An amendment to this paper has been published and can be accessed via a link at the top of the pa... more An amendment to this paper has been published and can be accessed via a link at the top of the paper.
New criteria for acute kidney injury (AKI) in cirrhosis have been proposed, but its prognostic si... more New criteria for acute kidney injury (AKI) in cirrhosis have been proposed, but its prognostic significance is unclear. This study aims to evaluate the prognostic significance of the AKI criteria in cirrhotic patients hospitalized for acute decompensation. This is a prospective cohort study. AKI was defined as an increase in creatinine (Cr) levels ≥ 0.3 mg/dL in 48 h or ≥ 50% of the basal value in the last 7d. AKI was divided into stages 1 (elevation: < 2x basal), 2 (2 or 3x), and 3 (> 3x). In this study, 227 patients aged 53.9 ± 11.5 years were included, of whom 37% had AKI (28% AKI1, 5% AKI2, and 4% AKI3). Thirty percent of the patients died or were transplanted within 90 days from causes related to the presence of ascites at hospital admission and higher values of Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) scores, but not to the presence of AKI. In a regression analysis conducted to assess the effect of the final Cr level in patients with AKI, 90-...
In 2012, the WHO estimated that 6 million new cases of syphilis per year would occur worldwide, i... more In 2012, the WHO estimated that 6 million new cases of syphilis per year would occur worldwide, including 937 000 in Brazil. Early diagnosis and treatment of syphilis are essential to reduce morbidity and prevent transmission. The availability of rapid tests (RTs) for this diagnosis means that testing can be performed more quickly, as a point-of-care test, even in non-laboratory environments and requires only simple technical training to antibodies detection. The objective of this study was to evaluate the performance and operational aspects of seven commercially available RTs for syphilis in Brazil. Seven rapid treponemal tests were evaluated for sensitivity, specificity, accuracy and Kappa value, according to a panel composed of 493 members. The operational performance of the assay was also determined for these tests. The seven RTs showed sensitivity ranging from 94.5% to 100% when compared with the reference tests and specificity of between 91.5% and 100%. All the RTs evaluated p...
Despite the circulating levels of PTX3 were related to the severity of various diseases, there ar... more Despite the circulating levels of PTX3 were related to the severity of various diseases, there are no studies investigating its role in patients with liver cirrhosis. We aimed to study PTX3 levels in patients with liver cirrhosis. A prospective cohort study included 130 patients hospitalized for acute decompensation of liver cirrhosis, 29 stable cirrhotic outpatients and 32 healthy controls evaluated in a tertiary hospital in Southern Brasil. The median PTX3 level was significantly higher in stable cirrhotic patients compared to controls (2.6 vs. 1.1 ng/mL; p < 0.001), hospitalized cirrhotic patients compared to controls (3.8 vs. 1.1 ng/mL; p < 0.001), and hospitalized cirrhotic patients compared to stable cirrhotic patients (3.8 vs. 2.6 ng/mL; p = 0.001). A positive correlation was found between PTX3 and serum creatinine (r = 0.220; p = 0.012), Chronic Liver Failure - Sequential Organ Failure Assessment score (CLIF-SOFA) (r = 0.220; p = 0.010), MELD (r = 0.279; p = 0.001) and...
Although both pro- and anti-inflammatory circulating cytokines are known to be elevated in liver ... more Although both pro- and anti-inflammatory circulating cytokines are known to be elevated in liver cirrhosis, its clinical significance is not completely recognized. Our aim was to evaluate the prognostic significance of circulating cytokines interleukin (IL)-6, IL-17 and IL-10 in different stages of cirrhosis. This prospective study included two cohorts: (1) stable cirrhosis attended in the Outpatient Clinic (n=118), and (2) subjects hospitalized for acute decompensation (AD) (n=130). Thirty healthy subjects served as control group. Patients with cirrhosis exhibited higher levels of cytokines as compared to controls. In stable cirrhosis, during a median follow-up of 17months, liver-related events occurred in 26 patients. Higher IL-10 levels and Child-Pugh B/C were independently associated with reduced event-free survival. In AD cohort, death after 90days of follow-up occurred in 39 patients and was independently associated with ascites, higher IL-6 and model for end-stage liver disea...
Molecular epidemiology of Mycobacterium tuberculosis is useful for understanding disease transmis... more Molecular epidemiology of Mycobacterium tuberculosis is useful for understanding disease transmission dynamics, and to establish strategic measures for TB control and prevention. The aim of this study was to analyze clinical, epidemiological and molecular characteristics of MTBC clinical isolates from Santa Catarina state, southern Brazil. During one-year period, 406 clinical isolates of MTBC were collected from Central Laboratory of Public Health and typed by spoligotyping. Demographic and clinical data were collected from the Brazilian National Mandatory Disease Reporting System. The majority of cases occurred in highest population densities regions and about 50% had some condition associated with TB. Among all isolates, 5.7% were MDR, which showed association with drug addiction. LAM was the most predominant lineage with 47.5%, followed by the T superfamily with 25.9% and Haarlem with 12.3%. The MST showed two major groups: the first was formed mainly by the LAM lineage and the second was mainly formed by the T and Haarlem lineages. Others lineages were distributed in peripheral positions. This study provides the first insight into the population structure of M. tuberculosis in SC State. Spoligotyping and other genotyping analyses are important to establish strategic measures for TB control and prevention.
A muitos tenho que agradecer porque ajudaram de forma decisiva para a concretização deste trabalh... more A muitos tenho que agradecer porque ajudaram de forma decisiva para a concretização deste trabalho. A todos, antes de tudo, agradeço pela amizade. À professora Yoshimi Imoto Yamamoto pela orientação e pelo apoio dispensado durante a execução dos trabalhos. Ao professor Luiz Fernando de Góes Siquira, co-orientador desta dissertação, que sempre encontrou um tempo para conversar sobre o trabalho, mesmo nos períodos em que sua agenda não permitia. À Coordenação Nacional de DST e Aids e ao seu Coordenador Dr. Pedro Chequer, que autorizou o uso das amostras do Primeiro Corte do Estudo com a População de Conscritos do Exército Brasileiro, coletadas em 19996. Ao professor Luiz Alberto Peregrino Ferreira, responsável pelo tema desta dissertação, e que negociou junto à empresa Organon os kits imunoenzimáticos, possibilitou que toda a sorologia fosse feita no Serviço de Análises Clínicas do HU-UFSC e que sempre teve paciência de ler e sugerir modificações no texto. À Dra. Miriam Franchini que também participou das negociações para a obtenção dos kits e que junto com o querido John Penny colaborou no abstract. Aos professores Maurício Alchorne e Sumie H. Shimizu, membros da banca, pela avaliação crítica e pelas sugestões apresentadas. À professora Regina Ary Flório da Cunha que durante a prova de qualificação apresentou importante contribuição ao trabalho. vii Ao Dr. Luiz Jorge Fagundes, pelo interesse, análise criteriosa e correções realizadas ao texto. À Empresa Organon por ter doado 25.000 testes do kit Trepanostika TM , e à Dra. Cíntia Vilhena dos Santos pela presteza com que instalou os equipamentos para realização dos testes e por ter vindo pessoalmente a Florianópolis implantar a metodologia. À Empresa Biolab, especialmente à Dra. Zilá Rosa Belém pela doação dos treponemas para a realização do Western blot. Ao Labortório Noel Nutels e ao seu Diretor Dr. Oscar Berro pela doação dos reagentes para o FTA-ABS. À Fundação Osvaldo Cruz-BioManguinhos, especialmente ao Dr. Antônio Gomes P. Ferreira por ter cedido as lâminas demarcadas utilizadas para fixar o antígeno para FTA-ABS.
Introduction: Over the last few years, the idea of ACLF has emerged to identify those subjects wi... more Introduction: Over the last few years, the idea of ACLF has emerged to identify those subjects with organ failure and high mortality rates. However, the absence of a precise definition has limited the clinical application and research related to the ACLF concept. We sought to validate the ACLF definition and the Chronic Liver Failure (CLIF)-Sequential Organ Failure Assessment (SOFA) Score recently proposed by the EASL-CLIF Consortium in a cohort of patients admitted for acute decompensation (AD) of cirrhosis. Methods: The diagnosis of cirrhosis was established either histologically (when available) or by the combination of clinical, imaging, and laboratory findings in patients with evidence of portal hypertension. Patients were clinically assessed within 24 hours of admission and at days 3, 7, 30 and 90 post enrollment. All subjects underwent laboratory evaluation at admission. The CLIF-SOFA score and the ACLF criteria were applied according to the EASL-CLIF Consortium definition. R...
Introduction: Decreased IGF-1 serum levels have been reported in patients with cirrhosis and seem... more Introduction: Decreased IGF-1 serum levels have been reported in patients with cirrhosis and seem to correlate with hepatic dysfunction intensity. However, data about its prognostic significance is still lacking. We sought to investigate the relationship between serum IGF-1 levels and short-term prognosis in patients admitted for acute decompensation of cirrhosis. Methods: In this prospective cohort study, patients admitted in the emergency department were followed during their hospital stay and 90-day mortality was evaluated by phone call, in case of hospital discharge. All subjects underwent laboratory evaluation at admission. The acute-on-chronic liver failure (ACLF) criteria were applied according to the EASL-CLIF Consortium definition. Twenty-one patients were also evaluated in the outpatient clinic after discharge and were compared in two moments (inpatient and outpatient evaluation). Results: Between December 2011 and November 2013, 103 patients were included, with a mean age...
Estima-se que um terço da população mundial esteja infectada com Mycobacterium tuberculosis, o qu... more Estima-se que um terço da população mundial esteja infectada com Mycobacterium tuberculosis, o que resulta em 2 milhões de mortes anualmente. No mundo, são registrados mais de 8 milhões de novos casos de tuberculose (TB) por ano e o Brasil ocupa o 19° lugar dentre os 23 países detentores da maior carga de TB. Os fatores determinantes para o controle desta doença incluem a detecção rápida, a terapia adequada e os meios para que sejam evitadas futuras transmissões. O diagnóstico convencional (baciloscopia e cultura do microrganismo) apresenta limitações quanto ao tempo de execução e à operacionalidade, visto que o resultado pode levar até 60 dias para ser liberado. Portanto, a importância da detecção precoce do bacilo se torna fundamental para o bloqueio da cadeia de transmissão da TB. Já as micobacterioses, doenças causadas pelas micobactérias não tuberculosas, também estão provocando um importante impacto em razão do aumento dos surtos de infecções cirúrgicas. A identificação rápida e específica destes microrganismos é importante para o diagnóstico e a consequente escolha do tipo de tratamento do paciente, que está diretamente relacionada com a espécie. Portanto, o conhecimento dos agentes etiológicos das doenças causadas pelas micobactérias e o diagnóstico sensível e específico permitem o tratamento adequado e, consequentemente, o bloqueio da cadeia de transmissão da TB e o controle dos surtos relacionados às micobactérias não tuberculosas. DESCRITORES: Tuberculose. Micobactérias não tuberculosas.
An amendment to this paper has been published and can be accessed via a link at the top of the pa... more An amendment to this paper has been published and can be accessed via a link at the top of the paper.
New criteria for acute kidney injury (AKI) in cirrhosis have been proposed, but its prognostic si... more New criteria for acute kidney injury (AKI) in cirrhosis have been proposed, but its prognostic significance is unclear. This study aims to evaluate the prognostic significance of the AKI criteria in cirrhotic patients hospitalized for acute decompensation. This is a prospective cohort study. AKI was defined as an increase in creatinine (Cr) levels ≥ 0.3 mg/dL in 48 h or ≥ 50% of the basal value in the last 7d. AKI was divided into stages 1 (elevation: < 2x basal), 2 (2 or 3x), and 3 (> 3x). In this study, 227 patients aged 53.9 ± 11.5 years were included, of whom 37% had AKI (28% AKI1, 5% AKI2, and 4% AKI3). Thirty percent of the patients died or were transplanted within 90 days from causes related to the presence of ascites at hospital admission and higher values of Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) scores, but not to the presence of AKI. In a regression analysis conducted to assess the effect of the final Cr level in patients with AKI, 90-...
In 2012, the WHO estimated that 6 million new cases of syphilis per year would occur worldwide, i... more In 2012, the WHO estimated that 6 million new cases of syphilis per year would occur worldwide, including 937 000 in Brazil. Early diagnosis and treatment of syphilis are essential to reduce morbidity and prevent transmission. The availability of rapid tests (RTs) for this diagnosis means that testing can be performed more quickly, as a point-of-care test, even in non-laboratory environments and requires only simple technical training to antibodies detection. The objective of this study was to evaluate the performance and operational aspects of seven commercially available RTs for syphilis in Brazil. Seven rapid treponemal tests were evaluated for sensitivity, specificity, accuracy and Kappa value, according to a panel composed of 493 members. The operational performance of the assay was also determined for these tests. The seven RTs showed sensitivity ranging from 94.5% to 100% when compared with the reference tests and specificity of between 91.5% and 100%. All the RTs evaluated p...
Despite the circulating levels of PTX3 were related to the severity of various diseases, there ar... more Despite the circulating levels of PTX3 were related to the severity of various diseases, there are no studies investigating its role in patients with liver cirrhosis. We aimed to study PTX3 levels in patients with liver cirrhosis. A prospective cohort study included 130 patients hospitalized for acute decompensation of liver cirrhosis, 29 stable cirrhotic outpatients and 32 healthy controls evaluated in a tertiary hospital in Southern Brasil. The median PTX3 level was significantly higher in stable cirrhotic patients compared to controls (2.6 vs. 1.1 ng/mL; p < 0.001), hospitalized cirrhotic patients compared to controls (3.8 vs. 1.1 ng/mL; p < 0.001), and hospitalized cirrhotic patients compared to stable cirrhotic patients (3.8 vs. 2.6 ng/mL; p = 0.001). A positive correlation was found between PTX3 and serum creatinine (r = 0.220; p = 0.012), Chronic Liver Failure - Sequential Organ Failure Assessment score (CLIF-SOFA) (r = 0.220; p = 0.010), MELD (r = 0.279; p = 0.001) and...
Although both pro- and anti-inflammatory circulating cytokines are known to be elevated in liver ... more Although both pro- and anti-inflammatory circulating cytokines are known to be elevated in liver cirrhosis, its clinical significance is not completely recognized. Our aim was to evaluate the prognostic significance of circulating cytokines interleukin (IL)-6, IL-17 and IL-10 in different stages of cirrhosis. This prospective study included two cohorts: (1) stable cirrhosis attended in the Outpatient Clinic (n=118), and (2) subjects hospitalized for acute decompensation (AD) (n=130). Thirty healthy subjects served as control group. Patients with cirrhosis exhibited higher levels of cytokines as compared to controls. In stable cirrhosis, during a median follow-up of 17months, liver-related events occurred in 26 patients. Higher IL-10 levels and Child-Pugh B/C were independently associated with reduced event-free survival. In AD cohort, death after 90days of follow-up occurred in 39 patients and was independently associated with ascites, higher IL-6 and model for end-stage liver disea...
Molecular epidemiology of Mycobacterium tuberculosis is useful for understanding disease transmis... more Molecular epidemiology of Mycobacterium tuberculosis is useful for understanding disease transmission dynamics, and to establish strategic measures for TB control and prevention. The aim of this study was to analyze clinical, epidemiological and molecular characteristics of MTBC clinical isolates from Santa Catarina state, southern Brazil. During one-year period, 406 clinical isolates of MTBC were collected from Central Laboratory of Public Health and typed by spoligotyping. Demographic and clinical data were collected from the Brazilian National Mandatory Disease Reporting System. The majority of cases occurred in highest population densities regions and about 50% had some condition associated with TB. Among all isolates, 5.7% were MDR, which showed association with drug addiction. LAM was the most predominant lineage with 47.5%, followed by the T superfamily with 25.9% and Haarlem with 12.3%. The MST showed two major groups: the first was formed mainly by the LAM lineage and the second was mainly formed by the T and Haarlem lineages. Others lineages were distributed in peripheral positions. This study provides the first insight into the population structure of M. tuberculosis in SC State. Spoligotyping and other genotyping analyses are important to establish strategic measures for TB control and prevention.
A muitos tenho que agradecer porque ajudaram de forma decisiva para a concretização deste trabalh... more A muitos tenho que agradecer porque ajudaram de forma decisiva para a concretização deste trabalho. A todos, antes de tudo, agradeço pela amizade. À professora Yoshimi Imoto Yamamoto pela orientação e pelo apoio dispensado durante a execução dos trabalhos. Ao professor Luiz Fernando de Góes Siquira, co-orientador desta dissertação, que sempre encontrou um tempo para conversar sobre o trabalho, mesmo nos períodos em que sua agenda não permitia. À Coordenação Nacional de DST e Aids e ao seu Coordenador Dr. Pedro Chequer, que autorizou o uso das amostras do Primeiro Corte do Estudo com a População de Conscritos do Exército Brasileiro, coletadas em 19996. Ao professor Luiz Alberto Peregrino Ferreira, responsável pelo tema desta dissertação, e que negociou junto à empresa Organon os kits imunoenzimáticos, possibilitou que toda a sorologia fosse feita no Serviço de Análises Clínicas do HU-UFSC e que sempre teve paciência de ler e sugerir modificações no texto. À Dra. Miriam Franchini que também participou das negociações para a obtenção dos kits e que junto com o querido John Penny colaborou no abstract. Aos professores Maurício Alchorne e Sumie H. Shimizu, membros da banca, pela avaliação crítica e pelas sugestões apresentadas. À professora Regina Ary Flório da Cunha que durante a prova de qualificação apresentou importante contribuição ao trabalho. vii Ao Dr. Luiz Jorge Fagundes, pelo interesse, análise criteriosa e correções realizadas ao texto. À Empresa Organon por ter doado 25.000 testes do kit Trepanostika TM , e à Dra. Cíntia Vilhena dos Santos pela presteza com que instalou os equipamentos para realização dos testes e por ter vindo pessoalmente a Florianópolis implantar a metodologia. À Empresa Biolab, especialmente à Dra. Zilá Rosa Belém pela doação dos treponemas para a realização do Western blot. Ao Labortório Noel Nutels e ao seu Diretor Dr. Oscar Berro pela doação dos reagentes para o FTA-ABS. À Fundação Osvaldo Cruz-BioManguinhos, especialmente ao Dr. Antônio Gomes P. Ferreira por ter cedido as lâminas demarcadas utilizadas para fixar o antígeno para FTA-ABS.
Introduction: Over the last few years, the idea of ACLF has emerged to identify those subjects wi... more Introduction: Over the last few years, the idea of ACLF has emerged to identify those subjects with organ failure and high mortality rates. However, the absence of a precise definition has limited the clinical application and research related to the ACLF concept. We sought to validate the ACLF definition and the Chronic Liver Failure (CLIF)-Sequential Organ Failure Assessment (SOFA) Score recently proposed by the EASL-CLIF Consortium in a cohort of patients admitted for acute decompensation (AD) of cirrhosis. Methods: The diagnosis of cirrhosis was established either histologically (when available) or by the combination of clinical, imaging, and laboratory findings in patients with evidence of portal hypertension. Patients were clinically assessed within 24 hours of admission and at days 3, 7, 30 and 90 post enrollment. All subjects underwent laboratory evaluation at admission. The CLIF-SOFA score and the ACLF criteria were applied according to the EASL-CLIF Consortium definition. R...
Introduction: Decreased IGF-1 serum levels have been reported in patients with cirrhosis and seem... more Introduction: Decreased IGF-1 serum levels have been reported in patients with cirrhosis and seem to correlate with hepatic dysfunction intensity. However, data about its prognostic significance is still lacking. We sought to investigate the relationship between serum IGF-1 levels and short-term prognosis in patients admitted for acute decompensation of cirrhosis. Methods: In this prospective cohort study, patients admitted in the emergency department were followed during their hospital stay and 90-day mortality was evaluated by phone call, in case of hospital discharge. All subjects underwent laboratory evaluation at admission. The acute-on-chronic liver failure (ACLF) criteria were applied according to the EASL-CLIF Consortium definition. Twenty-one patients were also evaluated in the outpatient clinic after discharge and were compared in two moments (inpatient and outpatient evaluation). Results: Between December 2011 and November 2013, 103 patients were included, with a mean age...
Estima-se que um terço da população mundial esteja infectada com Mycobacterium tuberculosis, o qu... more Estima-se que um terço da população mundial esteja infectada com Mycobacterium tuberculosis, o que resulta em 2 milhões de mortes anualmente. No mundo, são registrados mais de 8 milhões de novos casos de tuberculose (TB) por ano e o Brasil ocupa o 19° lugar dentre os 23 países detentores da maior carga de TB. Os fatores determinantes para o controle desta doença incluem a detecção rápida, a terapia adequada e os meios para que sejam evitadas futuras transmissões. O diagnóstico convencional (baciloscopia e cultura do microrganismo) apresenta limitações quanto ao tempo de execução e à operacionalidade, visto que o resultado pode levar até 60 dias para ser liberado. Portanto, a importância da detecção precoce do bacilo se torna fundamental para o bloqueio da cadeia de transmissão da TB. Já as micobacterioses, doenças causadas pelas micobactérias não tuberculosas, também estão provocando um importante impacto em razão do aumento dos surtos de infecções cirúrgicas. A identificação rápida e específica destes microrganismos é importante para o diagnóstico e a consequente escolha do tipo de tratamento do paciente, que está diretamente relacionada com a espécie. Portanto, o conhecimento dos agentes etiológicos das doenças causadas pelas micobactérias e o diagnóstico sensível e específico permitem o tratamento adequado e, consequentemente, o bloqueio da cadeia de transmissão da TB e o controle dos surtos relacionados às micobactérias não tuberculosas. DESCRITORES: Tuberculose. Micobactérias não tuberculosas.
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