Gram-Negative Bacteria drug effects, Gram-Positive Bacteria drug effects
- Abstract
Introduction: The present study aimed to determine the incidence of health care-associated infections (HCAIs) and identify the main resistant microorganisms in intensive care unit (ICU) patients in a Brazilian university hospital., Methods: A retrospective cohort study was conducted in a Brazilian teaching hospital between 2012 and 2014., Results: Overall, 81.2% of the infections were acquired in the ICU. The most common resistant pathogenic phenotypes in all-site and bloodstream infections were oxacillin-resistant coagulase-negative staphylococci and carbapenem-resistant Acinetobacter spp. (89.9% and 87.4%; 80.6% and 70.0%), respectively., Conclusions: There is an urgent need to focus on HCAIs in ICUs in Brazil.
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- 2020
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8. KLOTHO polymorphisms and age-related outcomes in community-dwelling older subjects: The São Paulo Ageing & Health (SPAH) Study.
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Pereira RMR, Freitas TQ, Franco AS, Takayama L, Caparbo VF, Domiciano DS, Machado LG, Figueiredo CP, Menezes PR, Onuchic LF, and de Castro I
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- Aged, Cardiovascular Diseases genetics, Cardiovascular Diseases pathology, Humans, Klotho Proteins, Male, Prognosis, Risk Factors, Stroke genetics, Stroke pathology, Survival Rate, Aging genetics, Cardiovascular Diseases mortality, Glucuronidase genetics, Independent Living statistics & numerical data, Polymorphism, Single Nucleotide, Stroke mortality
- Abstract
Defective KLOTHO gene expression in mice led to a syndrome resembling human ageing. This study evaluated three KLOTHO polymorphisms, namely G395A, C1818T, and C370S, in an elderly population (mean age of 73 years) and their associations with ageing-related outcomes (cardiovascular events, kidney function, osteoporosis, sarcopenia) and mortality. Estimated glomerular filtration rates (eGFR) was lower in subjects with 1818TT (P = 0.047) and 370SS (P = 0.046) genotypes. The 1818TT genotype (P = 0.006) and 1818T allele were associated with higher frequency of myocardial infarction (MI) (CC:1.7% vs. CT + TT:7.0%; P = 0.002). The 370SS genotype was associated with lower stroke frequency (P = 0.001). MI (OR 3.35 [95% CI: 1.29-8.74]) and stroke (OR 3.64 [95% CI: 1.48-8.97]) were associated with mortality. Regarding MI, logistic regression showed 1818T allele was a risk factor for death-related MI (OR 4.29 [95% CI: 1.60-11.52]; P = 0.003), while 370C was protective (OR 0.03 [95% CI: 0.01-0.08]; P < 0.001). Regarding stroke, the 395A and 370C alleles were protective factors (respectively: OR 0.28 [95% CI: 0.20-0.80]; P = 0.018; OR 0.10 [95% CI: 0.05-0.18]; P < 0.001). This is the first study to determine potential associations between common ageing-related outcomes/mortality and KLOTHO polymorphisms. The 1818T allele was a risk factor for MI-related death. The 395A and 370C alleles were protective factors for stroke-related death in elderly from community.
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- 2020
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9. Increased formation of reactive oxygen species during tumor growth: Ex vivo low-temperature EPR and in vivo bioluminescence analyses.
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Cheng G, Pan J, Podsiadly R, Zielonka J, Garces AM, Dias Duarte Machado LG, Bennett B, McAllister D, Dwinell MB, You M, and Kalyanaraman B
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- Animals, Electron Spin Resonance Spectroscopy, Mice, Oxidation-Reduction, Reactive Oxygen Species, Temperature, Neoplasms
- Abstract
Previous studies have shown that reactive oxygen species (ROS) such as superoxide or hydrogen peroxide generated at low levels can exert a tumor-promoting role via a redox-signaling mechanism. Reports also suggest that both tumorigenesis and tumor growth are associated with enhanced ROS formation. However, whether ROS levels or ROS-derived oxidative marker levels increase during tumor growth remains unknown. In this study, in vivo bioluminescence imaging with a boronate-based pro-luciferin probe was used to assess ROS formation. Additionally, probe-free cryogenic electron paramagnetic resonance was used to quantify a characteristic aconitase [3Fe4S]
+ center that arises in the tumor tissue of mouse xenografts from the reaction of the native [4Fe4S]2+ cluster with superoxide. Results indicated that tumor growth is accompanied by increased ROS formation, and revealed differences in oxidant formation in the inner and outer sections of tumor tissue, respectively, demonstrating redox heterogeneity. Studies using luciferin and pro-luciferin probes enabled the assessment of tumor size, ROS formation, and bioenergetic status (e.g., ATP) in luciferase-transfected mice tumor xenografts. Probe-free ex vivo low-temperature electron paramagnetic resonance can also be translated to clinical studies., (Copyright © 2019 Elsevier Inc. All rights reserved.)- Published
- 2020
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10. Novel small IncX3 plasmid carrying the bla KPC-2 gene in high-risk Klebsiella pneumoniae ST11/CG258.
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Fuga B, Ferreira ML, Cerdeira LT, de Campos PA, Dias VL, Rossi I, Machado LG, Lincopan N, Gontijo-Filho PP, and Ribas RM
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- Brazil epidemiology, Gene Order, Genome, Bacterial, High-Throughput Nucleotide Sequencing, Humans, Klebsiella Infections epidemiology, Multilocus Sequence Typing, Klebsiella Infections microbiology, Klebsiella pneumoniae classification, Klebsiella pneumoniae genetics, Plasmids genetics, beta-Lactamases genetics
- Abstract
This study used whole-genome sequencing (WGS) and PFGE to analysis KPC-2-producing Klebsiella pneumoniae strains from clinical specimens collected in Brazilian hospitals. The study identifies the emergence of a novel small IncX3 plasmid (pKPB11), 12,757-bp in length, in a high-risk K. pneumoniae ST11/CG258 lineage, a successful clonal group in Brazil, carrying the bla
KPC-2 gene on a non-Tn4401 genetic element (NTEKPC -Ic). Comparative analysis of the pKPB11 showed that this plasmid reduced its size, losing part of its conjugation apparatus. The pKPB11 was also compared to another strain sequenced in this study (KPC89) that had the hybrid IncX3-IncU plasmid (pKP89), of approximately 45 kb in length, similarly carrying the blaKPC-2 gene on NTEKPC -Ic. To the best of our knowledge, pKPB11 is the first example of small IncX3 plasmid found in a high-risk KPC-2-producing K. pneumoniae ST11/CG258., (Copyright © 2019 Elsevier Inc. All rights reserved.)- Published
- 2020
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11. Incidence of infections caused by carbapenem-resistant Acinetobacter baumannii.
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Rossi I, Royer S, Ferreira ML, Campos PA, Fuga B, Melo GN, Machado LG, Resende DS, Batistão D, Urzedo JE, Gontijo-Filho PP, and Ribas RM
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- Acinetobacter Infections microbiology, Acinetobacter Infections mortality, Acinetobacter baumannii drug effects, Adolescent, Adult, Aged, Aged, 80 and over, Brazil epidemiology, Cross Infection microbiology, Cross Infection mortality, Female, Hospitals, University, Humans, Incidence, Inpatients, Male, Middle Aged, Prevalence, Retrospective Studies, Risk Factors, Survival Analysis, Young Adult, Acinetobacter Infections epidemiology, Acinetobacter baumannii isolation & purification, Anti-Bacterial Agents pharmacology, Carbapenems pharmacology, Cross Infection epidemiology, beta-Lactam Resistance
- Abstract
Background: Carbapenem-resistant Acinetobacter baumannii (CR-Ab) has become a worrying health care problem, mainly in developing countries, such as Brazil. The objective was to investigate the prevalence and prognostic factors for CR-Ab infections at a Brazilian university hospital and examine the impact of inappropriate antimicrobial therapy on patient outcome., Methods: A retrospective study on hospitalized patients with CR-Ab infections was carried out from January 2013 to December 2017. An epidemiologic analysis was carried out to determine the frequency of infections, the epidemiologic indicators by year, the risk factors for 30-day mortality, and the impact of inappropriate therapy., Results: A total of 489 patients were included in the study. A rate of 0.7 per 1,000 patient-day CR-Ab infections was observed, mostly in the lungs (54.7%), and predominantly in the adult intensive care unit. The occurrence of infections by CR-Ab per 1,000 patient-days in November 2014 exceeded the established control limit, confirming an outbreak., Conclusions: The prevalence of CR-Ab increased in the investigated hospital, passing to an endemic pathogen with a direct impact on mortality and the control of these strains., (Copyright © 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
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12. Early Dissemination of IncQ1 Plasmids in KPC-2-Producing Klebsiella pneumoniae CG258.
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Campos PA, Fuga B, Cerdeira LT, Ferreira ML, Dias VL, Machado LG, Rossi I, Lincopan N, Gontijo-Filho PP, and Ribas RM
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- Anti-Bacterial Agents, DNA, Bacterial genetics, Humans, Klebsiella Infections microbiology, Microbial Sensitivity Tests, Drug Resistance, Bacterial genetics, Genes, Bacterial genetics, Klebsiella pneumoniae drug effects, Klebsiella pneumoniae genetics, Plasmids genetics, beta-Lactamases genetics
- Published
- 2019
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13. Molecular Detection of Class 1 Integron-Associated Gene Cassettes in KPC-2-Producing Klebsiella pneumoniae Clones by Whole-Genome Sequencing.
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Fuga B, Royer S, Campos PA, Ferreira ML, Rossi I, Machado LG, Cerdeira LT, Fonseca Batistão DWD, Brito CS, Lincopan N, Gontijo-Filho PP, and Ribas RM
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- Brazil, DNA Transposable Elements genetics, Drug Resistance, Multiple, Bacterial genetics, Humans, Integrons, Whole Genome Sequencing methods, Klebsiella pneumoniae genetics, beta-Lactamases genetics
- Abstract
The dissemination of antimicrobial resistance genes and the bacterium that harbor them have increasingly become a public concern, especially in low- and middle-income countries. The present study used whole-genome sequencing to analyze 10 KPC-2-producing Klebsiella pneumoniae isolates obtained from clinical specimens originated from Brazilian hospitals. The study documents a relevant "snapshot" of the presence of class 1 integrons in 90% of the strains presenting different gene cassettes ( dfrA30, dfrA15, dfrA12, dfrA14, aadA1, aadA2, and aac(6')Iq ), associated or not with transposons. Two strains presented nonclassical integron (lacking the normal 3'conserved segment). In general, most strains showed a complex resistome, characterizing them as highly resistant. Integrons, a genetically stable and efficient system, confer to bacteria as highly adaptive and low cost evolution potential to bacteria, even more serious when associated with high-risk clones, indicating an urgent need for control and prevention strategies to avoid the spread of resistance determinants in Brazil. Despite this, although the class 1 integron identified in the KPC-2-producing K. pneumoniae clones is important, our findings suggest that other elements probably have a greater impact on the spread of antimicrobial resistance, since many of these important genes were not related to this cassette.
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- 2019
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14. Association of Appendicular Lean Mass, and Subcutaneous and Visceral Adipose Tissue With Mortality in Older Brazilians: The São Paulo Ageing & Health Study.
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de Santana FM, Domiciano DS, Gonçalves MA, Machado LG, Figueiredo CP, Lopes JB, Caparbo VF, Takayama L, Menezes PR, and Pereira RM
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- Aged, Brazil epidemiology, Female, Humans, Male, Multivariate Analysis, ROC Curve, Survival Analysis, Aging physiology, Intra-Abdominal Fat pathology, Mortality, Subcutaneous Fat pathology, Thinness pathology
- Abstract
Body composition changes as a result of ageing may impact the survival of older adults. However, its influence on mortality risk is uncertain. Currently, the best method for body composition analysis in clinical practice is DXA. Nonetheless, the few studies on body composition by DXA and mortality risk in the elderly have some limitations. We investigated the association between body composition by DXA and mortality in a cohort of elderly subjects. Eight hundred thirty-nine community-dwelling subjects (516 women, 323 men) ≥ 65 years of age were assessed by a questionnaire, clinical data, laboratory exams, and body composition by DXA at baseline. Total fat and its components (eg, visceral adipose tissue [VAT]) were estimated. Appendicular lean mass (ALM) adjusted for fat and ALM divided by height² was used to ascertain the presence of low muscle mass (LMM). Mortality was recorded during follow-up. Multivariate logistic regression was used to compute ORs for all-cause and cardiovascular mortality. Over a mean follow-up of 4.06 ± 1.07 years, there were 132 (15.7%) deaths. In men, after adjustment for relevant variables, the presence of LMM (OR, 11.36, 95% CI, 2.21 to 58.37, P = 0.004) and VAT (OR, 1.99, 95% CI, 1.38 to 2.87, P < 0.001, for each 100-g increase) significantly increased all-cause mortality risk, whereas total fat, measured by the fat mass index, was associated with decreased mortality risk (OR, 0.48, 95% CI, 0.33 to 0.71, P < 0.001). Similar results were observed for cardiovascular mortality. In women, only LMM was a predictor of all-cause (OR, 62.88, 95% CI, 22.59 to 175.0, P < 0.001) and cardiovascular death (OR, 74.54, 95% CI, 9.72 to 571.46, P < 0.001). LMM ascertained by ALM adjusted for fat and fat mass by itself are associated with all-cause and cardiovascular mortality risk in the elderly. Visceral and subcutaneous fat have opposite roles on mortality risk in elderly men. Thus, DXA is a promising tool to estimate risk of mortality in the elderly. © 2019 American Society for Bone and Mineral Research., (© 2019 American Society for Bone and Mineral Research.)
- Published
- 2019
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15. Association of Colistin-Resistant KPC Clonal Strains with Subsequent Infections and Colonization and Biofilm Production.
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Ferreira ML, Araújo BF, Gonçalves IR, Royer S, Campos PA, Machado LG, Batistão DWF, Brito CS, Gontijo-Filho PP, and Ribas RM
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- Adult, Bacterial Adhesion, Bacterial Proteins biosynthesis, Biofilms, Brazil, Colony Count, Microbial, Cross Infection microbiology, Drug Resistance, Multiple, Bacterial genetics, Humans, Klebsiella Infections mortality, Microbial Sensitivity Tests, beta-Lactamases biosynthesis, Anti-Bacterial Agents pharmacology, Bacterial Proteins genetics, Colistin pharmacology, Drug Resistance, Bacterial drug effects, Klebsiella Infections microbiology, Klebsiella pneumoniae genetics, beta-Lactamases genetics
- Abstract
Carbapenemase-producing organisms are pandemic and a significant threat to public health. We investigated the clonal relatedness of colistin-resistant Klebsiella pneumoniae strains producing KPC-type carbapenemase (KPC-KP) causing subsequent infections or colonization. Moreover, we aimed to gain insight into the ability of biofilm production in K. pneumoniae strains producing carbapenemase. Twenty-two consecutive KPC-KP and one KPC-negative strain was identified from an adult intensive care unit in Brazil. Seventy-five percent of isolates that harbored the bla
KPC gene exhibited genetic relatedness by pulsed-field gel electrophoresis, and none presented the plasmid-mediated mcr-1 and blaNDM genes. This study showed that the majority of repeated KPC infections in adults were caused by a clone that caused the previous infections/colonizations even after a long period of time and illustrates the capacity of multiple clones producing biofilms to coexist in the same patient at the same time, becoming a reservoir of KPC-KP in the hospital environment.- Published
- 2018
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16. Insights into a novel Tn4401 deletion (Tn4401i) in a multidrug-resistant Klebsiella pneumoniae clinical strain belonging to the high-risk clonal group 258 producing KPC-2.
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Araújo BF, Royer S, Campos PA, Ferreira ML, Gonçalves IR, Machado LG, Lincopan N, Fernandes MR, Cerdeira LT, Batistão DWDF, Gontijo-Filho PP, and Ribas RM
- Subjects
- Brazil, Humans, Klebsiella pneumoniae enzymology, Klebsiella pneumoniae isolation & purification, Polymerase Chain Reaction, Whole Genome Sequencing, DNA Transposable Elements, Drug Resistance, Multiple, Bacterial, Klebsiella Infections microbiology, Klebsiella pneumoniae drug effects, Klebsiella pneumoniae genetics, Sequence Deletion, beta-Lactamases genetics
- Published
- 2018
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17. First case of New Delhi metallo-β-lactamase-1 of the same pulsotype of multi-drug-resistant Klebsiella pneumoniae in Minas Gerais, Brazil.
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Gonçalves IR, Campos PA, Ferreira ML, Royer S, Machado LG, Araújo BF, Almeida VVP, Batistão DWF, Gontijo-Filho PP, and Ribas RM
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- Brazil, DNA, Bacterial chemistry, DNA, Bacterial genetics, Female, Humans, Klebsiella pneumoniae genetics, Klebsiella pneumoniae isolation & purification, Middle Aged, Sequence Analysis, DNA, Urine microbiology, Drug Resistance, Multiple, Bacterial, Genotype, Klebsiella Infections microbiology, Klebsiella pneumoniae classification, Klebsiella pneumoniae enzymology, Molecular Typing, beta-Lactamases genetics
- Published
- 2018
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18. Sdha+/- Rats Display Minimal Muscle Pathology Without Significant Behavioral or Biochemical Abnormalities.
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Siebers EM, Choi MJ, Tinklenberg JA, Beatka MJ, Ayres S, Meng H, Helbling DC, Takizawa A, Bennett B, Garces AM, Dias Duarte Machado LG, Dimmock D, Dwinell MR, Geurts AM, and Lawlor MW
- Subjects
- Animals, DNA, Mitochondrial genetics, DNA, Mitochondrial metabolism, Electron Transport Complex II analysis, Gene Knockout Techniques methods, Male, Muscle, Skeletal chemistry, Rats, Rats, Transgenic, Electron Transport Complex II genetics, Electron Transport Complex II metabolism, Hand Strength physiology, Muscle, Skeletal metabolism, Muscle, Skeletal pathology
- Abstract
Mitochondrial diseases (MDs) result from alteration of the mitochondrial respiratory chain (MRC) function. Despite the prevalence of MDs in the population, the paucity of animal models available limits the understanding of these disorders. Mutations in SDHA, a gene that codes for the alpha subunit of succinate dehydrogenase (SDH), can cause some forms of MD. SDHA is a crucial contributor to MRC function. In order to expand the range of MD animal models available, we attempted to generate a Sdha knockout rat. Since homozygous Sdha-/- rats could neither be identified in newborn litters, nor as early as embryonic day 14, we evaluated wild-type (WT) and heterozygous Sdha+/- genotypes. No differences in behavioral, biochemical, or molecular evaluations were observed between WT and Sdha+/- rats at 6 weeks or 6 months of age. However, 30% of Sdha+/- rats displayed mild muscle fiber atrophy with rare fibers negative for cytochrome oxidase and SDH on histochemical staining. Collectively, our data provide additional evidence that modeling SDH mutations in rodents may be challenging due to animal viability, and heterozygous rats are insufficiently symptomatic at a phenotypic and molecular level to be of significant use in the study of SDH deficiency.
- Published
- 2018
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19. Detection of mitochondria-generated reactive oxygen species in cells using multiple probes and methods: Potentials, pitfalls, and the future.
- Author
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Cheng G, Zielonka M, Dranka B, Kumar SN, Myers CR, Bennett B, Garces AM, Dias Duarte Machado LG, Thiebaut D, Ouari O, Hardy M, Zielonka J, and Kalyanaraman B
- Subjects
- Aconitate Hydratase metabolism, Cell Line, Electron Transport Complex I antagonists & inhibitors, Electron Transport Complex III antagonists & inhibitors, Energy Metabolism drug effects, Enzyme Inhibitors pharmacology, Humans, Mitochondria drug effects, Oxidation-Reduction drug effects, Oxidative Stress drug effects, Superoxides metabolism, Mitochondria metabolism, Molecular Probe Techniques, Reactive Oxygen Species metabolism
- Abstract
Reactive oxygen and nitrogen species (ROS/RNS) such as superoxide (O
2 ̇̄ ), hydrogen peroxide, lipid hydroperoxides, peroxynitrite, and hypochlorous and hypobromous acids play a key role in many pathophysiological processes. Recent studies have focused on mitochondrial ROS as redox signaling species responsible for promoting cell division, modulating and regulating kinases and phosphatases, and activating transcription factors. Many ROS also stimulate cell death and senescence. The extent to which these processes occur is attributed to ROS levels (low or high) in cells. However, the exact nature of ROS remains unknown. Investigators have used redox-active probes that, upon oxidation by ROS, yield products exhibiting fluorescence, chemiluminescence, or bioluminescence. Mitochondria-targeted probes can be used to detect ROS generated in mitochondria. However, because most of these redox-active probes (untargeted and mitochondria-targeted) are oxidized by several ROS species, attributing redox probe oxidation to specific ROS species is difficult. It is conceivable that redox-active probes are oxidized in common one-electron oxidation pathways, resulting in a radical intermediate that either reacts with another oxidant (including oxygen to produce O2 ̇̄ ) and forms a stable fluorescent product or reacts with O2 ̇̄ to form a fluorescent marker product. Here, we propose the use of multiple probes and complementary techniques (HPLC, LC-MS, redox blotting, and EPR) and the measurement of intracellular probe uptake and specific marker products to identify specific ROS generated in cells. The low-temperature EPR technique developed to investigate cellular/mitochondrial oxidants can easily be extended to animal and human tissues., (© 2018 Cheng et al.)- Published
- 2018
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20. Molecular characterization and clonal dynamics of nosocomial blaOXA-23 producing XDR Acinetobacter baumannii.
- Author
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Royer S, de Campos PA, Araújo BF, Ferreira ML, Gonçalves IR, Batistão DWDF, Brígido RTES, Cerdeira LT, Machado LG, de Brito CS, Gontijo-Filho PP, and Ribas RM
- Subjects
- Acinetobacter baumannii genetics, Amino Acid Sequence, Anti-Bacterial Agents pharmacology, Bacterial Outer Membrane Proteins chemistry, Bacterial Outer Membrane Proteins genetics, Bacterial Proteins genetics, Carbapenems pharmacology, Drug Resistance, Bacterial drug effects, Drug Resistance, Bacterial genetics, Membrane Transport Proteins genetics, Membrane Transport Proteins metabolism, Microbial Sensitivity Tests, Multilocus Sequence Typing, Porins chemistry, Porins genetics, Sequence Alignment, Tigecycline pharmacology, Whole Genome Sequencing, beta-Lactamases genetics, Acinetobacter baumannii enzymology, Bacterial Proteins metabolism, beta-Lactamases metabolism
- Abstract
The emergence of infections associated to new antimicrobial resistance in Acinetobacter baumannii (Ab) genotypes represents a major challenge. In this context, this study aimed to determine the diversity of resistance mechanisms and investigate clonal dissemination and predominant sequence types (STs) in multidrug-resistant Ab strains of clinical (tracheal aspirate, n = 17) and environmental (surface, n = 6) origins. Additionally, the major clones found in clinical (A) and environmental (H) strains had their complete genomes sequenced. All strains were submitted to polymerase chain reactions (PCR) for the detection of the ISAba1/blaOXA-51-like and ISAba1/blaOXA-23-like genes, while the expression of genes encoding the carO porin, AdeABC (adeB), AdeFGH (adeG), and AdeIJK (adeJ) efflux pumps was determined by real time PCR (qPCR). Most of the strains were characterized as extensively drug-resistant (XDR) with high minimal inhibitory concentrations (MICs) detected for tigecycline and carbapenems. Associations between ISAba1/OXA-51 and ISAba1/OXA-23 were observed in 91.3% and 52.2% of the strains, respectively. Only the adeB gene was considered hyper-expressed. Furthermore, most of the strains analyzed by the MuLtilocus Sequence-Typing (MLST) were found to belong to the clonal complex 113 (CC113). In addition, a new ST, ST1399, belonging to CC229, was also discovered herein. Strains analyzed by whole genome sequencing presented resistance genes linked to multidrug-resistance phenotypes and confirmed the presence of Tn2008, which provides high levels carbapenem-resistance., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2018
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21. Dental erosion in schoolchildren and associated factors: A cross-sectional study.
- Author
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Frazao JB, Machado LG, and Ferreira MC
- Subjects
- Age Factors, Beverages, Brazil epidemiology, Child, Cross-Sectional Studies, Feeding Behavior, Female, Humans, Male, Prevalence, Socioeconomic Factors, Tooth Erosion epidemiology
- Abstract
Context: Throughout life, the teeth are exposed to different types of wear, including dental erosion, which is characterized by the loss of surface-mineralized tissue due to a chemical process without bacterial involvement and strongly influenced by eating habits., Aim: The aim of this study to evaluate the prevalence of dental erosion in schoolchildren and associated factors., Setting and Design: This is a cross-sectional study., Material and Methods: The study was conducted at a public and private school in the city of São Luís (MA), Brazil, involving a sample of 239 children aged 6-10 years. Data were collected through a questionnaire and clinical examination. Dental erosion was evaluated using the Basic Erosive Wear Examination., Statistical Analysis: Data analysis involved descriptive statistics, Pearson's Chi-square test, the linear trend Chi-square test, and Fisher's exact test, with the level of significance set to 5%., Results: The male sex accounted for 50.2% of the sample and the female sex accounted for 49.8%; 62.8% attended the public school and 37.2% attended the private school. The prevalence of dental erosion was 11.7%, with the highest prevalence among 9-year-olds (46.4%). Dental erosion was significantly associated with age (P = 0.009) and type of school (P < 0.001)., Conclusion: The present findings underscore the need for strategies to prevent or arrest the erosive process through local actions involving schoolchildren, parents/caregivers, and teachers., Competing Interests: There are no conflicts of interest
- Published
- 2018
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22. Visceral fat measured by DXA is associated with increased risk of non-spine fractures in nonobese elderly women: a population-based prospective cohort analysis from the São Paulo Ageing & Health (SPAH) Study.
- Author
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Machado LG, Domiciano DS, Figueiredo CP, Caparbo VF, Takayama L, Oliveira RM, Lopes JB, Menezes PR, and Pereira RM
- Subjects
- Absorptiometry, Photon, Aged, Aging, Female, Humans, Prospective Studies, Adiposity, Bone Density, Intra-Abdominal Fat diagnostic imaging, Osteoporotic Fractures epidemiology
- Abstract
The present study investigates the relationship between visceral fat measured by dual-energy X-ray absorptiometry (DXA) and the incidence of non-spine fractures in community-dwelling elderly women. We demonstrated a potential negative effect of visceral fat on bone health in nonobese women., Introduction: The protective effect of obesity on bone health has been questioned because visceral fat has been demonstrated to have a deleterious effect on bone. The aim of this study was to investigate the association of visceral fat measured by DXA with the incidence of non-spine fractures in community-dwelling elderly women., Methods: This longitudinal prospective population-based cohort study evaluated 433 community-dwelling women aged 65 years or older. A specific clinical questionnaire, including personal history of a fragility fracture in non-spine osteoporotic sites, was administered at baseline and after an average of 4.3 years. All incidences of fragility fractures during the study period were confirmed by affected-site radiography. Visceral adipose tissue (VAT) was measured in the android region of a whole-body DXA scan., Results: The mean age was 72.8 ± 4.7 years, and 28 incident non-spine osteoporotic fractures were identified after a mean follow-up time of 4.3 ± 0.8 years. According to the Lipschitz classification for nutritional status in the elderly, 38.6 % of women were nonobese (BMI ≤ 27 kg/m
2 ) and 61.4 % were obese/overweight. Logistic regression models were used to estimate the relationship between VAT and non-spine fractures in elderly women. After adjusting for age, race, previous fractures, and BMD, VAT (mass, area, volume) had a significant association with the incidence of non-spine fractures only in nonobese elderly women (VAT mass: OR, 1.42 [95 % CI, 1.09-1.85; p = 0.010]; VAT area: OR, 1.19 [95 % CI, 1.05-1.36; p = 0.008]; VAT volume: OR, 1.40 [95 % CI, 1.09-1.80; p = 0.009])., Conclusion: This study suggests a potential negative effect of visceral adiposity on bone health in nonobese women.- Published
- 2016
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23. Design of a spring-assisted exoskeleton module for wrist and hand rehabilitation.
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Perry JC, Trimble S, Castilho Machado LG, Schroeder JS, Belloso A, Rodriguez-de-Pablo C, and Keller T
- Subjects
- Fingers, Hand Strength, Humans, Spain, Thumb, Exoskeleton Device, Hand physiology, Wrist physiology
- Abstract
This paper reports on the development of a low-profile exoskeleton module to enable training of the fingers and thumb in grasp and release tasks. The design has been made as an add-on module for use with the ArmAssist arm rehabilitation system (Tecnalia, Spain). Variable-position springs and adjustable link lengths provide adaptability to fit a variety of users. Additive manufacturing has been utilized for the majority of components allowing easy modifications. A few structural components were machined from aluminum or steel to produce a functional prototype with sufficient strength for direct evaluation. The design includes independent and adjustable assistance in finger and thumb extension using various width elastic bands, and measurement of user grasp/release forces in finger flexion/extension, thumb flexion/extension, and thumb adduction/abduction using low-profile force sensitive resistors.
- Published
- 2016
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24. Arthroscopic surgical treatment of pigmented villonodular synovitis of the elbow: case report.
- Author
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Ramos MA, Balsini NE, Ramos F, and Machado LG
- Abstract
This case concerns a male patient complaining of pain and discomfort in his right elbow, associated with decreased range of motion. Elbow radiography showed an osteolytic lesion in the metaphyseal region of the distal humerus and magnetic resonance imaging showed intra-articular tumor formation with swelling that suggested pigmented villonodular synovitis. Arthroscopic treatment was performed in order to obtain a synovial biopsy and then to carry out total synovectomy. Anatomopathological examination confirmed the diagnosis. The patient presented excellent progress through the physiotherapeutic rehabilitation proposed and continued to be asymptomatic 12 months after the operation.
- Published
- 2016
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- View/download PDF
25. Bone Mineral Density and Parathyroid Hormone as Independent Risk Factors for Mortality in Community-Dwelling Older Adults: A Population-Based Prospective Cohort Study in Brazil. The São Paulo Ageing & Health (SPAH) Study.
- Author
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Domiciano DS, Machado LG, Lopes JB, Figueiredo CP, Caparbo VF, Oliveira RM, Scazufca M, McClung MR, and Pereira RM
- Subjects
- Accidental Falls mortality, Aged, Aged, 80 and over, Brazil epidemiology, Cardiovascular Diseases blood, Cardiovascular Diseases mortality, Female, Follow-Up Studies, Humans, Male, Vitamin D blood, Bone Density, Mortality, Parathyroid Hormone blood
- Abstract
Previous studies have shown a relationship between osteoporosis and increased mortality risk. However, none of these studies performed a concomitant evaluation of the parathyroid hormone (PTH)-calcium-vitamin D axis and bone mass to accurately determine the contribution of each of these parameters to survival in older subjects. Thus, we sought to investigate the association between bone parameters and mortality in a longitudinal, prospective, population-based cohort of 839 elderly subjects. Clinical data (including history of fractures and cardiovascular events) were assessed using a specific questionnaire. Laboratory exams, including serum 25OHD and PTH, were also performed. Bone mineral density (BMD) at the lumbar spine and hip were evaluated using DXA. All analyses were performed at baseline (2005 to 2007). Mortality was recorded during follow-up. Multivariate Cox proportional regression was used to compute hazard ratios for all-cause and cardiovascular mortality. Over a mean 4.06 ± 1.07 years, there were 132 (15.7%) deaths. These individuals were compared to 707 subjects who were alive at the end of the coverage period for mortality data collection. In a multivariate Cox proportional hazards model, age (HR 1.32; 95% CI, 1.13 to 1.55; p = 0.001, for each 5-year increase), male gender (HR 1.90; 95% CI, 1.30 to 2.79; p = 0.001), recurrent falls (more than two in the previous year; HR 1.65; 95% CI, 1.06 to 2.56; p = 0.026), diabetes mellitus (HR 2.17; 95% CI, 1.46 to 3.21; p < 0.001), low physical activity score (HR 1.78; 95% CI, 1.14 to 2.79; p = 0.011), prior cardiovascular event (HR 1.76; 95% CI, 1.18 to 2.63; p = 0.006), total hip BMD (HR 1.41; 95% CI, 1.15 to 1.72; p = 0.001, per each 1 SD decrease), and intact PTH (iPTH) (HR 1.06; 95% CI, 1.04 to 1.08; p < 0.001, per each 10 pg/mL increase) were independently associated with all-cause mortality. The subjects in the highest quartile of PTH (>49 pg/mL) were at a higher risk of cardiovascular death (HR 3.09; 95% CI, 1.36 to 6.99; p = 0.007) compared with the subjects in the lowest quartile (<26 pg/mL). Low BMD and higher PTH were significantly associated with mortality in community-dwelling older adults. These findings support the notion that careful screening of these bone parameters might lead to better management of older patients and improve outcomes in this population. © 2016 American Society for Bone and Mineral Research., (© 2016 American Society for Bone and Mineral Research.)
- Published
- 2016
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- View/download PDF
26. Persistent hypovitaminosis D and loss of hip bone mineral density over time as additional risk factors for recurrent falls in a population-based prospective cohort of elderly persons living in the community. The São Paulo Ageing & Health (SPAH) Study.
- Author
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Machado KL, Domiciano DS, Machado LG, Lopes JB, Figueiredo CP, Takayama L, Oliveira RM, Menezes PR, and Pereira RM
- Subjects
- Absorptiometry, Photon methods, Aged, Aged, 80 and over, Bone Density physiology, Brazil epidemiology, Female, Hip Joint physiopathology, Humans, Male, Osteoporosis epidemiology, Osteoporosis physiopathology, Osteoporotic Fractures complications, Osteoporotic Fractures epidemiology, Osteoporotic Fractures physiopathology, Prospective Studies, Recurrence, Risk Factors, Vitamin D Deficiency epidemiology, Vitamin D Deficiency physiopathology, Accidental Falls statistics & numerical data, Osteoporosis etiology, Vitamin D Deficiency complications
- Abstract
Unlabelled: We performed concomitant evaluation of clinical, laboratory, and bone mineral density (BMD) parameters as potential risk factors for falls in a population-based prospective cohort of older adults, since previous studies have focused mostly in clinical risk factors. Loss of hip BMD and persistent hypovitaminosis D were associated with recurrent falls in community-dwelling elderly., Introduction: Few studies have performed a concomitant evaluation of clinical data, laboratory bone parameters, and bone mineral density (BMD) to determine more accurately the contribution of each of these variables to risk of falls in elderly persons. We investigated the association between bone parameters and recurrent falls in a population-based prospective cohort of community-dwelling older adults., Methods: A total of 705 elderly individuals (448 women, 257 men) were evaluated with clinical data, BMD, and laboratory bone tests at baseline and after a mean follow-up of 4.3 ± 0.8 years. Individuals with recurrent falls (≥2 falls in the previous year from the date of the second evaluation) were considered chronic fallers. Logistic regression models were used to identify independent risk factors for recurrent falls., Results: The frequency of chronic fallers was 16.5%. In multivariate analyses, risk factors for recurrent falls were visual impairment (odds ratio (OR) = 2.49, 95% confidence interval (CI) 1.30-4.74, p = 0.006), use of psychotropic drugs (OR = 2.47, 95% CI 1.37-4.49, p = 0.003), clinical fracture (OR = 2.78, 95% CI 1.48-5.20, p = 0.001), persistently low 25-hydroxyvitamin D (25OHD) (<20 ng/mL) (OR = 1.71, 95% CI 1.10-2.64, p = 0.016), and loss of total hip BMD during the study (OR = 1.21, 95% CI 1.17-1.25, p = 0.035 for each 4% decrease)., Conclusions: In addition to traditional clinical risk factors for falls, loss of hip BMD and hypovitaminosis D were associated with recurrent falls in community-dwelling elderly persons. Thus, recognizing these factors is essential to preventing falls and improving the outcomes of this population.
- Published
- 2015
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27. Incidence and risk factors for osteoporotic vertebral fracture in low-income community-dwelling elderly: a population-based prospective cohort study in Brazil. The São Paulo Ageing & Health (SPAH) Study.
- Author
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Domiciano DS, Machado LG, Lopes JB, Figueiredo CP, Caparbo VF, Takayama L, Oliveira RM, Menezes PR, and Pereira RM
- Subjects
- Age Distribution, Aged, Aged, 80 and over, Bone Density, Brazil epidemiology, Cohort Studies, Female, Health Surveys, Humans, Incidence, Lumbar Vertebrae physiopathology, Male, Osteoporotic Fractures etiology, Osteoporotic Fractures physiopathology, Poverty statistics & numerical data, Prospective Studies, Residence Characteristics, Risk Factors, Sex Distribution, Spinal Fractures etiology, Spinal Fractures physiopathology, Osteoporotic Fractures epidemiology, Spinal Fractures epidemiology
- Abstract
Unlabelled: We ascertained the incidence and predictors of radiographic vertebral fracture in a Brazilian elderly cohort, since no data in this field have been reported in low-income countries. This is the first population-based study to demonstrate the high frequency of vertebral fracture in elderly Latin Americans. Age, prior fracture, BMD, and bone turnover were predictors of fracture., Introduction: Vertebral fractures are associated with increased future fracture risk and mortality. No data on incidence of osteoporotic vertebral fracture have been reported in low-income countries where the population's aging has been faster. Thus, we sought to describe the incidence and risk factors for radiographic vertebral fracture in a longitudinal prospective Brazilian population-based elderly cohort., Methods: 707 older adults (449 women and 258 men) were evaluated with spinal radiographs obtained at baseline and after a mean follow-up of 4.3 ± 0.8 years. New vertebral fracture was defined as distinct alteration in the morphology of vertebrae resulting in higher grade of deformity on the second radiograph when compared to the baseline radiograph. Clinical questionnaire, bone mineral density (BMD), and laboratory tests were performed at baseline. Multivariate Poisson regression models were used to identify independent predictors of fracture., Results: The age-standardized incidence of vertebral fracture was 40.3/1,000 person-years in women and 30.6/1,000 in men. In women, three models of risk factors for fracture were fitted: (1) age (relative risks (RR) 2.46, 95 % confidence interval (CI) 1.66-3.65), previous osteoporotic fracture (RR 1.65, 95 % CI 1.00-2.71), and lumbar spine BMD (RR 1.21, 95 % CI 1.03-1.41); (2) age (RR 2.25, 95 % CI 1.52-3.34) and femoral neck BMD (RR 1.42, 95 % CI 1.11-1.81); (3) age (RR 2.11, 95 % CI 1.41-3.15) and total hip BMD (RR 1.56, 95 % CI 1.21-2.0). In men, the highest quartile of cross-linked C-telopeptide (CTx) (RR 1.96, 95 % CI 0.98-3.91) and prior fracture (RR 2.10, 95 % CI 1.00-4.39) were predictors of new vertebral fracture., Conclusions: This is the first population-based study to ascertain the incidence of vertebral fracture in elderly Latin Americans, confirming the high frequency of the disorder. Age, prior fracture, BMD, and bone turnover were predictors of the short-term incidence of vertebral fracture.
- Published
- 2014
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- View/download PDF
28. Integrative review: indicators of result process of organ donation and transplants.
- Author
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Ferraz AS, Santos LG, Roza Bde A, Schirmer J, Knihs Nda S, and Erbs JL
- Subjects
- Humans, Organ Transplantation, Outcome and Process Assessment, Health Care, Tissue and Organ Procurement
- Abstract
Objective: Identify by integrated review the main result indicators in the process of organ donation and transplants used in Brazil and worldwide. The integrated review of this literature was performed on bibliographic database MedLine/PubMed and LILACS and governmental and nongovernmental sites between 1995 and 2011. The describers/keywords used were organ donations, organ transplant and results in health, being selected 26 articles and nine sites. The evidence level classification in the articles changed from one to six., Results: The evidence level in the articles in its totality was 66.6% was four (12:18 PubMed) all the articles of LILACS database (8). The indicators showed in the articles intends to evaluate, assess, measure and control data related to the profile of the donor, clinical and hospital conditions, ischemia timing, organ size, surgical procedure and the complications that came from transplants.
- Published
- 2013
- Full Text
- View/download PDF
29. Medical applications of shape memory alloys.
- Author
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Machado LG and Savi MA
- Subjects
- Humans, Orthopedic Fixation Devices, Stents, Thermodynamics, Vena Cava Filters, Alloys therapeutic use, Biocompatible Materials therapeutic use, Elasticity, Prostheses and Implants, Surgical Instruments
- Abstract
Shape memory alloys (SMA) are materials that have the ability to return to a former shape when subjected to an appropriate thermomechanical procedure. Pseudoelastic and shape memory effects are some of the behaviors presented by these alloys. The unique properties concerning these alloys have encouraged many investigators to look for applications of SMA in different fields of human knowledge. The purpose of this review article is to present a brief discussion of the thermomechanical behavior of SMA and to describe their most promising applications in the biomedical area. These include cardiovascular and orthopedic uses, and surgical instruments.
- Published
- 2003
- Full Text
- View/download PDF
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