28 results on '"de Mello LM"'
Search Results
2. Brazilian Guideline on Menopausal Cardiovascular Health - 2024.
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de Oliveira GMM, de Almeida MCC, Arcelus CMA, Espíndola L, Rivera MAM, da Silva-Filho AL, Marques-Santos C, Fernandes CE, Albuquerque CJDM, Freire CMV, Izar MCO, Costa MENC, de Castro ML, Lemke VMG, de Lucena AJG, Brandão AA, Macedo AVS, Polanczyk CA, Lantieri CJB, Nahas EP, Alexandre ERG, Campana EMG, Bragança ÉOV, Colombo FMC, Barbosa ICQ, Rivera IR, Kulak J, Moura LAZ, Pompei LM, Baccaro LFC, Barbosa MM, Rodrigues MAH, Albernaz MA, de Decoud MSP, Paiva MSMO, Sanchez-Zambrano MB, Campos MDSB, Acevedo M, Ramirez MS, de Souza OF, de Medeiros OO, de Carvalho RCM, Machado RB, da Silva SCTF, Rodrigues TCV, Avila WS, da Costa-Paiva LHS, and Wender MCO more...
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- 2024
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3. The evolving landscape of locally advanced cervical cancer treatment.
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Gouveia MC, Graziano LM, Leis LV, and Scaranti M
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Competing Interests: Competing interests: MCG: Speaker fees: Novartis, Knight Therapeutics. MS: Speaker fees and/or honoraria for consulting or advisory functions: MSD, AstraZeneca, Libbs, GSK, Zodiac, Roche, Orentt, MDHealth, Sanofi, Gilead, Amgen, Sophia genetics. LDMG and LVL have no competing interests to declare. more...
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- 2024
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4. Brazilian Guideline on Menopausal Cardiovascular Health - 2024.
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Oliveira GMM, Almeida MCC, Arcelus CMA, Neto Espíndola L, Rivera MAM, Silva-Filho ALD, Marques-Santos C, Fernandes CE, Albuquerque CJDM, Freire CMV, Izar MCO, Costa MENC, Castro ML, Lemke VMG, Lucena AJG, Brandão AA, Macedo AVS, Polanczyk CA, Lantieri CJB, Nahas EP, Alexandre ERG, Campana EMG, Bragança ÉOV, Colombo FMC, Barbosa ICQ, Rivera IR, Kulak J, Moura LAZ, Pompei LM, Baccaro LFC, Barbosa MM, Rodrigues MAH, Albernaz MA, Decoud MSP, Paiva MSMO, Sanchez-Zambrano MB, Campos MDSB, Acevedo M, Ramirez MS, Souza OF, Medeiros OO, Carvalho RCM, Machado RB, Silva SCTFD, Rodrigues TCV, Avila WS, Costa-Paiva LHSD, and Wender MCO more...
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- Humans, Female, Brazil, Heart Disease Risk Factors, Middle Aged, Risk Factors, Women's Health, Cardiovascular Diseases prevention & control, Menopause physiology
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- 2024
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5. Performance Comparison of Meta-Heuristics Applied to Optimal Signal Design for Parameter Identification.
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Santos Neto AFD, Santos MFD, Silva MFD, Honório LM, Oliveira EJ, and Neto ESA
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This paper presents a comparative study that explores the performance of various meta-heuristics employed for Optimal Signal Design, specifically focusing on estimating parameters in nonlinear systems. The study introduces the Robust Sub-Optimal Excitation Signal Generation and Optimal Parameter Estimation (rSOESGOPE) methodology, which is originally derived from the well-known Particle Swarm Optimization (PSO) algorithm. Through a real-life case study involving an Autonomous Surface Vessel (ASV) equipped with three Degrees of Freedom (DoFs) and an aerial holonomic propulsion system, the effectiveness of different meta-heuristics is thoroughly evaluated. By conducting an in-depth analysis and comparison of the obtained results from the diverse meta-heuristics, this study offers valuable insights for selecting the most suitable optimization technique for parameter estimation in nonlinear systems. Researchers and experimental tests in the field can benefit from the comprehensive examination of these techniques, aiding them in making informed decisions about the optimal approach for optimizing parameter estimation in nonlinear systems. more...
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- 2023
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6. Influence of atherosclerosis risk factors on the anatomical distribution of peripheral arterial disease in patients with chronic limb-threatening ischemia: a cross-sectional study.
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Dos Santos VP, Cerutti CI, Alencar MJC, Queiroz AB, Ferreira LM, Fidelis C, de Araújo JS, and Alves CAS
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Background: Atherosclerosis risk factors can have different impacts on cardiovascular diseases and on the anatomical distribution of Peripheral Arterial Disease (PAD)., Objectives: To study the influence of atherosclerosis risk factors on the anatomical distribution of PAD in patients with chronic limb-threatening ischemia (CLTI)., Methods: We performed an observational, cross-sectional, and analytical study that included 476 hospitalized patients with CLTI due to PAD. We compared the presence of atherosclerosis risk factors (age, gender, diabetes mellitus, smoking, and hypertension) in patients with PAD involving three different anatomic areas (aortoiliac, femoropopliteal, and infrapopliteal). Multivariate analysis was performed to identify associations between atherosclerosis risk factors and PAD distribution., Results: The mean age of the 476 patients was 69 years, 249 (52%) were men, and 273 (57%) had diabetes. Seventy-four percent (353) had minor tissue loss. Multivariate analysis identified three risk factors associated with PAD anatomical distribution (gender, smoking, and DM). Women had a 2.7 (CI: 1.75-4.26) times greater chance of having femoropopliteal disease. Smokers had a 3.6-fold (CI: 1.54-8.30) greater risk of aortoiliac disease. Diabetic patients were 1.8 (CI: 1.04-3.19) times more likely to have isolated infrapopliteal occlusive disease., Conclusions: The study showed that gender, DM, and smoking impact on the anatomical distribution of PAD in patients with CLTI. Diabetic patients were more likely to have only infrapopliteal disease, women had a greater risk of femoropopliteal PAD, and smokers had a greater risk of aortoiliac occlusive disease., Competing Interests: Conflicts of interest: No conflicts of interest declared concerning the publication of this article., (Copyright© 2023 The authors.) more...
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- 2023
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7. The specialty of allergy and clinical immunology in Brazil.
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de Mello LM, Serpa FS, Chiabai J, Fernandes FR, Chong-Neto HJ, Sarinho ESC, Rubini NPM, and Solé D
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Objective: To assess the profile of allergist/immunologist (A/I) physicians in Brazil, the workplace, the access to diagnostic and therapeutic procedures, and the impact of the COVID-19 pandemic on professional practice., Methods: This cross-sectional study was conducted as an online survey. All adhering members of the Brazilian Association of Allergy and Immunology (ASBAI) received a Google Forms tool by email. The questionnaire addressed sociodemographic and professional aspects of the Brazilian allergists/immunologists (A/I) daily routine. The information was analyzed by SPSS version 20.0., Results: Four hundred and sixty members answered the questionnaire. Women were predominant among the responders (336; 73%), and the median age was 47 years (range, 27-82 years). Most participants worked in the private sector (437, 95%), whereas 256 (47%) worked in the public sector. Among the public sector employees, 210 (82%) reported having access to some diagnostic test for allergic diseases and inborn errors of immunity. Only 91 (35%) A/I physicians in the public system had access to allergen-specific immunotherapy, compared to 416 (95, 9%) of those in the private sector. Regarding biological drugs, 135 (52.7%) and 314 (71.9%) of the A/I physicians working in the public and private sector, respectively, reported access. Two hundred and eighty-three (61.6%) had at least a 50% reduction in the number of consultations, and 245 (56%) provided telemedicine care during the COVID-19 pandemic., Conclusion: Brazilian A/I have incorporated the most recent advances in managing immunoallergic diseases into their clinical practice, but they still have little access to various diagnostic methods. Strategies to enable the presence of A/I in public health services should be discussed and implemented. The coronavirus pandemic has accelerated the incorporation of telemedicine as a viable and promising method of medical care and can expand access to the specialty., (Copyright © 2022 de Mello, Serpa, Chiabai, Fernandes, Chong-Neto, Sarinho, Rubini and Solé.) more...
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- 2022
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8. Depression, suicidal motivation and suicidal ideation among individuals with asthma: a cross-sectional study.
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Vázquez VS, de Lima VB, de Mello LM, Duarte DCB, Saback de Oliveira TD, and Cruz ÁA
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Background: Asthma is a chronic disease associated with risk of depression and suicidal events. The present study estimated the frequency of depression, suicidal motivation (SM) and suicidal ideation (SI) and identified clinical and psychosocial factors associated with these outcomes among individuals with asthma., Methods: Cross-sectional study of a non-probabilistic sample of 1,358 adults with asthma and controls without asthma. Asthma severity and asthma control were assessed by a physician according to WHO (2009) and GINA (2012) criteria. Depression, SM and SI were screened by Beck Depression Inventory (BDI). Psychosocial factors were evaluated by a Community Violence Questionnaire, a Social Support Scale, a Stress Perceived Scale and a Resilience Scale. Chi-Square Test, and logistic regression models were performed to evaluate association between variables and outcomes., Results: Among all participants, 222 (16.30%) had depression, 331 (24.40%) SM and 73 (5.40%) SI. There were 138 (12.10%) individuals with mild depression and SM, and 14 (1.20%) with mild depression and SI. After adjustment, severe asthma (SA) increased the chance of depression by 53.00% whereas mild to moderate asthma (MMA) increased by eleven-fold the likelihood of SI. Perception of low social support increased the chance of depression (OR 3.59; 95% CI, 2.44-5.28) and low resilience by (OR 2.96; 95% CI, 2.00-4.38); distress increased the odds of SM by 37.00%, and low affective support perception raised the likelihood of SI by (OR 6.82; 95% CI, 1.94-2.90)., Conclusions: Asthma, whether mild to moderate or severe, increased the chance of depression and SI. It is noteworthy that individuals with mild depression and MMA are at greater risk for SM and SI. Among the psychosocial variables, perception of low social support and low resilience were the variables associated with depression; distress impacted on SM, and the perception of low affective support raised the chance of SI., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/jtd-20-3197). The “GARD Section” was commissioned by the editorial office without any funding or sponsorship. VVS reports doctoral scholarship from Coordination for the Improvement of Higher Education Personnel - Brazil (CAPES) during the conduct of the study. Bidu DC reports grants from National Council for Scientific and Technological Development (CNPq), during the conduct of the study. AAC reports grants and personal fees from Brazilian Research Council (CNPq), grants from GlaxoSmithKline, during the conduct of the study; personal fees from Sanofi, personal fees from Boehringer Ingelheim, personal fees from AstraZeneca, personal fees from Chiesi, personal fees from Mylan, personal fees from Novartis, personal fees from GSK, personal fees from Eurofarma, personal fees from Mantecorp, outside the submitted work. AAC serves as the unpaid director of the series as an unpaid editorial board member of Journal of Thoracic Disease. The other authors have no conflicts of interest to declare., (2021 Journal of Thoracic Disease. All rights reserved.) more...
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- 2021
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9. The Role of the Transdiaphragmatic Pressure Gradient (TGP) in the Pathophysiology of Proximal Reflux.
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Del Grande LM, Herbella FAM, and Patti MG
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- Esophageal pH Monitoring, Humans, Manometry, Esophagitis, Peptic, Gastroesophageal Reflux etiology
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Introduction: An increased transdiaphragmatic pressure gradient (TGP) is a main element for distal gastroesophageal reflux disease (GERD). The role of TGP for proximal reflux is still unclear. This study aims to evaluate the presence, severity, and importance of proximal reflux in relationship to the TGP, comparing healthy volunteers, obese individuals, and patients with chronic obstructive pulmonary disease (COPD)., Methods: We studied 114 individuals comprising 19 healthy lean volunteers, 47 obese individuals (mean body mass index 45 ± 7 kg/m
2 ), and 48 patients with COPD. All patients underwent high-resolution manometry and dual-channel esophageal pH monitoring. Esophageal motility, thoracic pressure (TP), abdominal pressure (AP), TGP, DeMeester score, and % of proximal acid exposure time (pAET) were recorded., Results: Pathologic distal GERD was found in 0, 44, and 57% of the volunteers, obese, and COPD groups, respectively. pAET was similar among groups, only higher for obese individuals GERD + as compared to obese individuals GERD - and COPD GERD -. pAET did not correlate with any parameter in healthy individuals, but it correlated with AP in the obese, TP in the COPD individuals, and TGP and DeMeester score in both groups. When all individuals were analyzed as a total, pAET correlated with AP, TGP, and DeMeester score. DeMeester score was the only independent variable that correlated with pAET., Conclusions: Our results show that (a) TGP is an important mechanism associated with distal esophageal acid exposure and this fact is linked with proximal acid exposure and (b) obesity and COPD both seem to be primary causes for GERD but not directly for proximal reflux. more...- Published
- 2021
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10. Association between Asthma and Type 2 Diabetes Mellitus: Mechanisms and Impact on Asthma Control-A Literature Review.
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Torres RM, Souza MDS, Coelho ACC, de Mello LM, and Souza-Machado C
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- Adult, Humans, Quality of Life, Asthma epidemiology, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 epidemiology
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The study aimed to analyze the scientific production on the association between asthma and type 2 diabetes mellitus (T2DM) in adults, the mechanisms that explain this association, and its impact on asthma control. A literature review of scientific articles indexed in the MEDLINE/PUBMED, BVS, CINAHL, Cochrane Library, and Web of Science databases was carried out, considering publications from January 2009 to December 2019, using the following descriptors: "asthma", "type 2 diabetes", "adult," and "association". Of 962 articles found, 18 were included because they met the eligibility criteria. It is suggested that the association between asthma and T2DM is caused by low-grade systemic inflammation (7 articles) or the use of corticosteroids (7 articles). It is noticed that there is a limited scientific production regarding the consequences of this association for the control of asthma (5 articles). It is concluded that asthma and T2DM are two common chronic conditions of increasing prevalence and that often coexist in the same patient. It is suggested that this coexistence worsens asthma control. Therefore, the study may support public policies and clinical health practices that value the approach of comorbidities associated with asthma such as T2DM, in order to minimize additional health risks and reduce the quality of life., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Raimeyre Marques Torres et al.) more...
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- 2021
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11. Impaired immunoregulatory network of the CD4 T lymphocytes in refractory asthma.
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Fernandes JS, Araujo MI, de Almeida TVVS, Andrade LS, Lopes DM, de Mello LM, Carvalho EM, Cruz ÁA, and Cardoso LS
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- Adult, Age of Onset, Asthma diagnosis, Biomarkers, CTLA-4 Antigen metabolism, Cytokines metabolism, Female, Flow Cytometry, Humans, Hypersensitivity, Immediate immunology, Hypersensitivity, Immediate metabolism, Hypersensitivity, Immediate pathology, Immunoglobulin E immunology, Immunophenotyping, Leukocytes, Mononuclear immunology, Leukocytes, Mononuclear metabolism, Male, Middle Aged, Respiratory Function Tests, T-Lymphocyte Subsets immunology, T-Lymphocyte Subsets metabolism, Vitamin D metabolism, Asthma immunology, Asthma metabolism, CD4-Positive T-Lymphocytes immunology, CD4-Positive T-Lymphocytes metabolism, Immunomodulation
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Background: The immunopathogenesis of severe asthma has been associated with an inefficient regulatory response. There are a few studies about the CD4 T cells profile among individuals with severe asthma refractory to treatment., Objective: To evaluate the CD4 T lymphocyte profile from individuals with severe asthma according to their response to treatment, relating to their atopy status and age of asthma onset., Methods: We evaluated nineteen individuals with severe asthma refractory to treatment (SAR), 21 with well-controlled or partly controlled severe asthma (CSA) and 23 with mild-to-moderate asthma (MMA). Lymphocytes were obtained from PBMC, and the frequency of expression of different molecules in this population was assessed using the flow cytometry., Results: We observed the frequency of CD4
+ IFN-γ+ T cells was higher in atopic individuals with SAR than with CSA. In addition, among the atopic and early-onset asthma (EOA), the frequency of CD4+ CTLA-4+ T cells was lower in the SAR group than the CSA group. In relation to non-atopic and late-onset asthma (LOA) phenotypes, we noted the frequency of CD4+ FoxP3+ T cells was lower in individuals with SAR than with CSA. We also observed among the LOA patients, the frequency of CD4+ TGF-β+ T cells was decreased in SAR group than the in CSA group., Conclusion and Clinical Relevance: Our data suggest that refractoriness to treatment in asthma is associated with a lower expression of distinct regulatory molecules by CD4 T cells between those who are atopic and have EOA and those who are non-atopic and have LOA. Thus, these results may contribute to the identification of new regulatory strategies to treat asthma according to their phenotypes., (© 2019 John Wiley & Sons Ltd.) more...- Published
- 2019
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12. Eosinophilic asthma, according to a blood eosinophil criterion, is associated with disease severity and lack of control among underprivileged urban Brazilians.
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Lima-Matos A, Ponte EV, de Jesus JPV, Almeida PCA, Lima VB, Kwon N, Riley J, de Mello LM, and Cruz ÁA
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- Adult, Biomarkers blood, Brazil, Case-Control Studies, Female, Humans, Male, Middle Aged, Severity of Illness Index, Urban Population, Asthma diagnosis, Asthma etiology, Eosinophils, Leukocyte Count, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia diagnosis
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Background: Asthma is a syndrome with multiple phenotypes. Peripheral blood eosinophil counts might be the ideal biomarker to identify subjects with eosinophilic asthma. It is available, inexpensive, and it is associated with eosinophilia in sputum., Objective: The aim of this study was to evaluate whether blood eosinophilia is associated with asthma severity and to evaluate whether blood eosinophilia is associated with lack of control of asthma symptoms and airway obstruction., Methods: Case control study. The cases were subjects recruited from a cohort of patients with severe asthma, in Salvador-BR, demanding continuous inhaled corticosteroids and LABA. There were two control groups: 1) subjects with mild/moderate asthma, 2) subjects with no asthma. Subjects enrolled in the study answered questionnaires, had their blood and stool samples collected, performed spirometry and SPT. We established a cutoff ≥ 260 cells/mm3 for blood eosinophilia., Results: We evaluated 544 subjects in the case group, 452 subjects with mild to moderate asthma and 450 subjects with no asthma. The subjects of the case group had higher odds of presenting the eosinophilic phenotype in comparison to subjects with mild to moderate asthma [OR 1.60 95CI(1.19-2.16)] and no asthma [OR 3.93; 95CI(2.90-5.33)]. The eosinophilic phenotype, according to blood count, is associated with uncontrolled asthma [OR 1.56; 95CI(1.06-2.28)], but it is not associated with airway obstruction [OR 0.87; 95CI(0.61-1.24)]., Conclusion: We conclude that the blood eosinophilia is a biomarker associated with asthma severity and poor symptom control, but we found no association with reduced lung function., (Published by Elsevier Ltd.) more...
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- 2018
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13. Lessons Learned at the Epicenter of Brazil's Congenital Zika Epidemic: Evidence From 87 Confirmed Cases.
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Meneses JDA, Ishigami AC, de Mello LM, de Albuquerque LL, de Brito CAA, Cordeiro MT, and Pena LJ
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- Antibodies, Viral blood, Antibodies, Viral cerebrospinal fluid, Arthrogryposis epidemiology, Arthrogryposis virology, Brain abnormalities, Brain virology, Brazil epidemiology, Cerebellum abnormalities, Cerebellum diagnostic imaging, Cerebellum virology, Developmental Disabilities diagnostic imaging, Developmental Disabilities epidemiology, Developmental Disabilities virology, Female, Fetal Diseases epidemiology, Fetal Diseases virology, Gestational Age, Humans, Immunoglobulin M blood, Immunoglobulin M cerebrospinal fluid, Infant, Microcephaly diagnostic imaging, Microcephaly epidemiology, Microcephaly virology, Mothers, Nervous System Malformations diagnostic imaging, Nervous System Malformations epidemiology, Nervous System Malformations virology, Neuroimaging, Pregnancy, Pregnancy Complications, Infectious virology, Prospective Studies, Respiratory Paralysis diagnostic imaging, Respiratory Paralysis epidemiology, Respiratory Paralysis virology, Ultrasonography, Zika Virus immunology, Zika Virus isolation & purification, Zika Virus Infection virology, Epidemics statistics & numerical data, Pregnancy Complications, Infectious epidemiology, Zika Virus Infection congenital, Zika Virus Infection epidemiology
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Congenital Zika virus infection has stimulated great international concern. A prospective case series of 87 infants with laboratory-confirmed congenital Zika syndrome (CZS) at the epicenter of the Brazilian Zika epidemic in Pernambuco state is presented. Mothers were interviewed for symptoms of possible Zika virus (ZIKV) infection during pregnancy, and fetal ultrasounds were obtained. Infant cerebrospinal fluid (CSF) samples were tested for ZIKV-specific antibodies, and sera were screened for other congenital infections. Neuroimaging and ophthalmologic evaluations were also performed. Sixty-six mothers (76%) reported symptoms of ZIKV infection during gestation. Fetal ultrasounds were available from 90% of the mothers, and all demonstrated brain structural abnormalities. All of the CSF samples tested positive for ZIKV immunoglobulin M. The majority of infants (89%) were term; the mean birth weight was 2577 ± 260 g, and the mean head circumference was 28.1 ± 1.8 cm. Severe microcephaly, defined as head circumference 3 SD below the mean for sex and gestational age, was found in 72 (82%) infants. All infants had an abnormal neurological exam, and 18 (20.7%) had arthrogryposis. The main abnormalities detected in computed tomography scans were calcifications (99%), followed by ventricular enlargement (94%), cortical hypogyration (81%), and less commonly, cerebellar hypoplasia (52%). Unilateral diaphragm paralysis was identified in 3 infants. Maternal young age, term infant, small for gestational age, and the presence of ophthalmologic abnormalities were significantly associated with a smaller head circumference Z score. Our findings, based on laboratory-confirmed ZIKV infection, add valuable evidence for the understanding of CZS., (© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.) more...
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- 2017
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14. Danger in the streets: exposures to bloodborne pathogens after community sharp injuries in Rio de Janeiro, Brazil.
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Costa MD, Rapparini C, Schmaltz CAS, Tuyama M, Lauria LM, Saraceni V, and Barroso PF
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- Adolescent, Adult, Aged, Brazil epidemiology, Child, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Needles statistics & numerical data, Residence Characteristics, Waste Products adverse effects, Blood-Borne Pathogens, Needlestick Injuries epidemiology
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Objective: Exposures to sharps injuries occurring in the community are relatively frequent. We describe characteristics of community sharp exposures reported in the city of Rio de Janeiro from 1997 to 2010., Methods: A cross-sectional analysis of exposure reports to sharps in the community reported to a surveillance system, designed for health care workers, of the Municipal Health Department of Rio de Janeiro. The characteristics of exposed individuals analyzed included types of exposure, the circumstances of the accident, and the prophylaxis offered., Results: 582 exposures were studied. Median age was 30 years and 83 (14%) involved children with less than 10 years of age. Two hundred and seventeen (37%) occurred with sharps found in the streets. The exposure was percutaneous in 515 (89%) and needles where involved in 406 (70%) of them. The sharps were present in the trash in 227 (39%) or in the environment in 167 (29%) of the reports. Professionals who work with frequent contact with domestic or urban waste were 196 (38%). The source was known in 112 (19%) of the exposures and blood was involved in 269 (46%). Only 101 (19%) of the injured subjects reported a complete course of vaccination for hepatitis B. Antiretroviral prophylaxis was prescribed for 392 (68%) of the exposed subjects., Conclusions: Sharps injuries occurring in the community are an important health problem. A great proportion would be avoided if practices on how to dispose needles and sharps used outside health units were implemented., (Copyright © 2017 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda. All rights reserved.) more...
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- 2017
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15. PREVALENCE AND PREDICTORS OF CHANGES IN BOWEL HABITS AFTER LAPAROSCOPIC CHOLECYSTECTOMY.
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Del Grande LM, Leme LFP, Marques FP, Ramos AT, Ramos PT, and Souza FA
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- Adolescent, Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Diagnostic Self Evaluation, Female, Humans, Male, Middle Aged, Prevalence, Prognosis, Retrospective Studies, Young Adult, Cholecystectomy, Laparoscopic, Defecation, Gastrointestinal Diseases epidemiology, Postoperative Complications epidemiology
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Background:: The incidence of cholecystolithiasis is approximately 15% of the population. It is believed that between 30-40% of cholecystectomy patients have symptoms after surgery, being changes in bowel habits the most common among them., Aim:: 1) Defining the prevalence, and 2) identifying predictors of changes in bowel habits after laparoscopic cholecystectomy., Methods:: This is a retrospective cross-sectional study with an initial sample of 150 patients diagnosed with cholecystolithiasis operated between July and September 2014. Patients were submitted to a questionnaire about the presence of gastrointestinal symptoms and changes in stools consistency before and after the surgical procedure. They were divided into two groups (with or without changes in bowel habits) being combined with the following variables: high blood pressure, body mass index, hypothyroidism, adherence to postoperative dietary orientations, previous abdominal and bariatric surgery., Results:: The prevalence of changes in bowel habits in the study population was 35.1%. The association between it and gastrointestinal symptoms was demonstrated to be statistically significant (‰2=7.981; p=0.005), and people who did not have gastrointestinal symptoms had 2.34 times the odds of not presenting changes in bowel habits. None of the other investigated factors had shown to be a predictor of risk for post-cholecystectomy changes in bowel habits., Conclusion:: 1) There was a high prevalence of changes in bowel habits, and 2) there was association between changes in bowel habits and the presence of gastrointestinal symptoms., Racional:: A incidência da colecistopatia calculosa é de aproximadamente 15% da população brasileira. Acredita-se que entre 30-40% dos pacientes colecistectomizados apresentem sintomas pós-operatório, sendo a alteração do hábito intestinal o mais comum., Objetivo:: 1) Determinar a prevalência, e 2) identificar preditores de mudanças do hábito intestinal pós-colecistectomia videolaparoscópica., Métodos:: Estudo transversal retrospectivo com amostra inicial de 150 pacientes diagnosticados com colecistopatia calculosa, operados entre julho e setembro de 2014. Os pacientes foram submetidos a um questionário sobre a presença de sintomas gastrointestinais após a operação, e a alterações do aspecto das fezes antes e depois do procedimento. A amostra foi dividida em dois grupos (com ou sem mudanças do hábito intestinal) sendo realizadas associações com as seguintes variáveis: hipertensão arterial, IMC, hipotireoidismo, seguimento de dieta no pós-operatório, operação abdominal prévia e operação bariátrica., Resultados:: A prevalência de mudanças do hábito intestinal na população estudada foi de 35,1%. A associação entre elas e sintomas gastrointestinais demonstrou-se estatisticamente significativa (‰2=7,981; p=0,005), sendo que as pessoas que não apresentavam os sintomas tinham 2,34 vezes mais chances de não apresentarem mudanças do hábito intestinal. Nenhum dos demais fatores investigados demonstrou ser preditor de risco para mudanças do hábito intestinal pós-colecistectomia., Conclusões:: 1) Observou-se alta prevalência de mudanças do hábito intestinal, e 2) houve associação entre mudança do hábito intestinal e a presença de sintomas gastrointestinais. more...
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- 2017
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16. [Cost-Effectiveness of using Picture Archiving and Communication System (PACS) in digital mammography].
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Aparecido Nunes A, Barbosa Coelho E, de Souza JP, Zangiacomi Martinez E, Wichert Ana L, do Valle Lessa Dallora ME, de Azevedo Marques PM, and de Mello LM
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- Breast Neoplasms diagnostic imaging, Cost-Benefit Analysis, Female, Humans, Mammography economics, Radiology Information Systems economics
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- 2016
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17. Analysis of factors associated with excess weight in school children.
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Pinto RP, Nunes AA, and de Mello LM
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- Adolescent, Child, Cross-Sectional Studies, Exercise, Feeding Behavior, Female, Health Behavior, Humans, Male, Prevalence, Overweight epidemiology, Pediatric Obesity epidemiology
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Objective: To determine the prevalence of overweight and obesity in schoolchildren aged 10 to 16 years and its association with dietary and behavioral factors., Methods: Cross-sectional study that evaluated 505 adolescents using a structured questionnaire and anthropometric data. The data was analyzed through the T Test for independent samples and Mann-Whitney Test to compare means and medians, respectively, and Chi
2 Test for proportions. Prevalence Ratio (RP) and the 95% confidence interval was used to estimate the degree of association between variables. The logistic regression was employed to adjust the estimates to confounding factors. The significance level of 5% was considered for all analysis., Results: Excess weight was observed in 30.9% of the schoolchildren: 18.2% of overweight and 12.7% of obesity. There was no association between weight alterations and dietary/behavioral habits in the bivariate and multivariate analyses. However, associations were observed in relation to gender. Daily consumption of sweets [PR=0.75 (0.64-0.88)] and soft drinks [PR=0.82 (0.70-0.97)] was less frequent among boys; having lunch daily was slightly more often reported by boys [OR=1.11 (1.02-1.22)]. Physical activity practice of (≥3 times/week) was more often mentioned by boys and the association measures disclosed two-fold more physical activity in this group [PR=2.04 (1.56-2.67)] when compared to girls. Approximately 30% of boys and 40% of girls stated they did not perform activities requiring energy expenditure during free periods, with boys being 32% less idle than girls [PR=0.68 (0.60-0.76)]., Conclusions: A high prevalence of both overweight and obesity was observed, as well as unhealthy habits in the study population, regardless of the presence of weight alterations. Health promotion strategies in schools should be encouraged, in order to promote healthy habits and behaviors among all students., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2016 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.) more...- Published
- 2016
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18. Analyses of Budget Impact Considering the Use of the Picture Archiving and Communication System.
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Aparecido Nunes A, de Mello LM, Barbosa Coelho E, de Souza JP, Zangiacomi Martinez E, Wichert Ana L, do Valle Lessa Dallora ME, Pazin Filho A, and de Azevedo Marques PM
- Abstract
Objective: To analyze the budget impact of using the picture archiving and communication system (PACS) in comparison to the screen/film system., Methods: The budget impact analysis was conducted on the basis of registry data from the Clinics Hospital of the Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil. The budget impacts were compared between the PACS, with high- and low-cost PACS architectures, and the screen/film system by considering reference and alternative scenarios over the course of 5 years., Results: The budget impact associated with the use of PACS was lower than that associated with the use of the screen/film system in all the evaluated scenarios. The low-cost PACS architecture (mini-PACS) had an even lower budget impact, especially in the scenario in which a simulation of lower numbers of medical examinations was performed., Conclusions: The screen/film system had a high budget impact in all the scenarios evaluated, wherein its costs were higher than the available budget. In contrast, the PACS (high- and low-cost architectures) showed a budget impact that allowed for savings in resources, especially the mini-PACS. Therefore, we recommend the implementation and use of the PACS in health services with any volume of examinations performed., (Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.) more...
- Published
- 2015
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19. Profile analysis of patients with HIV/AIDS hospitalized after the introduction of antiretroviral therapy.
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Nunes AA, Caliani LS, Nunes MS, da Silva AS, and de Mello LM
- Subjects
- Acquired Immunodeficiency Syndrome, Adult, Brazil epidemiology, Cross-Sectional Studies, Female, HIV Infections complications, HIV Infections mortality, Humans, Male, Middle Aged, Young Adult, Antiretroviral Therapy, Highly Active, HIV Infections drug therapy, Hospitalization
- Abstract
Since the introduction of highly active antiretroviral therapy (HAART) in 1996, there have been worldwide shifts in the causes of hospitalization for patients with HIV/AIDS. The aim of this study was to describe the characteristics of HIV/AIDS patient hospitalizations between 1997 and 2012. This cross-sectional study used a hospital database that centralizes records of admissions in 31 hospitals, both public and private, across 26 municipalities in the interior of São Paulo. In order to verify associations between the variables, we used the prevalence ratio (PR) and a 95% confidence interval. Among 9,797 adults and children, 10,696 admissions were registered, which was equal to 1.09 admissions per patient. Most (62%) of the patients were male, and the predominant age group was 21 and 50 years (63.5%). Mortality was higher among male patients from all age groups (PR= 1.42 [95% CI: 1.28-1.57]; p < 0.05). The main cause of hospitalization (54.5% of the total) was infectious disease, whether opportunistic or not. This was true, even in the post-HAART era. Furthermore, gender and age differences were noted in patient mortality rates. more...
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- 2015
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20. Rituximab, fludarabine, and cyclophosphamide versus fludarabine and cyclophosphamide for treatment of chronic lymphocytic leukemia: A systematic review with meta-analysis.
- Author
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Nunes AA, da Silva AS, Souza KM, Koury Cde N, and de Mello LM
- Subjects
- Antibodies, Monoclonal, Murine-Derived administration & dosage, Antineoplastic Combined Chemotherapy Protocols adverse effects, Cyclophosphamide administration & dosage, Humans, Leukemia, Lymphocytic, Chronic, B-Cell mortality, Randomized Controlled Trials as Topic, Remission Induction, Rituximab, Treatment Outcome, Vidarabine administration & dosage, Vidarabine analogs & derivatives, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Leukemia, Lymphocytic, Chronic, B-Cell drug therapy
- Abstract
Background: Chronic lymphocytic leukemia (CLL) is a disease of the lymphoid system, in which the most common therapy is fludarabine plus cyclophosphamide (FC). The addition of rituximab to FC has been used, a combination known as FCR., Objectives: To perform a systematic review with meta-analysis of clinical trials between 2000 and 2012 comparing FC and FCR in patients with CLL., Material and Methods: Electronic databases were searched using keywords related to the objectives of this review. The outcomes examined were progression-free survival and complete remission., Results: The progression-free survival and the overall survival showed significant difference between the two regimens, with complete remission being more frequent in FCR-treated patients (odds ratio=2.58; 95% CI: 2.13-3.13). Patients treated with FCR showed significantly higher neutropenia and serious adverse reactions., Conclusion: Despite the favorable results of the FCR regimen on outcomes including complete remission, progression-free survival, and overall survival, there is a lack of methodological rigor and appropriate analyses in many of these studies, and thus, there is a need for further studies examining the effect of rituximab in CLL patients., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.) more...
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- 2015
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21. Mechanical properties of composites as functions of the syringe storage temperature and energy dose.
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Chaves FO, Farias NC, Medeiros LM, Alonso RC, Di Hipólito V, and D'Alpino PH
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- Analysis of Variance, Curing Lights, Dental, Elastic Modulus, Materials Testing, Polymerization, Radiation Dosage, Silorane Resins chemistry, Stress, Mechanical, Time Factors, Composite Resins chemistry, Composite Resins radiation effects, Syringes, Temperature
- Abstract
Objective: To investigate the mechanical properties of different classifications of composites indicated for posterior application as functions of the storage condition and of the energy dose., Material and Methods: Specimens (8 x 2 x 2 mm) were obtained according to the factors: I) Composites (3M ESPE): Filtek P60, Filtek Z350XT, and Filtek Silorane; II) Syringe storage conditions: room temperature, aged, oven, refrigerator, and freezer; and III) Energy dose: 24 J/cm(2) and 48 J/cm(2). After photoactivation, the specimens were stored at 37 ºC for 24 h. After storage, a three-point bending test was carried out in a universal testing machine at 0.5 mm/min. Flexural strength (S) and flexural modulus (E) were calculated. Data were analyzed by three-way ANOVA and Tukey's test (α = 0.05)., Results: Different storage conditions significantly affected the silorane composite for S; conversely, no effects were noted in terms of E. The accelerated aging protocol significantly increased the S of Filtek P60 and Filtek Silorane, whereas storage in the oven significantly decreased the S for all of the composites tested. Filtek P60 was the only composite not affected by the lower storage temperatures tested for S, whereas for the silorane this parameter was impacted at the same conditions. The factor "dose" was not statistically significant., Conclusions: The syringe storage at different temperature conditions proved to influence mostly the flexural strength, a clinically important characteristic considering the posterior indication of the materials tested. The silorane composite should not be stored at lower temperatures. more...
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- 2015
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22. [Factors associated with the demand for health services from a gender-relational perspective].
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Levorato CD, de Mello LM, da Silva AS, and Nunes AA
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- Adolescent, Adult, Aged, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Surveys and Questionnaires, Young Adult, Health Services supply & distribution, Interpersonal Relations
- Abstract
Male culture values involve risk behaviors to health, since the way men perceive and experience their masculinity is one of the most influential shapers of falling sick and dying. The scope of this study was to identify the factors associated with the demand for health services and differences between the sexes by selecting users of health services. The dependent variables were sex of the user (cultural indicator) and failure to seek out health services. Independent variables included socio-demographic and clinical-epidemiological characteristics. The Prevalence Ratio studied by univariate and multivariate analysis was used in the analysis of the association between variables. The factors associated with non-demand for health services included: being male, hours of operation of health care facilities, working hours of the user and not having any disease. By multivariate analysis the factors facilitating demand for health services (protection) were: being female aged 26 to 49 years. Effective consolidation of a health care model that questions the contradiction that exists between the epidemiological data regarding men's health and the position of the health services using common sense regarding the apparent invulnerability of men to falling sick is of great relevance. more...
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- 2014
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23. [Evaluation and incorporation of health technologies: process and methodology adopted by a high-complexity care university].
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Nunes AA, de Mello LM, Ana LW, Marques PM, Dallora ME, Martinez EZ, Pazin Filho A, and Coelho EB
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- Brazil, Humans, Decision Making, Hospitals, University, Technology Assessment, Biomedical methods
- Abstract
The demographic and epidemiological transitions tend to increase the role of hospitals in medical care. Within such organizations, effective, safe, and cost-effective health technologies ensure better quality of care and increase users' survival, thus emphasizing the importance of evaluation of such hospital-based technologies. This article aims to present a model for the evaluation and incorporation of technology in a teaching hospital that provides high-complexity care. The article describes an approach to methods/processes assessment that can be used easily by any hospital. The model allowed proper health technology assessment (HTA), thereby legitimizing decisions on technology incorporation by the hospital administration with high levels of acceptance and adoption by the clinical staff, suggesting that hospital-based HTA (provided that it is well-structured, with the support of institutional administration) can be a powerful tool for dissemination and valorization of HTA culture in an environment with the widest use and the greatest impact on the health system's budget. more...
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- 2013
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24. Factors associated with community-acquired pneumonia in hospitalised children and adolescents aged 6 months to 13 years old.
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Barsam FJ, Borges GS, Severino AB, de Mello LM, da Silva AS, and Nunes AA
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- Adolescent, Age Factors, Brazil, Case-Control Studies, Child, Child, Preschool, Community-Acquired Infections epidemiology, Female, Humans, Infant, Logistic Models, Male, Risk Factors, Socioeconomic Factors, Surveys and Questionnaires, Breast Feeding statistics & numerical data, Hospitalization, Pneumonia epidemiology, Smoking adverse effects
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Unlabelled: According to the World Health Organisation, community-acquired pneumonia is the main cause of paediatric death, accounting for 20 % of deaths in children younger than 5 years old, and 90 % of these deaths occur in non-industrialised countries. This study has as objective to evaluate the influence of socio-economic, environmental and breastfeeding factors on the occurrence of pneumonia. An unmatched case-control study was conducted in children aged 6 months to 13 years old at a children's hospital in Brazil. Multivariate analysis by logistic regression was performed to determine the variables used to predict pneumonia. A total of 252 children were selected. In the adjusted (by age) multivariate analysis, the following variables were associated with community-acquired pneumonia: (a) protective factors: breastfeeding >3 months, absence of other unrelated comorbidities, non-smoking mother, being the only child, child's age >5 years and mother's age >19 years old; (b) risk factors: maternal education <8 years and child's birth order [≥second]. In the multivariate analysis, considering only children from 6 months to 5 years old, the following variables were associated with community-acquired pneumonia: (a) protective factors: breastfeeding >3 months, non-smoking mother and no smokers in the child's bedroom; (b) risk factors: maternal education <8 years and prenatal complications., Conclusion: These findings contribute favourably to effectively minimising the risk factors related to the disease process and natural history of community-acquired pneumonia. more...
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- 2013
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25. Re: donor-specific HLA antibodies: risk factors and outcomes after kidney transplantation.
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Nunes AA and de Mello LM
- Subjects
- Female, Humans, Male, HLA Antigens immunology, Histocompatibility, Isoantibodies blood, Kidney Transplantation
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- 2013
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26. Prevalence of rotavirus in acute diarrhea and its association with clinical signs and symptoms.
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Nunes AA, de Mello LM, Parrode RN, Bittar JP, and Domingues AL
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- Brazil epidemiology, Child, Preschool, Cross-Sectional Studies, Diarrhea epidemiology, Electrophoresis, Polyacrylamide Gel, Feces virology, Female, Gastroenteritis diagnosis, Gastroenteritis epidemiology, Genotype, Humans, Infant, Male, Prevalence, RNA, Viral genetics, Reverse Transcriptase Polymerase Chain Reaction, Rotavirus classification, Rotavirus isolation & purification, Rotavirus Infections diagnosis, Rotavirus Infections epidemiology, Diarrhea virology, Gastroenteritis virology, Rotavirus genetics, Rotavirus Infections virology
- Abstract
Rotaviruses are the main etiological agents of acute infectious diarrhea in children. Thus, the objective of this study is to contribute to the information about the rotavirus variants circulating in Brazil. A cross-sectional study was conducted on 124 fecal samples collected from children up to the age of 5 years, with acute gastroenteritis. Thirty-one samples were positive for rotavirus A. Regarding the G genotyping, 16 (80%) were classified as G1 and regarding P genotyping all strains were classified as P[8]. The determination of the prevalence of rotavirus infection and the characterization of the viral strains circulating are expected to contribute to the information we have about the molecular biology and epidemiology of disease. more...
- Published
- 2010
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27. TH1/TH2 balance in concomitant immediate and delayed-type hypersensitivity diseases.
- Author
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de Mello LM, Bechara MI, Solé D, and Rodrigues V
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- Adult, Allergens immunology, Animals, Antigens, Dermatophagoides pharmacology, Arthropod Proteins, Cells, Cultured, Cysteine Endopeptidases, Cytokines biosynthesis, Dermatophagoides pteronyssinus immunology, Female, Humans, Hypersensitivity, Delayed metabolism, Hypersensitivity, Immediate metabolism, Leukocytes, Mononuclear drug effects, Leukocytes, Mononuclear metabolism, Male, Middle Aged, Nickel pharmacology, Phytohemagglutinins pharmacology, Recombinant Proteins pharmacology, Skin Tests, Th1 Cells drug effects, Th1 Cells metabolism, Th2 Cells drug effects, Th2 Cells metabolism, Cytokines immunology, Hypersensitivity, Delayed immunology, Hypersensitivity, Immediate immunology, Leukocytes, Mononuclear immunology, Th1 Cells immunology, Th2 Cells immunology
- Abstract
In spite of the observation of mutual inhibitory properties of TH1 and TH2 CD4+ cells, a group of patients developed simultaneously immediate and delayed-type hypersensitivity reactions that are theoretically antagonistic. Patients presenting concomitant hypersensitivity reactions were evaluated for cytokine production. PBMC from 45 patients and 13 non-atopic individuals were cultured with mite allergen and mitogen and the supernatants obtained were evaluated for cytokine production by ELISA. The analysis of the cytokines levels revealed increased production of pro-inflammatory cytokine TNF-alpha in the non-atopic individuals after specific and mitogen stimulus. The IL-4 was largely observed on serum samples and IL-5 levels were higher in the double sensitized group (group DerpNi) after PHA stimulus. The IL-13 levels were increased in sensitized groups (Derp and DerpNi groups) after PHA stimuli. Atopic patients (Derp and DerpNi groups) presented lowest levels IFN-gamma and the analysis of TGF-beta production after rDER P I stimulation have shown increased levels among sensitized patients to Dermatophagoides pteronyssinus mite. IL-10 levels did not differ after antigen stimulation but basal production was higher on Derp and DerpNi groups. Furthermore, negative correlations were observed between IFN-gamma levels and IL-4, IL-13 and IL-10. This study has shown patients able to react, concomitantly, to the two types of antigens - rDER P I and NiSO4, present distinct pattern of cytokine production. The increased levels of IL-13 in the sensitive individuals to mite antigen (rDER P I) and IFN-gamma in NiSO4 sensitized individuals confirm the role of the type TH2 response in the atopies and TH1 type in DCA. more...
- Published
- 2009
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28. Sudden sensorineural hearing loss: a case report supporting the immunologic theory.
- Author
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Werneck AL, Gurgel LC, de Mello LM, and de Albuquerque GQ
- Subjects
- Anti-Inflammatory Agents therapeutic use, Antithyroid Agents adverse effects, Autoimmune Diseases drug therapy, Cross Reactions, Female, Hearing Loss, Sensorineural drug therapy, Humans, Hyperthyroidism drug therapy, Methylprednisolone therapeutic use, Middle Aged, Propylthiouracil adverse effects, Autoimmune Diseases immunology, Hearing Loss, Sensorineural immunology
- Abstract
Sudden sensorineural hearing loss (SSNHL) is one of the autoimmune diseases of the inner ear (AIED), which is characterized by a hearing loss of above 30 decibels in at least three contiguous audiometric frequencies over a time course of 72 hours or shorter. Its cause can be found in only 10% to 15% of patients. Histopathologic findings have reported retrograde neuronal degeneration and atrophy of Corti's organ and of the vascular stria. This paper describes a case of a middle-aged female patient undergoing a treatment for hyperthyroidism who developed bilateral SSNHL. The patient was treated with methylprednisone (1 mg/kg/day) for three days with considerable hearing improvement. This treatment was followed by lung and kidney tuberculosis. The immune mechanism of this entity and the possibility of interconnected participation of the antigen type, of an autoimmune disease and of bacterial infection are discussed. more...
- Published
- 2003
- Full Text
- View/download PDF
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