2025.1
1. Twice-Yearly Lenacapavir for HIV Prevention in Men and Gender-Diverse Persons. N Engl J Med. 2025;392(13):1261-1276. doi: 10.1056/NEJMoa2411858.
Kelley CF(1)(2), Acevedo-Quiñones M(3), Agwu AL(4), Avihingsanon A(5), Benson P(6), Blumenthal J(7), Brinson C(8), Brites C(9), Cahn P(10), et al.; PURPOSE 2 Study Team.
Afiliação:
(1) Hope Clinic of Emory University School of Medicine, Decatur, GA
(2) Grady Health System, Atlanta.
(3) Centro Ararat, San Juan, Puerto Rico.
(4) Divisions of Pediatric and Adult Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore.
(5) HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Centre and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
(6) Be Well Medical Center, Berkley, MI.
(7) Department of Medicine, University of California San Diego, San Diego.
(8) Central Texas Clinical Research, Austin, TX.
(9) Complexo Hospitalar Universitário Professor Edgard Santos, Salvador, Brazil.
(10) Fundación Huésped, Buenos Aires.
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Resumo: Twice-yearly subcutaneous lenacapavir has been shown to be efficacious for prevention of human immunodeficiency virus (HIV) infection in cisgender women. The efficacy of lenacapavir for preexposure prophylaxis (PrEP) in cisgender men, transgender women, transgender men, and gender-nonbinary persons is unclear. METHODS: In this phase 3, double-blind, randomized, active-controlled trial, we randomly assigned participants in a 2:1 ratio to receive subcutaneous lenacapavir every 26 weeks or daily oral emtricitabine-tenofovir disoproxil fumarate (F/TDF). The primary efficacy analysis compared the incidence of HIV infection in the lenacapavir group with the background HIV incidence in the screened population. The secondary efficacy analysis compared the incidence of HIV infection in the lenacapavir group with that in the F/TDF group. RESULTS: Among 3265 participants who were included in the modified intention-to-treat analysis, HIV infections occurred in 2 participants in the lenacapavir group (0.10 per 100 person-years; 95% confidence interval [CI], 0.01 to 0.37) and in 9 participants in the F/TDF group (0.93 per 100 person-years; 95% CI, 0.43 to 1.77). The background HIV incidence in the screened population (4634 participants) was 2.37 per 100 person-years (95% CI, 1.65 to 3.42). The incidence of HIV infection in the lenacapavir group was significantly lower than both the background incidence (incidence rate ratio, 0.04; 95% CI, 0.01 to 0.18; P<0.001) and the incidence in the F/TDF group (incidence rate ratio, 0.11; 95% CI, 0.02 to 0.51; P = 0.002). No safety concerns were identified. A total of 26 of 2183 participants (1.2%) in the lenacapavir group and 3 of 1088 (0.3%) in the F/TDF group discontinued the trial regimen because of injection-site reactions. CONCLUSIONS: The HIV incidence with twice-yearly lenacapavir was significantly lower than the background incidence and the incidence with F/TDF. (Funded by Gilead Sciences; PURPOSE 2 ClinicalTrials.gov number, NCT04925752.).
2. Drug-induced Liver Injury in Latin America: 10-year Experience of the Latin American DILI (LATINDILI) Network. Clin Gastroenterol Hepatol. 2025 Jan;23(1):89-102. doi: 10.1016/ j.cgh.2024.06.030.
Bessone F(1), Hernandez N(2), Medina-Caliz I(3), García-Cortés M(4), Schinoni MI(5), Mendizabal M(6), Chiodi D(2), Nunes V(5), Ridruejo E(7), Pazos X(2), Santos G(5), Fassio E(8), Parana R(9), Reggiardo V(10), et al.
Afiliação:
(1) Hospital Provincial del Centenario, Facultad de Medicina, Universidad Nacional de Rosario, Rosario, Argentina.
(2) Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
(3) Servicios de Aparato Digestivo y Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Universidad de Málaga, Málaga, Spain.
(4) Servicios de Aparato Digestivo y Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
(5) Hospital Universitário Prof. Edgard Santos-UFBA, Salvador de Bahia, Brazil.
(6) Hospital Universitario Austral, Buenos Aires, Argentina.
(7) Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina.
(8) Hospital Alejandro Posadas, Buenos Aires, Argentina.
(9) Hospital Universitário Prof. Edgard Santos-UFBA, Salvador de Bahia, Brazil; Facultad de Medicina, Universidad Nacional de Bahia, Salvador de Bahia, Brazil.
(10) Hospital Provincial del Centenario, Facultad de Medicina, Universidad Nacional de Rosario, Rosario, Argentina.
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Resumo: Latin America is a region of great interest for studying the clinical presentation of idiosyncratic drug-induced liver injury (DILI). A comprehensive analysis of patients enrolled into the LATINDILI Network over a decade is presented. METHODS: emographics, clinical presentation, histological findings and outcome of prospectively recruited DILI cases in the LATINDILI Network were analyzed. Suspected culprit drugs were classified according to the Anatomical Therapeutic Chemical classification. Causality was assessed using the Roussel Uclaf Causality Assessment Method (RUCAM) scale. RESULTS: Overall, 468 idiosyncratic DILI cases were analyzed (62% women; mean age, 49 years). patocellular injury predominated (62%); jaundice was present in 60% of patients, and 42% were hospitalized. Of the cases, 4.1% had a fatal outcome, and 24 patients (12%) developed chronic DILI. The most common drug classes were systemic anti-infectives (31%), musculoskeletal agents (12%), antineoplastic and immunomodulating agents (11%), and herbal and dietary supplements (9%). Notably, none of the patients with DILI due to antibacterials or immunosuppressants had a fatal outcome. In fact, Hy's law showed to have drug-specific predictive value, with anti-tuberculosis drugs, nimesulide, and herbal and dietary supplements associated with the worst outcome, whereas DILI caused by amoxicillin-clavulanate, nitrofurantoin, and diclofenac, which fulfilled Hy's law, did not have a fatal outcome. CONCLUSION: Features of DILI in Latin America are comparable to other prospective registries. However, the pattern of drugs responsible for DILI differs. An increasing incidence of herbal and dietary supplements, with high mortality rate, and likewise, nimesulide and nitrofurantoin, was noted. Thus, public health policies should raise awareness of the potential adverse effects of these compounds.
3. Practical recommendations for diagnosis, management, and follow-up of Niemann-Pick type-C disease patients: a Brazilian perspective. Arq Neuropsiquiatr. 2025 Mar;83(3):1-8. doi: 10.1055/s-0045-1807714.
Horovitz DDG(1), Pessoa A(2)(3), França Junior MC(4), Giugliani R(5)(6)(7)(8), Souza M(8), Embiruçu EK(9)(10), Braga-Neto P(3), Lourenço CM(11).
Afiliação:
(1) Fundação Oswaldo Cruz, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Departamento de Genética Médica, Rio de Janeiro RJ, Brazil.
(2) Hospital Infantil Albert Sabin, Serviço de Neurologia e Neurogenética, Fortaleza CE, Brazil.
(3) Universidade Federal do Ceará, Faculdade de Medicina, Fortaleza CE, Brazil.
(4) Universidade Estadual de de Campinas, Faculdade de Ciências Médicas, Departamento de Neurologia, Campinas SP, Brazil.
(5) Universidade Federal do Rio Grande do Sul, Departamento de Genética Médica, Porto Alegre RS, Brazil.
(6) Dasa Genômica, Porto Alegre RS, Brazil.
(7) Casa dos Raros, Centro de Atenção Integral e Treinamento em Doenças Raras, Porto Alegre RS, Brazil.
(8) Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre RS, Brazil.
(9) Universidade do Estado da Bahia, Departamento de Ciências da Vida, Salvador BA, Brazil.
(10) Hospital Universitário Professor Edgard Santos, Serviço de Genética Médica, Salvador BA, Brazil.
(11) Faculdade de Medicina de São José do Rio Preto, Centro de Referência de Doenças Raras, Unidade de Neurogenética, Clínica de Erros Inatos do Metabolismo, São José do Rio Preto SP, Brazil.
Resumo: Niemann-Pick type-C (NPC) disease is a rare genetic condition with a clinical spectrum ranging from a fatal prenatally-presenting and quickly lethal disorder to an adult-onset chronic neurodegenerative condition. Given the scarcity of information regarding NPC disease in Brazil, a group of experts decided to discuss some disease-related aspects at the national level. The present manuscript describes the results of a Brazilian consensus meeting conducted to propose recommendations for the diagnosis, management, and follow-up of NPC disease in Brazil, considering the clinical practice point of view. These recommendations include patient characteristics on clinical presentation, as systemic and neurological manifestations according to the age group and atypical manifestations; a flowchart for diagnostic confirmation, considering the Brazilian scenario; and treatment, encompassing disease-modifying therapy, supportive care, and patients' follow-up. The expert panel provided an objective basis of recommendations on NPC diagnosis and management in Brazil. The authors expect that this manuscript will help clinicians to identify, adequately treat and follow-up NPC patients in Brazil.
4. Description of lymphocyte and cytokine profiles in individuals with acute myeloid leukemia associated with FLT3-ITD and NPM1 mutation status. Eur J Cancer Prev. 2025 Mar 1;34(2):115-123. doi: 10.1097/CEJ.0000000000000905.
Reis R(1)(2), Müller GS(1)(2), Santos MM(1)(2), Santos AS(1)(2), Santos H(1)(3), Santos LS(1), Lopes BA(4), Trindade SC(5), Meyer RJ(1)(2)(5), Freire SM(1)(2)(6).
Afiliação:
(1) Immunology and Molecular Biology Laboratory, Federal University of Bahia.
(2) Postgraduate Program in Immunology, Federal University of Bahia.
(3) Professor Edgard Santos University Hospital, Salvador, BA.
(4) National Cancer Institute, Rio de Janeiro, RJ.
(5) Departament of Health, State University of Feira de Santana, Feira de Santana.
(6) Department of Biointeraction, Federal University of Bahia, Salvador, BA, Brazil.
The pathogenesis of acute myeloid leukemia (AML) involves mutations in genes such as FLT3 and NPM1 , which are also associated with the prognosis of the disease. The immune system influences disease progression, but the mechanisms underlying the interaction between the immune system and AML are not clear. In this study, the profiles of lymphocytes and cytokines were described in individuals with AML stratified by molecular changes associated with prognosis. The participants included in this study were newly diagnosed AML patients ( n = 43) who were about to undergo chemotherapy. Subtypes of lymphocytes in peripheral blood, including B cells, T cells, and natural killer cells, and serum concentrations of cytokines, including Th1, Th2, and Th17, were studied by flow cytometry assays (BD FACSCanto II). The correlations between lymphocyte subsets, cytokines, and genetic/prognostic risk stratification (based on the FLT3 and NPM1 genes) were analyzed. The differences in B lymphocytes (%), T lymphocytes (%), plasmablasts (%), leukocytes (cells/µl), and tumor necrosis factor (pg/ml) were determined between groups with FLT3-ITD+ and FLT3-ITD- mutations. The presence of mutations in NPM1 and FLT3-ITD and age suggested changes in the lymphocyte and cytokine profile in individuals with AML.
5. Recommendations for diagnosis and treatment of Atypical Hemolytic Uremic Syndrome (aHUS): an expert consensus statement from the Rare Diseases Committee of the Brazilian Society of Nephrology (COMDORA-SBN). J Bras Nefrol. 2025;47(2):e20240087. doi: 10.1590/2175-8239-JBN-2024-0087en.
Vaisbich MH(1), Andrade LGM(2), Barbosa MINH(3), Castro MCR(4), Miranda SMC(5), Poli-de-Figueiredo CE(6), Araujo SA(7), Ernandes Neto M(8), Penido MGMG(9), Sobral RML(10), Ferra Neto O(11), Neves PDMM(12)(13), Silva CABD(14), Barreto FC(15), Pietrobom IG(16), Palma LMP(17).
Afiliação:
(1) Universidade Federal de São Paulo, Instituto da Criança, Hospital das Clínicas - HCFMUSP, São Paulo, SP, Brazil.
(2) Universidade Estadual Paulista, Departamento de Medicina Interna, São Paulo, SP, Brazil.
(3) Hospital Federal de Bonsucesso, Serviço de Nefrologia e Transplante Renal, Rio de Janeiro, RJ, Brazil.
(4) Universidade de São Paulo, Unidade de Transplante Renal, São Paulo, SP, Brazil.
(5) Hospital Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brazil.
(6) Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
(7) Universidade Federal de Minas Gerais, Instituto de Nefropatologia, Centro de Microscopia Eletrônica, Belo Horizonte, MG, Brazil.
(8) Hospital Beneficiência Portuguesa de São Paulo, São Paulo, SP, Brazil.
(9) Universidade Federal de Minas Gerais, Nefrologia Pediátrica, Centro de Nefrologia da Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brazil.
(10) Universidade Federal da Bahia, Hospital Universitário Prof. Edgard Santos, Unidade do Aparelho Urinário, Salvador, BA, Brazil.
(11) Universidade Federal de Mato Grosso do Sul, Hospital Universitário Maria Aparecida Pedrossian, Campo Grande, MS, Brazil.
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Resumo: Atypical hemolytic uremic syndrome (aHUS) is a rare cause of thrombotic microangiopathy (TMA) caused by the dysregulation of the alternative complement pathway. The diagnosis of TMA is made clinically by the triad: microangiopathic hemolytic anemia, thrombocytopenia, and organ damage (mainly acute kidney injury). The heterogeneity of clinical manifestation and the lack of a gold standard diagnostic test makes the precise diagnosis of aHUS a challenging process that may impact patient management. Until one decade ago, there was no specific treatment for aHUS and patients were submitted to plasma therapy (plasma exchange and/or plasma infusion) and/or liver transplantation, procedures that are not free of serious complications and that do not address the underlying pathophysiology of the disease. Since 2011, an anti-C5 complement monoclonal antibody has been approved by the Food and Drug Administration (FDA) for aHUS patients beginning a new era in treatment. Clinical trials on new complement inhibitors may also add to the treatment portfolio in the future. The Brazilian population is a mixed race with a unique genetic and clinical profile. This consensus aims to offer recommendations for the diagnosis and treatment of patients with aHUS in this population based on expert experience, data from the aHUS Brazilian Registry and literature review. The GRADE system was used to classify the quality of the evidence. A síndrome hemolítico-urêmica atípica (SHUa) é uma causa rara de microangiopatia trombótica (MAT) causada pela desregulação da via alternativa do complemento. O diagnóstico de MAT é feito clinicamente pela tríade: anemia hemolítica microangiopática, trombocitopenia e lesão de órgãos (principalmente injúria renal aguda). A heterogeneidade das manifestações clínicas e a ausência de um teste diagnóstico padrão-ouro tornam o diagnóstico preciso da SHUa um processo desafiador, podendo ter impacto no manejo do paciente. Até uma década atrás, não havia tratamento específico para a SHUa e os pacientes eram submetidos à terapia plasmática (troca de plasma e/ou infusão de plasma) e/ou transplante de fígado, procedimentos que não estão isentos de complicações graves e que não abordam a fisiopatologia subjacente da doença. Desde 2011, um anticorpo monoclonal anti- complemento C5 foi aprovado pela Food and Drug Administration (FDA) para pacientes com SHUa, dando início a uma nova era no tratamento. Ensaios clínicos sobre novos inibidores do complemento também podem aumentar o portfólio de tratamentos no futuro. A população brasileira é miscigenada, com um perfil genético e clínico único. Este consenso tem como objetivo oferecer recomendações para o diagnóstico e tratamento de pacientes com SHUa nesta população, com base na experiência de especialistas, dados do Registro Brasileiro de SHUa e revisão da literatura. O sistema GRADE foi utilizado para classificar a qualidade das evidências.
6. CHA2DS2-VASc Score as a Predictor of Cardiovascular and All-Cause Mortality in a Prospective Cohort of Hemodialysis Patients of Predominantly African Ancestry: The PROHEMO. Nephron. 2025;11:1-12. doi: 10.1159/000543720.
Gutiérrez-Peredo GB(1), Gutiérrez-Peredo AJ(2), Montaño-Castellón I(2), Marques da Silva Neto M(3), Albuquerque da Silva F(2)(4), Silva Martins MT(2)(5), Mendes Matos C(2)(6), Correia Monteiro JM(7), Guimarães Silva P(7), Lopes GB(2)(7), Barreto Lopes M(2)(7)(8)(9), Correia LC(9)(10), Pecoits-Filho R(11)(12), Norris KC(13), Lopes AA(2)(7)(14)(15).
Afiliação:
(1) Master and Doctoral Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil, gabriel.medicina.umss@gmail.com.
(2) Master and Doctoral Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil.
(3) Department of Life Sciences, Bahia State University, Salvador, Brazil.
(4) Clinica NEPHRON, Salvador, Brazil.
(5) CLINIRIM, Salvador, Brazil.
(6) Instituto de Nefrologia e Dialise, Salvador, Brazil.
(7) Unit of Clinical Epidemiology and Evidence Based Medicine, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, Brazil.
(8) DaVita Kidney Care, Rio de Janeiro, Brazil.
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Resumo: Patients with chronic kidney disease undergoing maintenance hemodialysis (MHD) have an increased mortality. The CHA2DS2-VASc score, initially used for stroke prediction in atrial fibrillation, is relevant for various cardiovascular conditions. This study evaluates its effectiveness in predicting cardiovascular and all-cause mortality in MHD patients. METHODS: Data are from the "Prospective Study of the Prognosis of Patients on Chronic Hemodialysis" (PROHEMO) in Salvador, Brazil. Patients were divided by CHA2DS2-VASc scores: ≤2 and >2. Cox regression estimated hazard ratios (HR) for death, both unadjusted and adjusted for confounders. We assessed the distribution of each score variable and its association with mortality. A modified CHA2DS2-VASc score was created due to the low percentage of patients over 75 (1.3%) and normotensive (4.6%). RESULTS: A total of 237 patients (mean age 51.6 years; 57.0% male) were included in the study. There were 55 deaths, 21 from cardiovascular causes. For patients with a CHA2DS2-VASc score >2, the unadjusted hazard of all-cause mortality was doubled (HR = 2.05; 95% CI: 1.20, 3.49) compared to those with a score ≤2, and the risk for cardiovascular deaths was more than threefold (HR = 3.53; 95% CI: 1.46, 8.54). These ratios remained consistent after adjusting for covariates. In the most omprehensive Cox model, the HR for all-cause mortality was 2.43 (95% CI: 1.38, 4.23) and for cardiovascular mortality was 3.52 (95% CI: 1.40, 8.84), similar to results from the modified CHA2DS2-VASc score. CONCLUSIONS: The results support the CHA2DS2-VASc score as a practical tool for identifying MHD patients at higher risk of mortality, especially from cardiovascular causes.
7. Effectiveness of the primary Bacillus Calmette-Guérin vaccine against the risk of Mycobacterium tuberculosis infection and tuberculosis disease: a meta-analysis of individual participant data. Lancet Microbe. 2025;6(2):100961. doi: 10.1016/j.lanmic.2024.100961.
Pelzer PT(1), Stuck L(2), Martinez L(3), Richards AS(4), Acuña-Villaorduña C(5), Aronson NE(6), Bonnet M(7), Carvalho AC(8), Chan PC(9), Huang LM(10), Fang CT(11), Churchyard G(12), Corral-Londoño HD(13), Datta M(14), Espinal MA(15), Fielding K(16), Fiore-Gartland AJ(17), Garcia-Basteiro A(18), Hanekom W(19), Hatherill M(20), Hill PC(21), Huerga H(22), Jones-López EC(23), Kritski A(24), Mandalakas AM(25), Mangtani P(16), Martins Netto E(26), Mayanja H(27), et al.
Afiliação:
(1) Amsterdam University Medical Centres, Amsterdam, Netherlands; KNCV Tuberculosis Foundation, The Hague, Netherlands; London School of Hygiene & Tropical Medicine, London, UK; Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands. Electronic.
(2) Amsterdam University Medical Centres, Amsterdam, Netherlands; Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands.
(3) Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA.
(4) London School of Hygiene & Tropical Medicine, London, UK.
(5) Boston University Medical Center, Boston, MA, USA.
(6) Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
(7) TransVIHMI, University of Montpellier, IRD, INSERM, Montpellier, France.
(8) Laboratório de Inovações em Terapias, Ensino e Bioprodutos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
(9) Division of Chronic Infectious Disease, Taiwan Centers for Disease Control, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
(10) Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
(11) Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
(12) Aurum Institute, Johannesburg, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Department of Medicine, Vanderbilt University, Nashville, TN, USA.
(13) Universidad de Antioquia, National School of Public Health, Medellin, Colombia.
(14) A Society for Primary Health Care Intervention, Research and Education, Chennai, India.
(15) National Centre for Research on Maternal and Child Health, Santo Domingo, Dominican Republic.
(16) London School of Hygiene & Tropical Medicine, London, UK; nfectious Disease Epidemiology Department, Epicentre, Paris, France.
(17) Fred Hutchinson Cancer Center, Seattle, WA, USA.
(18) Barcelona Institute for Global Health, Barcelona, Spain.
(19) Africa Health Research Institute, Durban, South Africa.
(20) South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa.
(21) Centre for International Health, University of Otago, Dunedin, New Zealand.
(22) Field Epidemiology Department, Epicentre, Paris, France.
(23) Division of Infectious Diseases, Department of Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA.
(24) Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
(25) Baylor College of Medicine, Houston, TX, USA; Research Center Borstel, Sülfeld, Germany.
(26) Faculdade de Medicina da Bahia, Salvador, Brazil; Hospital Universitário Professor Edgard Santos, Salvador, Brazil; Universidade Federal da Bahia, Salvador, Brazil.
(27) Makerere University Infectious Diseases Institute, Kampala, Uganda.
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Resumo: Tuberculosis vaccine trials using disease as the primary endpoint are large, time consuming, and expensive. An earlier immunological measure of the protection against disease would accelerate tuberculosis vaccine development. We aimed to assess whether the effectiveness of the Bacillus Calmette-Guérin (BCG) vaccine for prevention of Mycobacterium tuberculosis infection was consistent with that for prevention of tuberculosis disease. METHODS: We conducted an individual participant data (IPD) meta-analysis on experimental and observational longitudinal studies before April 6, 2018, identified through systematic reviews, known to us through expert knowledge in the field, reporting on BCG vaccination status, M tuberculosis infection test (QuantiFERON IFN-γ release assay [IGRA] and tuberculin skin test [TST]), and tuberculosis incidence. Cohort studies were included only for countries with a mandatory neonatal BCG vaccination policy. Exclusion criteria were previous or current tuberculosis disease, HIV infection, tuberculosis preventive treatment usage, and for household contacts, a positive baseline IGRA or TST test and young children aged 0-2 years; for randomised controlled trials, TST results within 2 years after random assignation were excluded. We contacted the investigators of the identified studies to provide IPD. We compared the protective efficacy of the BCG vaccine against M tuberculosis infection with that against tuberculosis disease using mixed-effects, multivariable proportional hazards modelling, by study type, M tuberculosis infection test (IGRA and TST), cutoff for defining test positivity, age, sex, and latitude. FINDINGS: We identified 79 studies eligible for full screening and of these, IPD datasets from 14 studies were included in our analysis: 11 household contact studies (29 147 participants), two adolescent cohort studies (11 368 participants), and one randomised controlled trial (2963 participants). Among 28 188 participants we found no protection by the BCG vaccine against TST conversion regardless of cutoff in any type of study. Among 1491 household contacts, but not among 5644 adolescents, the BCG vaccine protected against QuantiFERON conversion at the primary cutoff of 0·7 IU/mL or more with the adjusted hazard ratio (0·65, 95% CI 0·51-0·82) being consistent with that for protection against disease (0·68, 0·18-2·59). Protection against QuantiFERON conversion at cutoff of 0·35 IU/mL or more (0·64, 0·51-0·81) was similar. INTERPRETATION: Protection from the BCG vaccination against M tuberculosis infection, measured as QuantiFERON conversion, is inconsistent across different groups. Among groups with recent household exposure, QuantiFERON conversion is consistent with protection against disease and could be evaluated as a proxy for disease in tuberculosis vaccine trials. We found that TST lacks value for prevention in phase 2b proof-of-concept trials.
8. Brazilian Thoracic Association recommendations for the management of lymphangioleiomyomatosis. J Bras Pneumol. 2025 Feb 10;51(1):e20240378. doi: 10.36416/1806-3756/e20240378.
Baldi BG(1), Feitosa PHR(2), Rubin AS(3), Amaral AF(1), Freitas CSG(4), Costa CHD(5), Mancuzo EV(6), Nascimento ECTD(7), Araujo MS(8), Rocha MJJ(9), Oliveira MR(1), Galvão TS(10), Torres PPTES(11), Carvalho CRR(1).
Afiliação:
(1) Divisao de Pneumologia, Instituto do Coracao - InCor - Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo - HCFMUSP - São Paulo (SP) Brasil.
(2) Hospital da Asa Norte, Brasília (DF) Brasil.
(3) Serviço de Pneumologia, Pavilhão Pereira Filho, Santa Casa de Porto Alegre, Porto Alegre (RS) Brasil.
(4) Hospital AC Camargo, São Paulo (SP) Brasil.
(5) Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ) Brasil.
(6) Serviço de Pneumologia e Cirurgia Torácica, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil.
(7) Departamento de Patologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo - HCFMUSP - São Paulo (SP) Brasil.
(8) Divisão de Pneumologia, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba (PR) Brasil.
(9) Hospital de Messejana, Fortaleza (CE) Brasil.
(10) Hospital Universitário Professor Edgar Santos, Universidade Federal da Bahia, Salvador (BA) Brasil.
(11) Hospital Israelita Albert Einstein, Goiânia (GO) Brasil.
Resumo: Lymphangioleiomyomatosis (LAM) is a rare disease, characterized as a low-grade neoplasm with metastatic potential that mainly affects women of reproductive age, in which there is proliferation of atypical smooth muscle cells (LAM cells) and formation of diffuse pulmonary cysts. It can occur in a sporadic form or in combination with tuberous sclerosis complex. In recent decades, a number of advances have been made in the understanding of the pathophysiology and management of LAM, leading to improvements in its prognosis: identification of the main genetic aspects and the role of the mechanistic target of rapamycin (mTOR) pathway; relationship with hormonal factors, mainly estrogen; characterization of pulmonary and extrapulmonary manifestations in imaging studies; identification and importance in the diagnosis of VEGF-D; a systematic diagnostic approach, often without the need for lung biopsy; use of and indications for the use of mTOR inhibitors, mainly sirolimus, for pulmonary and extrapulmonary manifestations; pulmonary rehabilitation and the management of complications such as pneumothorax and chylothorax; and the role of and indications for lung transplantation. To date, no Brazilian recommendations for a comprehensive approach to the disease have been published. This document is the result of a non-systematic review of the literature, carried out by 12 pulmonologists, a radiologist, and a pathologist, which aims to provide an update of the most important topics related to LAM, mainly to its diagnosis, treatment, and follow-up, including practical and multidisciplinary aspects of its management. A linfangioleiomiomatose (LAM) é uma doença rara, caracterizada como uma neoplasia de baixo grau, com potencial metastatizante, que atinge principalmente mulheres em idade reprodutiva, em que se evidencia proliferação de células musculares lisas atípicas (células LAM) e formação de cistos pulmonares difusos. A LAM pode ocorrer na forma esporádica ou associada ao complexo de esclerose tuberosa. Vários progressos ocorreram no entendimento da fisiopatologia e no manejo da LAM nas últimas décadas, determinando melhora do seu prognóstico, incluindo: identificação dos principais aspectos genéticos e do papel da via da proteína alvo mecanístico da rapamicina (mTOR); relação com fatores hormonais, principalmente estrogênio; caracterização das manifestações pulmonares e extrapulmonares em exames de imagem; identificação e importância no diagnóstico do VEGF-D; abordagem diagnóstica sistematizada, muitas vezes sem necessidade de biópsia pulmonar; uso e indicações dos inibidores de mTOR, principalmente sirolimo, para quadros pulmonares e extrapulmonares; reabilitação pulmonar, abordagem de complicações, como pneumotórax e quilotórax; e papel e indicações do transplante pulmonar. Não havia até o momento uma publicação nacional com recomendações para a ampla abordagem da doença. Este documento se caracteriza como uma revisão não sistemática da literatura, realizada por 12 pneumologistas, um radiologista e um patologista, que visa atualizar os tópicos mais importantes elacionados principalmente ao diagnóstico, tratamento e seguimento da LAM, incluindo aspectos práticos e multidisciplinares do seu manejo.
9. Promising results of ultrasound guided foam sclerotherapy for treating chronic venous ulcers. J Vasc Surg Venous Lymphat Disord. 2025;13(3):102198. doi: 10.1016/j.jvsv.2025.102198.
Bacelar ACC(1), Netto EM(2), Barreto N(3), Neves R(3), Heine C(3), Botelho P(3), Almeida CS(4), Ramalho E(3), Aras R(5).
Afiliação:
(1) Serviço de Angiologia e Cirurgia Vascular, Hospital Ana Nery, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Bahia, Brazil. Electronic
(2) Laboratório de Pesquisa em Infectologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
(3) Serviço de Angiologia e Cirurgia Vascular, Hospital Ana Nery, Salvador, Bahia, Brazil.
(4) Monitoria de Habilidades Cirúrgicas I, Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil.
(5) Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
Resumo: Despite advances in wound care, the dressing and management of chronic ulcers on lower limbs remains unsatisfactory. The simplicity, cost effectiveness, and diverse application possibilities of ultrasound-guided foam sclerotherapy make it an attractive and effective approach to treat patients with no access to or contraindications to more invasive methods. We sought to evaluate the healing rate of chronic venous ulcers (Clinical, Etiological, Anatomical, Pathophysiological [CEAP] C6) in patients treated with ultrasound guided foam sclerotherapy. METHODS: From January 2018 to December 2020, 279 patients (336 legs) classified at the first consultation as stage 6 for CEAP disease were followed during treatment of axial venous reflux in saphenous and tributary veins with polidocanol (Aethosxysklerol) foam and evaluated at 52 weeks for complete healing rates or ≥50% ulcer size reduction, using Kaplan-Meier statistics and Cox regression to study the influence of covariates. RESULTS: The average age of the 279 patients was 55 years. Of these, 156 (56%) showed complete healing in 52 weeks and 89 (32%) achieved a wound area reduction of >50%. Ulcer size, severity, lymphedema, and reduced dorsiflexion of the ankle were significantly associated with healing difficulty. Time of ulcer progression up to beginning of treatment (P < .01), ulcer size (P = .01), lymphedema (P = .006), reduced dorsiflexion of the ankle (P = .01), and age ≥65 years (P = .003) were significantly associated with difficulty in healing. Patients with a mean Venous Clinical Severity Score of 18.7 had a better prognosis (18.7 vs 22.5; P < .001). CONCLUSIONS: Most patients with chronic venous ulcers (CEAP 6) treated with foam sclerotherapy achieved healing or significant improvement within 52 weeks. Healing was highly influenced by time until treatment, ulcer size, reduced dorsiflexion of the ankle and/or lymphedema presence, and the use of compression therapy.
10. The Dublin International Society of Urological Pathology (ISUP) Consensus Conference on Best Practice Recommendations on the Pathology of Urachal Neoplasms. Am J Surg Pathol. 2025 Jun 5. doi: 10.1097/PAS.0000000000002416.
Reis H(1), Al-Ahmadie H(2), Gaisa NT(3), Lopez-Beltran A(4), Maclean F(5), Tsuzuki T(6), Werneck da Cunha I(7), Amin MB(8), Aning J(9), Aron M(10), Athanazio D(11), Bambury RM(12), et al.
Afiliação:
(1) Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt.
(2) Department of Pathology.
(3) Institute of Pathology, University Hospital, RWTH Aachen University; Institute of Pathology, University Hospital Ulm, University of Ulm.
(4) Department of Morphological Sciences, Unit of Anatomic Pathology, Cordoba University Medical School, Cordoba, Spain.
(5) Douglass Hanly Moir Pathology, Faculty of Medicine and Health Sciences Macquarie University, North Ryde, Australia.
(6) Department of Surgical Pathology, Aichi Medical University, Aichi, Japan.
(7) Pathology Department, Rede D'OR-Sao Luiz, São Paulo, Brazil.
(8) Department of Pathology and Laboratory Medicine and Urology, University of Tennessee Health Science, Memphis, TN.
(9) Department of Urology, Southmead Hospital, North Bristol Hospitals Trust, Bristol, UK.
(10) Department of Pathology, University of Southern California, Los Angeles, CA.
(11) Oncoclinicas Precision Medicine, São Paulo, Brazil; Hospital Universitário Professor Edgard Santos/Federal University of Bahia, Brazil.
(12) Department of Medical Oncology, Cork University Hospital, Cork, Ireland.
...
Resumo: This manuscript summarizes the first part of the proceedings of the 2023 Dublin ISUP Consensus Conference encompassing the best practice recommendations on the pathology of neoplasms of urachal origin. The rationale for convening this consensus conference was the lack of structured and consented histopathologic recommendations in these rare tumors. Consensus among the meeting participants (n=80) was reached on the following statements: (1) combination of gross, histologic, clinical and imaging findings with exclusion of secondary tumor metastasis are to be used in the diagnosis of urachal carcinoma; (2) the 2022 World Health Organization (WHO) separate criteria for the diagnosis of urachal adenocarcinoma and for nonglandular carcinoma should be applied; (3) specific elements are to be evaluated and recorded in the gross examination of resection specimens containing urachal tumors; (4) sampling considerations for resection specimens containing urachal tumors are advised; (5) participants are against using 5% or 10% cutoff for the extent of intraepithelial carcinoma in urachal mucinous cystic tumor of low malignant potential; (6) use of immunohistochemical markers for the differential diagnosis of urachal adenocarcinomas in transurethral resection (TUR) specimen is considered optional; (7) similar tumor classificatory (nosology) rules for carcinomas arising from bladder mucosa (eg, urothelial carcinoma, squamous cell carcinoma, and neuroendocrine carcinoma) should be applied for nonglandular urachal carcinomas; (8) a new staging approach other than the previously proposed systems should be designed for urachal carcinoma; (9) a system modifying the current Tumor-Node-Metastasis TNM)/American Joint Committee on Cancer (AJCC) staging system for urinary bladder cancer is considered appropriate for a study in urachal carcinoma; and (10) several histologic elements are to be reported when diagnosing urachal carcinoma in TUR and resection specimens. This report from the Dublin ISUP consensus conference will serve as a practice recommendation for pathologists and as a guide for future standardized reporting protocols and research regarding urachal tumors. In addition, an international database for urachal cancers under the guidance of ISUP is being planned to be established to address pertinent issues in the pathology of urachal cancers.
11. Effects of multicomponent combinations training on respiratory function in individuals with Parkinson's disease: A randomized clinical trial. J Bodyw Mov Ther. 2025 Jun;42:15-22. doi: 10.1016/j.jbmt.2024.11.029.
Barretto CD(1), Freitas VH(2), Miranda BS(3), Sales M(4), Santos CL(5), Fonseca ÉPD(6), Pellicer MG(7), Dominguez-Ferraz D(8).
Afiliação:
(1) Professor Edgar Santos University Hospital Complex, Brazilian Hospital Services Company, Federal University of Bahia, Salvador, BA, Brazil.
(2) Department of Physical Education, Faculty of Education, Federal University of Bahia, Salvador, BA, Brazil; Postgraduate Program in Rehabilitation Sciences, Multidisciplinary Institute of Rehabilitation and Health, Federal University of Bahia, Salvador, BA, Brazil.
(3) Department of Physiotherapy, Multidisciplinary Institute of Rehabilitation and Health, Federal University of Bahia, Salvador, Bahia, Brazil.
(4) Santa Casa Faculty, Salvador, BA, Brazil.
(5) Postgraduate Program in Rehabilitation Sciences, Multidisciplinary Institute of Rehabilitation and Health, Federal University of Bahia, Salvador, BA, Brazil; Department of Physiotherapy, Multidisciplinary Institute of Rehabilitation and Health, Federal University of Bahia, Salvador, Bahia, Brazil.
(6) Sanar Publisher, Salvador, BA, Brazil.
(7) Faculty of Medicine. Department of Physiotherapy, Autonomous University of Barcelona, Barcelona, Spain.
(8) Postgraduate Program in Rehabilitation Sciences, Multidisciplinary Institute of Rehabilitation and Health, Federal University of Bahia, Salvador, BA, Brazil; Department of Physiotherapy, Multidisciplinary Institute of Rehabilitation and Health, Federal University of Bahia, Salvador, Bahia, Brazil.
Resumo: Individuals with mild to moderate Parkinson's disease may experience respiratory impairments. Exercise interventions can be prophylactic, reduce progression, and/or mitigate these problems, improving the patient's quality of life. This study aimed to analyze and compare the effect of two different combinations of multicomponent training on lung function, respiratory muscle strength, and aerobic capacity in individuals with Parkinson's disease. METHODS: A randomized clinical trial was conducted. 13 people with a mild to moderate Parkinson's disease diagnosis were randomly assigned to two groups - group 1 (G1) undertook stretching, stationary bicycle, and strength exercises; and G2 undertook stretching, stationary bicycle exercises, inspiratory muscle training, and abdominal exercises. Both groups undertook two 60-min sessions of multicomponent training per week for 12 weeks. Maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), forced vital capacity, forced expiratory volume in 1 s, thoracoabdominal expansion, the 6-min walk test, and the five times sit-to-stand test were measured. The study was approved by the Human Research Ethics Committee, with the consent of all participants. RESULTS: We observed effects on MIP and MEP over this time in both groups. Other variables did not present effects for time, group, or interaction. CONCLUSION: 12 weeks of training with both combinations of multicomponent training increased respiratory muscle strength in individuals with mild to moderate Parkinson's disease.
12. Hemodynamic management in liver transplantation: toward an evidence-based perioperative strategy. Braz J Anesthesiol. 2025 May-Jun;75(3):844621. doi: 10.1016/j.bjane.2025.844621.
Schmidt AP(1), Martinelli ES(2), de Moura VC(3), Azi LMTA(4).
Afiliação:
(1) Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil; Santa Casa de Porto Alegre, Serviço de Anestesia, Porto Alegre, RS, Brazil; Hospital Nossa Senhora da Conceição, Serviço de Anestesia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-graduação em Ciências Pneumológicas, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-graduação em Ciências Cirúrgicas, Porto Alegre, RS, Brazil; Faculdade de Medicina da Universidade de São Paulo (FMUSP), Programa de Pós-graduação em Anestesiologia, Ciências Cirúrgicas e Medicina Perioperatória, São Paulo, SP, Brazil.
(2) Santa Casa de Porto Alegre, Serviço de Anestesia, Porto Alegre, RS, Brazil; Faculdade de Medicina da Universidade de São Paulo (FMUSP), Programa de Pós-graduação em Anestesiologia, Ciências Cirúrgicas e Medicina Perioperatória, São Paulo, SP, Brazil; University Health Network, Toronto General Hospital, Department of Anesthesia and Pain Management, Toronto, Canada; University of Toronto, Temerty Faculty of Medicine, Department of Anesthesiology and Pain Medicine, Toronto, Canada.
(3) Santa Casa de Porto Alegre, Serviço de Anestesia, Porto Alegre, RS, Brazil; Hospital Nossa Senhora da Conceição, Serviço de Anestesia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-graduação em Ciências Cirúrgicas, Porto Alegre, RS, Brazil.
(4) Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Departamento de Anestesiologia, Salvador, BA, Brazil.
Sem resumo.
13. Transforming perioperative care in Brazil: challenges and opportunities for improving outcomes. Braz J Anesthesiol. 2025 Mar-Apr;75(2):844596. doi: 10.1016/j.bjane.2025.844596.
Stefani LC(1), Azi LMTA(2), Schmidt AP(3).
Afiliação:
(1) Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Departamento de Cirurgia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Medicina: Ciências Médicas, Porto Alegre, RS, Brazil.
(2) Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Anestesiologia e Cirurgia, Salvador, BA, Brazil; Hospital Universitário Professor Edgard Santos (HUPES), Salvador, BA, Brazil.
(3) Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Santa Casa de Porto Alegre, Serviço de Anestesia, Porto Alegre, RS, Brazil; Hospital Nossa Senhora da Conceição, Serviço de Anestesia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Pneumológicas e Programa de Pós-Graduação em Ciências Cirúrgicas, Porto Alegre, RS, Brazil; Faculdade de Medicina da Universidade de São Paulo (FMUSP), Programa de Pós-Graduação em Anestesiologia, Ciências Cirúrgicas e Medicina Perioperatória, São Paulo, SP, Brazil.
Sem resumo.
14. Dysgraphia Following the Resection of a Left Parietal Glioma. Acta Neurochir Suppl. 2025;133:77-82. doi: 10.1007/978-3-031-61601-3_13.
de Almeida ERP(1), Santos LS(2), Maldonado IL(3)(4).
Afiliação:
(1) Escola Bahiana de Medicina e Saúde Pública, Fundação para o Desenvolvimento das Ciências, Salvador, Brazil.
(2) Hospital Santa Izabel, Santa Casa de Misericórdia da Bahia, Salvador, Brazil.
(3) Instituto de Ciências da Saúde & Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.
(4) INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, Université de Tours, Tours, France. limamaldonado@univ-tours.fr.
Resumo: We report herein the case of a 41-year-old man operated on for a small inferior parietal lobule ganglioglioma with a sleep-awake-sleep protocol and language mapping to avoid major speech disorders. Postoperatively, however, writing disturbance was characterized by persistent graphemic errors that lasted for about 8 months. The topic is discussed in light of recent literature, exploring the possible relationship between writing difficulties and disconnections produced by a combination of resecting supramarginal gyrus components and interrupting arcuate fasciculus fibers. Awake mapping of eloquent structures is typically done using direct brain stimulation to maximize the extent of the resection while minimizing permanent neurological deficits. However, most intraoperative language tests focus on language skills such as oral and reading skills. Therefore, the detection of dysgraphia requires a high degree of attention from the surgical team and direct examination intra-and perioperatively. To this end, employing an intraoperative writing test during awake surgery may be considered. Advances in this field may aid in increasing the accuracy during parenchymal dissections, influencing the extent of the resection, improving the patient's functional prognosis and long-term quality of life.
15. Adherence to Guideline-Directed Medical Therapy Target in patients with heart failure and reduced ejection fraction: a cross-sectional study. Sao Paulo Med J. 2025 May 2;143(3):e2023315. doi: 10.1590/1516-3180.2023.0315. R2.13082024.
Costa FF(1), Chagas AKR(1), Santos ACML(1), Oliveira LB(2), Improta-Caria AC(3), Latado AL(4), Aras Júnior R(4).
Afiliação:
(1) Department of Cardiology, Hospital Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Empresa Brasileira de Serviços Hospitalares (EBSERH), Salvador, BA, Brazil.
(2) Research and Technological Innovation Management Sector, Hospital Universitário Professor Edgard Santos (HUPES), Salvador, BA, Brazil.
(3) Postdoctoral Researcher, School of Physical Education and Sport, Laboratory of Biochemistry and Molecular Biology of the Exercise, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
(4) Department of Internal Medicine, Faculty of Medicine, Hospital Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.
Resumo: Heart failure with reduced ejection fraction (HFrEF) represents a compelling cause of hospital morbidity and mortality in Brazil. There is low adherence to guideline-directed medical therapy (GDMT), which in turn, can result in higher morbidity and mortality. OBJECTIVES: The present study aims to evaluate adherence to GDMT in patients with HFrEF in a Brazilian University hospital service. DESIGN AND SETTINGS: Observational, cross-sectional, single-center study conducted at the Hospital Universitário Professor Edgard Santos (HUPES), Salvador, BA, Brazil. METHODS: The study was conducted with convenience sampling at the cardiology outpatient clinic of a university hospital service. Patients with left ventricular ejection fraction (LVEF) < 40% who had reverse remodeling were excluded. RESULTS: 289 patients were included, with mean age 63 years, 54.7% were male, 56,4% mixed-race and 27,7% had Chagasic cardiomyopathy. 93.1% were prescribed ACEi, ARB or ARNi, 95.8% betablockers, 69.2% spironolactone and 8% the combination hydralazine/isosorbide-dinitrate. 71,7% were using enalapril, losartan or ARNi above 50% of GDMT target doses; 81,2% were using beta-blockers and 100% were using spironolactone. Only 21,2% were prescribed GDMT target doses of enalapril, losartan or ARNi and 52,3% of beta-blockers. 98,5% of spironolactone prescriptions reached GDMT target doses. CONCLUSIONS: We found high frequencies of prescription of GDMT for HFrEF, considering the therapeutic goals recommended by cardiology guidelines, but, prescription of target doses were low in ACEi, ARB or ARNi and beta-blockers.
16. Lack of Hypoxia Inducible Factor-1α Influences on Macrophages Ability to eal with Leishmania braziliensis In Vitro and Affects Pathology In Vivo. . JID Innov. 2025 Jan 8;5(3):100347. doi: 10.1016/j.xjidi.2025.100347.
Sanches RCO(1), Vaz LG(1), Marinho FV(1), Guimarães ES(1), Carvalho EM(2)(3)(4), Carvalho LP(2)(3)(4), Oliveira SC(1)(4)(5)(6).
Afiliação:
(1) Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
(2) Serviço de Imunologia, Complexo Hospitalar Professor Edgar Santos, Universidade Federal da Bahia, Salvador, Brazil.
(3) Laboratório de Pesquisas Clínicas (LAPEC), Instituto Gonçalo Moniz (IGM), Fiocruz, Salvador, Brazil.
(4) Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Salvador, Brazil.
(5) Institut Pasteur de São Paulo, São Paulo, Brazil.
(6) Departamento de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil.
Resumo: Cutaneous leishmaniasis, caused by Leishmania braziliensis, still represents a serious health problem in Brazil, especially in the northeast region. Currently, to our knowledge, no report describes the role of hypoxia inducible factor-1α (HIF-1α) during L braziliensis infection. In this study, we demonstrated that the parasite induces HIF-1α expression and stabilization in bone marrow-derived macrophages only when added with exogenous IFN-γ plus lipopolysaccharide. Coherently, we did not find an enrichment in the glycolytic pathway upon bone marrow-derived macrophage infection. Evaluating the impact of HIF-1α absence during macrophage infection in vitro, we observed HIF-1α-knockout cells present at high levels of IL-10, reduced production of nitric oxide, and decreased expression of VEGF-A. As a result, parasite viability improves within HIF-1α-knockout cells. However, in vivo, the absence of myeloid cells expressing HIF-1α had no influence on nitric oxide at tissue levels and in parasite burden. Conversely, lack of HIF-1α significantly affects L braziliensis-induced pathology. Ear lesions induced in myeloid HIF-1α-knockout mice were thicker, presenting higher frequency of macrophages, neutrophils, CD4+, and CD8+ T cells as well as higher levels of IL-12, IL-1β, and IFN-γ, compared with those in wild-type mice. Moreover, draining lymph nodes from myeloid HIF-1α-knockout mice also harbored increased populations of T cells. Our data demonstrate that HIF-1α plays an important role during L braziliensis infection influencing skin pathology in vivo.
17. 4D-DIA Proteomics Uncovers New Insights into Host Salivary Response Following SARS-CoV-2 Omicron Infection. J Proteome Res. 2025 Feb 7;24(2):499-514. doi: 10.1021/acs.jproteome.4c00630.
de Lima IL(1), Cataldi TR(2), Brites C(3), Labate MTV(2), Vaz SN(3), Deminco F(3), da Cunha GS(1), Labate CA(2), Eberlin MN(1).
Afiliação:
(1) PPGEMN, School of Engineering, Mackenzie Presbyterian University & ackGraphe - Mackenzie Institute for Research in Graphene and Nanotechnologies, Mackenzie Presbyterian Institute, São Paulo, São Paulo 01302-907, Brazil.
(2) (2)Department of Genetics, "Luiz de Queiroz" College of Agriculture, University of São Paulo/ESALQ, Piracicaba, São Paulo 13418-900, Brazil.
(3) LAPI - Laboratory of Research in Infectology, University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia (UFBA), Salvador, Bahia , Brazil.
Resumo: Since late 2021, Omicron variants have dominated the epidemiological scenario as the most successful severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sublineages, driving new and breakthrough infections globally over the past two years. In this study, we investigated for the first time the host salivary response of COVID-19 patients infected with Omicron variants (BA.1, BA.2, and BA.4/5) by using an untargeted four-dimensional data-independent acquisition (4D-DIA)-based proteomics approach. We identified 137 proteins whose abundance levels differed between the COVID-19 positive and negative groups. Salivary signatures were mainly enriched in ribosomal proteins, linked to mRNAviral translation, protein synthesis and processing, immune innate, and antiapoptotic signaling. The higher abundance of 14-3-3 proteins (YWHAG, YWHAQ, YWHAE, and SFN) in saliva, first reported here, may be associated with increased infectivity and improved viral replicative fitness. We also identified seven proteins (ACTN1, H2AC2, GSN, NDKA, CD109, GGH, and PCYOX) that yielded comprehension into Omicron infection and performed outstandingly in screening patients with COVID-19 in a hospital setting. This panel also presented an enhanced anti-COVID-19 and anti-inflammatory signature, providing insights into disease severity, supported by comparisons with other proteome data sets. The salivary signature provided valuable insights into the host's response to SARS-CoV-2 Omicron infection, shedding light on the pathophysiology of COVID-19, particularly in cases associated with mild disease. It also underscores the potential clinical applications of saliva for disease screening in hospital settings. Data are available via ProteomeXchange with the identifier PXD054133.
18. Epidemiological and molecular analysis of a rabies outbreak in the state of Bahia, Brazil. Acta Trop. 2025 May;265:107617. doi: 10.1016/j.actatropica. 2025.107617.
Carneiro AJB(1), Ungar de Sá JE(2), Drexler JF(3), Stöcker A(4), Santos FD(5), Gonçalves RS(6), Becerra DRD(6), Cunha RM(6), Moraes-Silva E(7), Santana P(7), Zeppelini CG(8), Lustosa R(9), Franke CR(6).
Afiliação:
(1) Universidade Federal da Bahia, Escola de Medicina Veterinária e Zootecnia, Salvador, Bahia, Brazil; Ministério da Saúde, Secretaria de Vigilância em Saúde e Ambiente, Departamento de Emergências em Saúde Pública, Brasília, Distrito Federal, Brazil.
(2) Laboratório Central de Saúde Pública (LACEN/BA), Salvador, Bahia, Brazil.
(3) Institute of Virology, University of Bonn, Bonn, Germany.
(4) Laboratório de Pesquisa em Infectologia, Hospital Prof. Edgar Santos (HUPES/UFBA), Salvador, Bahia, Brazil.
(5) Universidade Federal da Bahia, Escola de Medicina Veterinária e Zootecnia, Salvador, Bahia, Brazil; Universidade Federal do Oeste da Bahia, Centro Multidisciplinar da Barra, Hospital Veterinário Universitário, Laboratório de GIS e One Health, Barra, Bahia, Brazil.
(6) Universidade Federal da Bahia, Escola de Medicina Veterinária e Zootecnia, Salvador, Bahia, Brazil.
(7) Agência Estadual de Defesa Agropecuária da Bahia (ADAB), Salvador, Bahia, Brazil.
(8) Universidade Federal da Baia, Instituto de Saúde Coletiva, Salvador, Bahia, Brazil; Institutionen för Vilt, Fisk och Miljö, Sveriges Lantbruksuniversitet, Umeå, Sweden.
(9) Universidade Federal da Bahia, Escola de Medicina Veterinária e Zootecnia, Salvador, Bahia, Brazil; Universidade Federal do Oeste da Bahia, Centro Multidisciplinar da Barra, Hospital Veterinário Universitário, Laboratório de GIS e One Health, Barra, Bahia, Brazil; Universidade Federal da Baia, Instituto de Saúde Coletiva, Salvador, Bahia, Brazil.
Resumo: This study aimed to genetically characterize rabies virus strains detected in biological samples from 55 laboratory-confirmed rabies-positive animals in the state of Bahia during an outbreak that occurred between 2007-2009. Samples from one donkey, one lesser spear-nosed bat (Phyllostomus elongatus), two crab-eating foxes (Cerdocyon thous), eight common vampire bats (Desmodus rotundus) and 43 bovines were submitted to rabies diagnosis. All samples were positive in the direct immunofluorescence test (DAFT), mice inoculation test (MIT) and reverse transcriptase polymerase chain reaction by (RT-PCR), followed by nucleotide sequencing and phylogenic analysis. The phylogeny presented two viral clades, one bat-specific and one carnivore-specific, with existence of nine sub-clusters associated to Desmodus rotundus and infection of bovines with the carnivore-specific strain. Phylogenetic analysis exposes a complex epidemiology that needs further elucidation for the improvement of control measures for rabies.
19. PCMMD: A Novel Dataset of Plasma Cells to Support the Diagnosis of Multiple Myeloma. Sci Data. 2025 Jan 27;12(1):161. doi: 10.1038/s41597-025-04459-1.
L B Andrade C(1)(2), Ferreira MV(1), M Alencar B(1), S B Filho JL(1), A Guimaraes M(1), Porto Cruz Moraes I(1), S Lopes TJ(3), S Dos Santos A(2), M Dos Santos M(2), C S E Silva MI(2), D R P Rosa IM(2), C de Carvalho G(2), M Santos HH(2), L Santos MM(4), Meyer R(2), P B Knop LM(5), M Freire S(2), A Rios R(6), N Rios T(1).
Afiliação:
(1) Federal University of Bahia, Institute of Computing, Salvador, 40170-110, Brazil.
(2) Federal University of Bahia, Institute of Health Sciences, Salvador, Brazil.
(3) Nezu Biotech GmbH, Heidelberg, 69121, Germany.
(4) Federal University of Bahia, Hospital Universitario Professor Edgard Santos - HUPES, Salvador, 40110-060, Brazil.
(5) Hospital Martagão Gesteira, LABCMI-HMG, Salvador, 40050-050, Brazil.
(6) Federal University of Bahia, Institute of Computing, Salvador, 40170-110, Brazil. ricardoar@ufba.br.
Resumo: Multiple Myeloma (MM) is a cytogenetically heterogeneous clonal plasma cell proliferative disease whose diagnosis is supported by analyses on histological slides of bone marrow aspirate. In summary, experts use a labor-intensive methodology to compute the ratio between plasma cells and non-plasma cells. Therefore, the key aspect of the methodology is identifying these cells, which relies on the experts' attention and experience. In this work, we present a valuable dataset comprising more than 5,000 plasma and non-plasma cells, labeled by experts, along with some patient diagnostics. We also share a Deep Neural Network model, as a benchmark, trained to identify and count plasma and non-plasma cells automatically. The contributions of this work are two-fold: (i) the labeled cells can be used to train new practitioners and support continuing medical education; and (ii) the design of new methods to identify such cells, improving the results presented by our benchmark. We emphasize that our work supports the diagnosis of MM in practical scenarios and paves new ways to advance the state-of-the-art.
20. Spinal Intradural-Extramedullary Neurocysticercosis: A Case Report. Cureus. 2025 May 19;17(5):e84397. doi: 10.7759/cureus.84397.
Fonseca JM(1), Borba LR(2), Chiaretti AS(3), Resende MC(4), Fonseca Junior LE(5).
Afiliação:
(1) Radiology, University of Florida, Gainesville, USA.
(2) Internal Medicine, Hospital Universitário Professor Edgard Santos, Salvador, BRA.
(3) Internal Medicine, Federal University of Bahia, Salvador, BRA.
(4) Family Medicine, Federal University of Bahia, Salvador, BRA.
(5) Pathology, Hospital Mater Dei, Salvador, BRA.
Resumo: Neurocysticercosis is a parasitic infection of the central nervous system (CNS) caused by the larval stage of the Taenia solium tapeworm. This condition is most commonly characterized by the development of cysts in the intracranial CNS, causing a wide range of neurological symptoms, such as seizures, headaches, and signs of increased intracranial pressure. Spinal intradural-extramedullary neurocysticercosis is a rare extracranial form of the disease that often resembles other conditions, such as arachnoid cysts or spinal tumors. We report the case of a 55-year-old man from Bahia, Brazil, who experienced chronic urinary retention, lower back pain, and bilateral leg tingling. Original MRI scans suggested multiple arachnoid cysts, but further imaging indicated neurocysticercosis as a possible diagnosis. The patient underwent T12-S1 laminectomy, where cystic lesions were identified and biopsied. Histopathology, posteriorly, confirmed the final diagnosis of neurocysticercosis, showing areas of necrosis and calcifications and viable parasite structures. After surgery, the patient still presented mild symptoms, such as constipation and left leg paresthesia. This case highlights the challenges of spinal neurocysticercosis diagnosis. We emphasize the importance of considering it in the differential diagnosis of spinal cystic lesions, especially in areas where the disease is common.
21. Gastric cancer treatment in Brazil: a multicenter study of the Brazilian Gastric Cancer Association. Rev Col Bras Cir. 2025 May 12;52:e20253815. doi: 10.1590/0100-6991e-20253815_en.
Ramos MFKP(1), Pereira MA(1), Ribeiro TF(2), Braghiroli Neto O(3), Coimbra FJF(4), Rodrigues MAG(5), Sabino FD(6), et al.
Afiliação:
(1) Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Instituto do Câncer - São Paulo - SP - Brasil.
(2) Hospital Aristides Maltez, Liga Bahiana Contra o Câncer, Cirurgia - Salvador - BA - Brasil.
(3) Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Departamento de Anestesia e Cirurgia - Salvador - BA - Brasil.
(4) Hospital AC Camargo Cancer Center, Departamento de Cirurgia Abdominal - São Paulo - SP - Brasil.
(5) Hospital das Clinicas da Universidade Federal de Minas Gerais, Departamento de Cirurgia - Belo Horizonte - MG - Brasil.
(6) Instituto Nacional do Câncer, Serviço de Cirurgia Abdômino-pélvica - Rio de Janeiro - RJ - Brasil.
...
Resumo: Gastric cancer (GC) has distinct characteristics and management according to the region of the world, and the objective of our study was to evaluate how it is being managed in Brazil. METHODS: This is a multicenter study that involved 18 oncology referral centers. Data were collected using the REDCap platform and compiled at the end of one year. RESULTS: All Brazilian regions were represented, and 635 patients were included. Most patients were from the Southeast (40.6%) and Northeast (29.6%) regions. The mean age was 62 years, with a predominance of males. Most patients (84.6%) had good performance status, with an ECOG score of 1-2. Less than 10% of patients were covered by medical insurance. A quarter of the patients underwent diagnostic laparoscopy, but endoscopic ultrasound and PET scans were rarely performed. The cT3 category was the most common (40.6%), lymph node involvement was described in 48.9%, and distant metastases, in 14.4% of the staging exams. The final cTNM staging was III (29.4%), II (26%), I (24.2%) and IV (20.5%). Most patients underwent surgery with curative intent (74.4%) and open access (82.8%). Preoperative chemotherapy was performed in 37.2% of cases, and the most common surgical procedures were subtotal gastrectomy (45.3%) and total gastrectomy (33.1%). CONCLUSION: The present study allowed us to evaluate the current panorama of surgical treatment of Gastric Cancer, representing all regions of Brazil. Stage III, distal, and diffuse tumors continue to be prevalent in Brazil, and there has been relevant use of diagnostic laparoscopy, preoperative chemotherapy, and minimally invasive surgery.
22. Enhancing sickle cell leg ulcer healing with combined photodynamic and photobiomodulation therapies: A pilot experience. J Tissue Viability. 2025 May;34(2):100879. doi: 10.1016/j.jtv.2025.100879.
Fortuna V(1), Oliveira GF(2), Xavier LM(3), Oliveira DV(3), Lima JG(2), Oliveira YS(2), Costa BS(2), Jesus GB(2), Yahouedehou SCMA(4), Zanchin EM(5), Meyer JR(2), Meneses JV(3), Gonçalves MS(6), Bagnato VS(7).
Afiliação:
(1) Department of Biochemistry and Biophysics, Institute of Health Sciences, Federal University of Bahia, Brazil; Laboratory of Immunology and Molecular Biology, Institute of Health Sciences, Federal University of Bahia, Brazil.
(2) Laboratory of Immunology and Molecular Biology, Institute of Health Sciences, Federal University of Bahia, Brazil.
(3) Prof Edgar Santos Hospital Complex, Federal University of Bahia, Brazil.
(4) Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil.
(5) Laboratory of Environmental Biophotonics, São Carlos Institute of Physics, University of São Paulo, São Carlos, SP, Brazil.
(6) Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil; Department of Clinical Analysis, Faculty of Pharmacy, Federal University of Bahia, Salvador, BA, Brazil.
(7) Laboratory of Environmental Biophotonics, São Carlos Institute of Physics, University of São Paulo, São Carlos, SP, Brazil; Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA.
Resumo: This study aimed to evaluate the safety and efficacy of combined photodynamic therapy (PDT) and photobiomodulation (PBM) in treating sickle cell leg ulcers (SCLUs), with a focus on pain reduction and enhanced healing. MATERIALS AND METHODS: In this prospective, open-label, uncontrolled pilot study, ten SCD patients with 17 chronic leg ulcers received PDT and PBM treatments. Ulcer severity, pain levels, and microbiome changes were monitored, and clinical data were analyzed using appropriate statistical methods. RESULTS: Among the treated ulcers, 64.7 % (11 out of 17) showed significant healing, with 9 ulcers achieving complete closure. The average reduction in ulcer size was significant, with a median healing time of 123 days. Pain levels decreased significantly in 82.3 % of treated ulcers (p < 0.001), and a 75.4 % reduction in bacterial load was observed, alongside increased microbiome diversity (p < 0.05). Elevated levels of IL-6 and PSGL-1 were associated with non-healing ulcers, indicating their potential as prognostic biomarkers. CONCLUSION: The combined PDT and PBM therapy proved to be effective and safe for SCLUs, offering significant improvements in healing and pain reduction. These findings suggest that integrating PDT and PBM into standard care protocols could enhance the management of SCLUs.
23. erformance of Pediatric Risk of Mortality IV in Brazilian PICUs: A Multicenter Prospective Study. Crit Care Explor. 2025 Mar 28;7(4):e1243. doi: 10.1097/CCE.0000000000001243.
Rodrigues-Santos G(1)(2), Prata-Barbosa A(2)(3), Lima-Setta F(2)(4), Silami PHNC(2), de Oliveira MBG(2), Robaina JR(2), Júnior JC(5)(6), de Oliveira FRC(7), de Carvalho LFA(8)(9), Digiovanni M(10), Novaes Bellinat AP(11), Peres da Silva T(12), de Castilho TRRN(13), Gregory SC(14), Scarlato ACCP(15), Riveiro PM(16), Filho JOP(17), Alves da Cunha AJL(2)(3), de Magalhães-Barbosa MC(2), de Souza Lopes C(1); Brazilian Research Network in Pediatric Intensive Care (BRnet-PIC).
Afiliação:
(1) Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Brazil.
(2) Department of Pediatrics, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil.
(3) Martagão Gesteira Institute of Pediatrics and Child Care, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
(4) Pediatric Intensive Care Unit, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, FIOCRUZ, Rio de Janeiro, RJ, Brazil.
(5) Pediatric Intensive Care Unit, Hospital Assunção, São Bernardo do Campo, SP, Brazil.
(6) Department of Pediatrics, Faculdade de Medicina de Jundiaí, Jundiaí, SP, Brazil.
...
(28) Hospital Infantil João Paulo II, Belo Horizonte, MG, Brazil.
(29) Hospital Aliança, Salvador, BA, Brazil.
(30) Hospital Municipal de Araguaína, Araguaína, TO, Brazil.
(31) Complexo Hospitalar Universitário Prof. Edgard Santos, Salvador, BA, Brazil.
(32) Hospital Sírio Libanês, São Paulo, SP, Brazil.
(33) Hospital Martagão Gesteira, Salvador, BA, Brazil.
(34) Hospital Universitario Evangélico Mackenzie, Curitiba, PR, Brazil.
Resumo: This is the first Brazilian study evaluating the performance of Pediatric Risk of Mortality (PRISM) IV and the first to use the calibration belt technique. OBJECTIVES: This study aimed to evaluate the performance of PRISM IV in a large cohort of patients admitted to Brazilian PICUs. DESIGN, SETTING AND PARTICIPANTS: This is a longitudinal, prospective, multicenter study conducted in 36 Brazilian PICUs with children between 29 days and 18 years old admitted from March 2020 to March 2022. MAIN OUTCOMES AND MEASURES: PRISM IV's performance was assessed using the standardized mortality ratio (SMR), the area under the receiver operating characteristic curve (AUROC) with 95% CI, and the calibration belt with 80% and 95% CI. RESULTS: A total of 12,046 patients from 36 PICUs were included. Observed overall in-hospital mortality was higher than predicted: observed = 249 (2.1%) × predicted = 188.1 (1.56%) (SMR = 1.32 [95% CI, 1.16-1.50]); discrimination was good (AUROC = 0.86 [95% CI, 0.83-0.89]), and calibration was poor, underestimating mortality over a wide range of predicted mortality (2-61%). To explore the impact of the COVID-19 pandemic on PRISM IV's performance, we divided the study period into prevaccine and postvaccine. In the prevaccine period, the SMR was 1.38 (95% CI, 1.17-1.62), the AUROC was 0.84 (95% CI, 0.80-0.88), and the range of miscalibration was broader than in the total cohort (underestimation in the 2-98% range). In the postvaccine period, the SMR was 1.26 (95% CI, 1.03-1.51), the AUROC was 0.90 (95% CI, 0.86-0.94), and the calibration belt underestimated mortality in a narrower range of 3-46% of predicted mortality. CONCLUSIONS AND RELEVANCE: PRISM IV showed good discrimination but miscalibration across a wide range of predicted mortality and different COVID-19 pandemic periods in a large cohort. Further research with subgroup analyses are needed to develop strategies to improve the performance of PRISM IV in different and heterogeneous Brazilian healthcare contexts.
24. Arterial Palmar Arch Aneurysms Management: Case Series. Vasc ndovascular Surg. 025 May 19:15385744251343706. doi: 10.1177/15385744251343706.
Carvalho Lujan RA(1), Godeiro Fernandez M(2), Costa Sampaio Silva F(3), Azevedo Lujan G(4), de Melo Mascarenhas DA(1), Pereira de Souza Filho ML(5), Aras Junior R(3).
Afiliação:
(1) Vascular Surgery Division, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, Brazil.
(2) Bahiana School of Medicine and Public Health, Salvador, Brazil.
(3) Postgraduate Program in Medicine and Health, Faculty of Medicine of Bahia, Federal University of Bahia, Salvador, Brazil.
(4) Brazilian Society of Anesthesia (SBA), Brazil.
(5) Pathology Division, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, Brazil.
Resumo: IntroductionTrue aneurysms of the upper limb, particularly in the hands, are rare and challenging to manage. We aim to report two cases of true arterial palmar arch aneurysms surgically treated.Case ReportThe first case involved a 45-year-old male professional martial artist with an ulnar artery aneurysm extending to the superficial palmar arch in the right hand. The second case was a 32-year-old female administrative assistant with a radial artery aneurysm in the left hand. Despite their respective professions, neither patient had a history of significant trauma, recent excessive training, or prolonged work hours. Clinically, both presented with local pain. Diagnostic imaging confirmed the aneurysms. The surgical interventions included proximal and distal vessel ligation and aneurysm resection under local anesthesia. Both patients were discharged on the first postoperative day without complications and showed no vascular complications during a 5-year follow-up.ConclusionAneurysms with marked rarity require individualized treatment with surgical options tailored to the clinical presentation and vascular status.
25. Denosumab regimens in the treatment of giant cell tumor of bone: A systematic review with meta-analysis. World J Orthop. 2025 Mar 18;16(3):102520. doi: 10.5312/wjo.v16.i3.102520.
Barreto BG(1)(2), Santili C(3), Guedes A(4)(5)(6), Moreira FD(4), Paz CLD(7).
Afiliação:
(1) Department of Orthopedics and Traumatology, Hospital Aristides Maltez, Salvador 40285-001, Bahia, Brazil.
(2) Department of Orthopedics and Traumatology, Hospital Santa Izabel, Salvador 40050-410, Bahia, Brazil.
(3) Department of Orthopedics and Traumatology, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo 01221-020, São Paulo, Brazil.
(4) Department of Orthopedics and Traumatology, Hospital Santa Izabel, Salvador 40050-410, Bahia, Brazil.
(5) Department of Orthopedics and Traumatology Medical Residency Program, Professor Edgard Santos University Hospital Complex, Brazilian Hospital Services Enterprise, Federal University of Bahia, Salvador 40110-060, Bahia, Brazil.
(6) Department of Orthopedics and Traumatology, Hospital Aristides Maltez, Salvador 400285-001, Bahia, Brazil.
(7) Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador 40000-000, Bahia, Brazil.
Resumo: Giant cell tumor of bone (GCTB) is a rare, locally aggressive neoplasm that should be treated surgically, whenever possible. This treatment approach may be linked with greater morbidity besides functional impairment. Denosumab is a human monoclonal antibody. Its administration inhibits bone resorption and has become part of the therapeutic armamentarium against GCTB, as it allows local control with a view to downstaging for a more conservative surgical procedure. However, there is no consensus in the literature regarding the optimal denosumab regimen for GCTB. Therefore, a wide discussion of denosumab regimen is necessary. AIM: To assess the effectiveness of various therapy protocols employing denosumab in individuals with GCTB. METHODS: A broad and systematic literature search was carried out using the PRISMA guidelines. We analyzed studies that reported skeletally mature patients with GCTB regardless of sex or ethnicity treated with denosumab. Articles with fewer than five patients and in languages except Spanish, Portuguese and English were excluded. Statistical analysis with proportion meta-analysis was performed due to the dichotomous nature of the data. RESULTS: 1005 articles were screened, of which 26 articles met the inclusion criteria and were selected, totaling 1742 patients, 51.8% women and 48.2% men, with an average of 35 years of age. Treatment with denosumab was associated with high rates of clinical benefit (CB) and imaging response (IR), without changing local recurrence rates when compared to patients treated without denosumab, regardless of the therapeutic regimen adopted and the number of doses applied. The adverse events (AE) presented were mostly mild, with the exception of a malignant transformation to osteosarcoma. CONCLUSION: Treatment of GCTB with denosumab is effective, showing high rates of CB and IR. The AE that occurred were mostly mild. We found no differences between the articles considering the researched outcomes regardless of the therapeutic regimen adopted.
26. The effect of antireaction medications on the association between periodontitis and leprosy reactions: An important methodological issue in periodontal medicine. J Periodontol. 2025 Jan;96(1):30-43. doi: 10.1002/JPER.23-0725.
Sacramento IS(1), Gomes-Filho IS(1), Cruz SSD(1)(2), Trindade SC(1), Figueiredo ACMG(3), Machado PRL(4), Vianna MIP(5), Falcão MML(1), Hintz AM(1), de Lacerda JA(5), Matos BC(5), Seymour GJ(6), Scannapieco FA(7), Loomer PM(8), Passos-Soares JS(1)(5).
Afiliação:
(1) Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil.
(2) Health Sciences Center, Federal University of Recôncavo of Bahia, Bahia, Brazil.
(3) Federal District Health State Department, Epidemiology Surveillance, Distrito Federal, Brasília, Brazil.
(4) Prof. Edgar Santos University Hospital, Federal University of Bahia, Salvador, Brazil.
(5) Department of Preventive Dentistry, Faculty of Dentistry, Federal University of Bahia, Salvador, Brazil.
(6) School of Dentistry, The University of Queensland, Queensland, Australia.
(7) Department of Oral Biology, University at Buffalo, Buffalo, New York, USA.
(8) School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Resumo: BACKGROUND: The treatment of leprosy reactions (LRs) involves thalidomide, corticosteroids, and other immunomodulatory medications. This study evaluated the effect of these treatments on the association between periodontitis and LRs, as well as factors associated with LRs. METHODS: This case-control study was conducted on 283 individuals followed at a leprosy outpatient clinic in Brazil. The case group was comprised of 158 individuals presenting type 1 or type 2 LRs, and the control group of 125 leprosy individuals without reactions. A complete oral examination was performed to diagnose periodontitis, the independent variable. Antireaction medication used was collected from medical records, and participants were classified according to the use of prednisone and/or thalidomide, time of use, or non-use of medication. Socioeconomic-demographic, clinical, and lifestyle covariables were collected by interview. Unconditional logistic regression analysis by subgroups evaluated the effect of antireaction medication on the association between periodontitis and LRs, estimating the odds ratio with a 95% confidence interval (OR; 95% CI).RESULTS: A relationship between periodontitis and LRs was observed only in the subgroup using the association prednisone and thalidomide: ORadjusted = 0.32; 95% CI = 0.11-0.95. Conversely, more severe periodontal clinical parameters were observed in cases versus controls. Several socioeconomic, health conditions, and lifestyle factors were associated with the presence of LRs. CONCLUSIONS: Although periodontal disease indicators were worse among the cases, the findings showed a negative relationship between periodontitis and LRs in individuals receiving associated prednisone and thalidomide. These medications appear to influence the inflammatory cascade between diseases, modifying and masking the manifestations of periodontitis.
27. Multidisciplinary nursing care in chronic Chagas disease: a scoping review. BMC Nurs. 2025 Jan 14;24(1):50. doi: 10.1186/s12912-024-02621-5.
Silva ÂAO(1)(2), Leony LM(1)(2), Daltro RT(1)(2), Santos EF(1)(2), Freitas NEM(1)(2), de Carvalho Medrado Vasconcelos L(1)(2), Sampaio DD(2), Santos FN(3), Fernandes LDD(4)(5), Aras R(5)(6), Hasslocher-Moreno AM(7)(8), Santos FLN(9)(10)(11).
Afiliação:
(1) Advanced Health Public Laboratory, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil.
(2) Interdisciplinary Research Group in Biotechnology and Epidemiology of Infectious Diseases (GRUPIBE), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil.
(3) School of Medicine, Saint Augustine College, Vitória da Conquista, Bahia, Brazil.
(4) General Hospital Roberto Santos, Salvador, Brazil.
(5) University Hospital Professor Edgard Santos, Salvador, Brazil.
(6) School of Medicine, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil.
(7) Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
(8) Integrated Translational Program in Chagas disease from Fiocruz - Fio-Chagas, Rio de Janeiro, Rio de Janeiro, Brazil.
(9) Advanced Health Public Laboratory, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil.
(10) Interdisciplinary Research Group in Biotechnology and Epidemiology of Infectious Diseases (GRUPIBE), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazi.
(11) Integrated Translational Program in Chagas disease from Fiocruz - Fio-Chagas, Rio de Janeiro, Rio de Janeiro, Brazil.
Resumo: Nurses provide essential care for symptomatic chronic Chagas disease carriers, caused by Trypanosoma cruzi, offering crucial support, symptom management, medication administration, and monitoring to enhance their health-related quality of life. OBJECTIVE: To increase healthcare professionals' awareness of the critical role played by high-quality care in the management of patients with chronic Chagas disease. METHODS: This scoping review employed the PRISMA-ScR method as a framework for article selection. A comprehensive search was conducted in the Scielo Brazil, PubMed, and LILACS databases, using the keywords "Chagas disease," "nursing," "nursing care", and "nursing assistance" in Portuguese, English, and Spanish. The search covered the period from 1980 to 2022. The initial review identified a total of 633 studies, from which 17 studies were ultimately selected for analysis. These included two observational studies, two case series, and seven literature reviews. RESULTS: These studies underscored the crucial role of nurses in supporting patients with chronic Chagas disease, particularly those with cardiac and/or digestive manifestations. Additionally, interventions pertaining to neonates with the infection and users of pacemakers/implantable cardioverter defibrillators were examined. CONCLUSION: Nurses play a critical role within a multidisciplinary care team in improving the health-related quality of life for individuals living with chronic Chagas disease, irrespective of the cardiac or digestive form of the disease. Therefore, it is essential to assess both the subjective and objective needs of infected individuals in order to develop tailored nursing care plans that address their individualized needs and clinical conditions.
28. Risk Factors for Viral Coinfections in Blood Donors in Bahia, Brazil. J Med Virol. 2025 Feb;97(2):e70186. doi: 10.1002/jmv.70186.
Luz E(1)(2)(3), Marques M(3)(4)(5), Arriaga MB(2), Campos LM(6), Lima L(7), Amaral S(1)(2)(3), Marques EL(7), Page K(8), Brites C(1)(2)(3).
Afiliação:
(1) Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, Brazil.
(2) Laboratório de Pesquisa em Infectologia, Hospital Universitário Professor Edgard Santos, Salvador, Brazil.
(3) Fundação Bahiana de Infectologia, Salvador, Brazil.
(4) Fundação de Hematologia e Hemoterapia da Bahia, Salvador, Brazil.
(5) Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Brazil.
(6) Hospital Universitário Professor Edgard Santos, Salvador, Brazil.
(7) Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil.
(8) Division of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico 87131, Albuquerque, New Mexico, USA.
Resumo: Human Immunodeficiency Virus (HIV), Human T Lymphotropic Virus (HTLV), hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) coinfection may lead to disease progression or worsen its clinical presentation. Viral coinfections screening during blood donation is critical. To identify risk factors for coinfection among blood donors, we assessed the blood donations at the Fundação de Hematologia e Hemoterapia da Bahia, from 2008 to 2017. We compared serological/molecular evidence of single infection versus two or more viral blood-borne infections-BBI). A multivariable logistic regression model was performed to evaluate independent associations between characteristics of donors with single infection and multiple infection using "non-infection" category as reference. Among 777,446 collected blood donations, 27 358 (3.5%) were reactive, most (n = 26 677, 97.6%) for a single infection and 681 (2.4%) for coinfection. The most frequent coinfections were HBV-HIV (30.6%), HBV-HCV (30.4%), and HBV-HTLV (24.4%). Male sex, lower education, being single, and being a first-time donor were independently associated with both single and coinfections. Nevertheless, the adjusted odds for risk factors of coinfections were much higher than those for single infection. Donors with single and coinfection for BBI shared identical risks, but they were significantly higher for coinfection. Preventive strategies addressing the identified risks can decrease transmission of viral BBI by blood transfusion.
29. Prevalence of burnout syndrome in Brazilian anesthesiologists during the COVID-19 pandemic: A cross-sectional survey. PLoS One. 2025 Feb 18;20(2):e0313538. doi: 10.1371/journal.pone.0313538.
Azi LMTA(1), Ferreira TS(2), Cerqueira-Silva T(3), Diego LAS(4), Albuquerque MAC(5), Azi ML(6).
Afiliação:
(1) Department of Anesthesiology and Surgery, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, Bahia, Brazil.
(2) Faculty of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil.
(3) Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil.
(4) Department of General and Specialized Surgery, Federal Fluminense University, Rio de Janeiro, Rio de Janeiro, Brazil.
(5) Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe, Brazil.
(6) Manoel Victorino Hospital, Secretary of Health for the State of Bahia, Salvador, Bahia, Brazil.
Resumo: BACKGROUND: Burnout syndrome, one of the consequences of chronic exposure to stressful, is more prevalent among physicians compared to the general population. Anesthesiology, alongside high-stress specialties such as emergency medicine and surgery, is particularly susceptible to this condition. During the COVID-19 pandemic, anesthesiologists were often on the front lines, potentially exacerbating burnout. This study aimed to assess the prevalence of burnout syndrome among Brazilian anesthesiologists during the pandemic. METHODS: A cross-sectional analytical observational study was conducted with all members of the Brazilian Society of Anesthesiology (SBA). Data were collected via sociodemographic questionnaires and the Maslach Burnout Inventory (MBI), disseminated by email. RESULTS: Burnout syndrome was identified in 19.6% (n = 213) of respondents, while 56.5% (n = 613) were at high risk for developing burnout. Having considered quitting the specialty was the variable most strongly associated with the prevalence of burnout syndrome and the high risk of burnout. As a protective factor, dedicating more time to leisure (over 5 hours per week) was related to a lower occurrence of burnout syndrome and its risk. CONCLUSION: Burnout syndrome is highly prevalent among Brazilian anesthesiologists and residents. Target strategies to mitigate burnout should be implemented by healthcare institutions, professional organizations, and government bodies.
30. Cross-cultural adaptation of the State Behavioral Scale to Brazilian Portuguese. Crit Care Sci. 2025 Mar 24;37:e20250183. doi: 10.62675/2965-2774.20250183. eCollection 2025.
Dantas JS(1), Castro MMC(2), Aguiar CVN(3).
Afiliação:
(1) Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia - Salvador (BA), Brazil.
(2) Universidade Federal da Bahia - Salvador (BA), Brazil.
(3) Escola Bahiana de Medicina e Saúde Pública - Salvador (BA), Brazil.
Resumo: OBJECTIVE: To perform a cross-cultural adaptation of the State Behavioral Scale to Brazilian Portuguese, assess its psychometric quality and use the scale to evaluate the level of sedation of patients on mechanical ventilation in the pediatric intensive care unit of a tertiary care hospital. METHODS: After receiving authorization by the main author, the State Behavioral Scale was adapted according to the following steps: translation of the original version into Portuguese; synthesis of the Portuguese versions; evaluation by a committee of judges; reverse translation by native speakers of the source language; synthesis of retroversions; pretest; and evaluation of psychometric quality. RESULTS: The adapted scale was administered to 20 patients by four evaluators, who performed daily evaluations in pairs simultaneously and independently. The intraclass correlation coefficient was 0.939 (p < 0.001) for the State Behavioral Scale and 0.976 (p < 0.001) for the COMFORT-B scale. The two scales were strongly correlated, with Spearman coefficients ranging from 0.884 to 0.908 (p < 0.001). In the study sample, most children (n = 43 observations; 48.9%) had scores of -1 (responsive to light touch or voice) or 0 (awake and able to calm down), which corresponded to light sedation. CONCLUSION: The translated and adapted version of the State Behavioral Scale showed high interrater agreement and high correlation with the COMFORT-B scale. The application of the scale showed an adequate level of sedation in most patients.
31. Retrospective cohort of a decade of pediatric kidney transplant in a Brazilian state: Clinical profile, main complications, and outcomes. PLoS One. 2025 May 30;20(5):e0323648. doi: 10.1371/journal.pone.0323648. eCollection 2025.
Lordelo MDR(1)(2)(3), Nunes CA(3)(4), Araújo-Pereira M(5)(6)(7), Barreto-Duarte
B(5)(6)(7)(8)(9), Andrade BB(1)(5)(6)(7)(8)(10).
Afiliação:
(1) rograma de Pós-Graduação em Medicina e Saúde Humana, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil.
(2) Departamento de Pediatria, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
(3) Hospital Ana Nery, Salvador, Bahia, Brazil.
(4) Complexo Hospitalar Universitário Professor Edgard Santos, Salvador, Bahia, Brazil.
(5) Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil.
(6) Instituto de Pesquisa Clínica e Translacional, Faculdade Zarns, Clariens Educação, Salvador, Brazil.
(7) Laboratory of Clinical and Translational Research, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil.
(8) Institute for Research in Priority Populations (IRPP), Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.
(9) Brazilian Tuberculosis Research Network (REDE-TB), Brazil.
(10) Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil.
Resumo: Pediatric kidney transplant is performed globally, although unevenly, with specific challenges in low-income countries with limited resources. We aimed to describe pediatric kidney transplantation in Bahia, a state located in one of the poorest regions in Brazil, and explore possible predictors of survival. This was a single-center retrospective cohort, and we included 101 pediatric kidney transplants performed between 2013 and 2022. There was no predominance of sex; the median age was 12 years old. Congenital anomalies of the kidney and urinary tract were the most common etiology of renal disease. 21 transplants were preemptive. Delayed graft function occurred in just over half of transplants. Patient survival rate was 96%, 96%, 89.1%, and 89.1% respectively at 1-year, 3-years, 5-years, and 10-years post-transplant. The overall graft survival rate was 80.2%, 76.9%, 66.8%, and 45.8% at 1-year, 3-years, 5-years, and 10-years post-transplant. Multivariate analysis of outcome predictors revealed that delayed graft function was a risk factor for graft survival in 5 years (adjusted HR 3.44 (1,18-10,05)). Pediatric kidney transplantation is a regionally feasible treatment, with good outcomes, although slightly inferior to those reported in the literature; efforts on reducing incidence in delayed graft function may improve graft survival.
32. Cutoff points for handgrip strength in patients with liver cirrhosis: a multicenter study. Eur J Clin Nutr. 2025 May;79(5):484-489. doi: 10.1038/s41430-024-01563-0.
Santos BC(1), Alves BC(2), Fonseca ALF(3), Ferreira SC(1), Mizubuti YGG(1), Saueressig C(2), Boulhosa RSDSB(4), Santos LAA(5), Cunha CM(4), Lyra AC(6), Oliveira LPM(4), de Jesus RP(4), Romeiro FG(5), Dall'Alba V(2)(7), Luft VC(7)(8), Correia MITD(9), Ferreira LG(3), Anastácio LR(10).
Afiliação:
(1) Food Science Graduate Program, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
(2) Gastroenterology and Hepatology Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
(3) Nutrition and Health Graduate Program, Universidade Federal de Lavras, Lavras, Brazil.
(4) Food, Nutrition, and Health Graduate Program, Universidade Federal da Bahia, Salvador, Brazil.
(5) Gastroenterology Division, Department of Internal Medicine, Universidade Estadual Paulista, Botucatu, Brazil.
(6) Gastro-Hepatology Service, Hospital Universitario Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.
(7) Food, Nutrition, and Health Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
(8) Epidemiology Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
(9) Surgery Graduate Program, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
(10) Food Science Graduate Program, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Resumo: OBJECTIVES: This study aimed to define handgrip strength (HGS) cutoff points to predict 1-year mortality in adult patients with liver cirrhosis. METHODS: This is an analysis of cohort databases from four reference centers in Brazil. Inpatients or outpatients with cirrhosis and aged ≥18 years were included. The best cutoff values of HGS (highest value from three attempts with the non-dominant hand) for predicting 1-year mortality, stratified by sex and age, were established based on the sensitivity and specificity analyses. Adjusted Cox regression models were used to test the predictive value of low HGS. RESULTS: The study included 724 patients with cirrhosis, with a median age of 57.0 years (IQR: 50.0-63.0), 66.4% (n = 481) male. Most patients had alcoholic cirrhosis (n = 281; 38.8%), 400 (55.3%) were classified as Child-Pugh B or C, and 134 (18.5%) patients died after 1-year. The HGS cutoffs were ≤33 kgf and ≤12 kgf for men and women aged <60 years, respectively, and ≤22 kgf and ≤10 kgf for older men and women, respectively (sensitivity: 70.9%; specificity: 61.2%). Low HGS was associated with a 2.5-fold increase in the risk of 1-year mortality. CONCLUSION: These cutoff points could be used to identify patients with higher mortality risk.
33. Cognitive impairment in Chagas disease patients in Brazil, 2007-2021: A cross-sectional study. PLoS Negl Trop Dis. 2025 May 29;19(5):e0012981. doi: 10.1371/journal.pntd.0012981.
Serrano CJ(1)(2), Lisbôa-Marques ME(1), Cerqueira-Silva T(1)(3), B Santos LS(1), Oliveira MA(1), Ferreira Felix I(1), de Sousa PRSP(1), Cardoso LGM(1), Muiños PJR(1), Maia RM(1), Catto MB(1), Wittlich EA(1), Rodrigues-Ribeiro L(1), Botelho VLPP(1), Nunes MCP(4), Ribeiro ALP(4), Barbosa E Silva LC(4), Aras R(1), Furie KL(5), Oliveira Filho J(1)(2).
Afiliação:
(1) Stroke and Cardiomyopathy Clinics, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.
(2) Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil.
(3) Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
(4) Department of Internal Medicine, Faculdade de Medicina, and Telehealth Center and Cardiology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
(5) Neurology Service, Brown University, Providence, Rhode Island, United States of America.
Resumo: INTRODUCTION: Chagas Disease (CD) is frequently associated with heart failure (HF). Cognitive impairment is reported, but whether it results from CD or is a nonspecific symptom of HF is unknown. We aimed to compare cognitive function of HF patients with or without CD. METHODS: Multicenter cross-sectional study of HF patients. Investigators blinded to the etiology of HF evaluated global cognition and domains of memory, executive and visuospatial function. Logistic regression tested the association between CD and cognitive impairment (Z-score < -1.5) in each domain adjusted for age, sex, educational level and left ventricular ejection fraction. RESULTS: We recruited 518 patients, 250 (48.3%) with CD. Cognitive impairment was more common in CD vs. non-CD patients (27.1% vs 13.1%, p < 0.001), mostly in memory (10.4% vs 5.0%, p = 0.022) and visuospatial function (45.2% vs 29.6%, p < 0.001). In the multivariable analysis, CD remained associated with global cognitive impairment (odds ratio 1.90; 95% CI 1.13-3.21, p = 0.016) and visuospatial function impairment (OR 1.56; 95% CI 1.02-2.39, p = 0.039). DISCUSSION: Chagas disease is associated with cognitive impairment independently of heart failure severity, suggesting other competing mechanisms.
34. Ancient origins and global spread of domestic cat hepatitis B virus. Virus Evol. 2025 Apr 5;11(1):veaf025. doi: 10.1093/ve/veaf025. eCollection 2025.
de Oliveira-Filho EF(1), Müller SF(2), Carneiro IO(3), de Carvalho OV(4)(5), Alfaro-Alarcón A(1)(6), Brünink S(1), Fernandes FD(7)(8), Anzolini Cassiano MH(1), Pedroso C(3), Lehmann F(1), Jo WK(1), Moreira-Soto A(1)(9), Brites C(10), Netto EM(10), Ristow LE(4), Maia RCC(11), Vogel FSF(7), de Almeida NR(3), Müller E(2), Franke CR(3), Drexler JF(1)(12).
Afiliação:
(1) Institute of Virology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin 10117, Germany.
(2) Laboklin, Bad Kissing, Bavaria 97688, Germany.
(3) Escola de Medicina Veterinária, Federal University of Bahia, Salvador, BA 40170-110, Brazil.
(4) Departamento de Biologia Molecular, Tecsa Laboratory, Belo Horizonte 30110-042, Brazil.
(5) Departamento de Pesquisa e Desenvolvimento, Bioclin/Quibasa, Belo Horizonte, MG 31565-130, Brazil. Department of Veterinary Pathology, School of Veterinary Medicine, National University of Costa Rica, Heredia 86-3000, Costa Rica.
(6) Departamento de Medicina Veterinária, Federal University of Santa Maria, Santa Maria, RS 97105-900, Brazil.
(7) Ritter dos Reis University Center, Porto Alegre, RS 91240-261, Brazil.
(8) Tropical Disease Research Program, School of Veterinary Medicine, National University of Costa Rica, Heredia 40101, Costa Rica.
(9) Hospital Universitário Professor Edgard Santos, Federal University of Bahia, Salvador 40110-100, Brazil.
(10) Departmento de Medicina Veterinária, Federal Rural University of Pernambuco, Recife, PE 52171-900, Brazil.
(11) Associated partner site Charité, German Centre for Infection Research (DZIF), Berlin, Germany.
Resumo: Mammalian hepadnaviruses have likely been evolving alongside their hosts for millions of years. Domestic cat HBV (DCHBV) has been detected in cats from several countries, but its genealogy, epidemiology, and host range remain unclear. Besides DCHBV, the only hepadnavirus identified among carnivores is the ringtail HBV (RtHBV). Because there is a gap in the felid fossil record of approximately 5-7 million years between the late Oligocene and the early Miocene, carnivore-derived viruses might help to shed light on Felidae evolution. Here, we screened 2260 sera and 154 paraffin-embedded liver samples from cats and 2123 sera from dogs sampled in Europe and South and Central America between 2018 and 2020 by PCR for DCHBV. We identified DCHBV genotype A (GtA) in 0.6% (7/1,195; 95% CI, 0.2-1.2) of cats sampled in Germany, France, Croatia, and Bulgaria and a genetically divergent DCHBV genotype B (GtB; 10.8% genomic sequence distance) in 0.2% of cats (2/1,065; 95% CI, 0.0-0.7) from Brazil. The detection rates of the two genotypes did not differ significantly (Fisher, P = .19). Viral loads ranged from 4 × 101-6 × 106 for DCHBV GtA to 5-7 × 103 for DCHBV GtB DNA copies per milliliter of serum. None of the cat livers or dog sera tested positive by PCR. Immunoglobulin G against the DCHBV core antigen (anti-DCHBc) was detected in 8/504 cat sera (1.6%; 95% CI, 0.7-3.1), without significant variation between countries (χ2, P = .17), and in none of 180 dog sera by indirect immunofluorescence assay (IFA). Neither IFA (Fisher, P = .11; n = 311) nor PCR (Fisher, P = .63; n = 699) positivity was significantly associated with increased liver enzymes in cats, respectively. Coevolutionary reconciliations of virus and host phylogenies and Bayesian hypothesis testing suggested evolutionary origins of DCHBV during the Miocene, ∼8-17 million years ago (mya) from ancestral carnivores, consistent with long-term evolution. The long-term association of DCHBV with felines aids in elucidating orthohepadnaviral infection patterns and felid genealogy.
35. Diversity and natural infection of phlebotomine sand flies (Diptera, Psychodidae) in an endemic area of American tegumentary leishmaniasis in southeastern Bahia, Brazil. Parasit Vectors. 2025 Feb 26;18(1):79. doi: 10.1186/s13071-025-06717-y.
Cova BO(1)(2)(3), de Oliveira LA(4)(5), Lima Machado PR(4)(5), de Carvalho EM(5)(6), Monte-Alegre AF(7)(5), Schriefer A(4)(7)(5).
Afiliação:
(1) Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Brazil.
(2) Programa de Pós-Graduação Em Ciências da Saúde, Faculdade de Medicina da Bahia, UFBA, Salvador, Brazil.
(3) Immunology Service of the Professor Edgard Santos Hospital Complex (COM-HUPES), Federal University of Bahia (UFBA), Augusto Viana Street, Canela, Salvador, Bahia, Brazil. bruno_cova@yahoo.com.br.
(4) Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Brazil.
(5) Programa de Pós-Graduação Em Ciências da Saúde, Faculdade de Medicina da Bahia, UFBA, Salvador, Brazil.
(6) Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Salvador, Bahia, Brazil.
(7) Departamento de Ciências da Biointeração, Instituto de Ciências da Saúde, UFBA, Salvador, Brazil.
Resumo: BACKGROUND: The Cacao Region spans several municipalities in the state of Bahia. It is one of the major foci of American tegumentary leishmaniasis (ATL) in Brazil. We report the findings of a pilot cross-sectional study describing the phlebotomine fauna found around living sites of newly diagnosed ATL cases in that area. METHODS: The sand fly fauna was studied from May 2018 to June 2019 via an entomological survey, as recommended by the Brazilian Ministry of Health. RESULTS: Six hundred nineteen phlebotomine sand flies of 20 species were captured: 272 males (44%) and 347 females (56%). Nyssomyia whitmani was the most prevalent (62.2%), followed by Nyssomyia intermedia (9.2%), Evandromyia bahiensis (6.3%), endemic to Bahia, and Trichophoromyia viannamartinsi (4.5%). Ninety-four percent of the female sand flies collected were screened for infection with Leishmania (Viannia) braziliensis by polymerase chain reaction (PCR). Of the 97 sand fly pools analyzed, seven were positive for L. (V.) braziliensis: three of Nyssomyia whitmani, two of Th. viannamartinsi and one each of Psychodopygus hirsutus hirsutus and Trichopygomyia longispina. The overall value of minimum infection rate (MIR) was 2.2%, and its stratification rates for the above species were 1.9, 10, 33 and 50%, respectively. All positive pools consisted of phlebotomine sand flies collected from the peridomiciles and extradomiciles of homes in the municipality of Taperoá in July 2018, resulting in an adjusted MIR of 7.8%, with 50% of the pools positive for L. (V.) braziliensis during that outbreak of ATL. CONCLUSIONS: Our findings suggest that areas experiencing outbreaks of ATL in affected regions present high proportions of infected phlebotomine sand flies involving a variety of species, some not usually considered involved in the L. (V.) braziliensis transmission cycle, such as Th. viannamartinsi.
36. Exploring Associations between Race/Ethnicity and Glaucoma Prevalence in a Multicenter Brazilian Study: The ELSA-Brasil. Ethn Dis. 2025 Mar 17;35(1):27-34. doi: 10.18865/EthnDis-2024-6. eCollection 2025 Mar.
Protásio PSPGV(1)(2)(3)(4), Almeida MDC(5), Maestri MK(6), da Silva Junior GB(7), Alvim S(8), Brunoni AR(9), Vidal KSM(9), Aquino EML(8), Lotufo PA(10), Barreto SM(11), Schmidt MI(12), Lopes AA(1)(13)(14).
Afiliação:
(1) Programa de Pós Graduação em Medicina e Saúde (PPGMS), Universidade Federal da Bahia (UFBA), Salvador, Brazil.
(2) Serviço de Oftalmologia, Hospital de Olhos Ruy Cunha (DAY HORC), Salvador, Brazil.
(3) Serviço de Oftalmologia, Instituto de Olhos Freitas (IOF), Salvador, Brazil.
(4) Serviço de Oftalmologia, Serviço Médico Universitário Rubens Brasil (SMURB) da Universidade Federal da Bahia (UFBA), Salvador, Brazil.
(5) Instituto Gonçalo Moniz (IGM), Fundação Oswaldo Cruz (Fiocruz), Salvador, Brazil.
(6) Professor de Oftalmologia, Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
(7) Programa de Pós-graduação em Saúde Coletiva, Universidade de Fortaleza, Fortaleza, Ceará, Brazil.
(8) Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Salvador, Brazil.
(9) Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil.
(10) Centro de Pesquisa Clínica e Epidemiologica, Hospital Universitario, Universidade de São Paulo (USP), São Paulo, Brazil.
(11) Medical School and Clinical Hospital/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
(12) Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
(13) Núcleo de Epidemiologia Clínica e Medicina Baseada em Evidências, Hospital Universitário Professor Edgard Santos (HUPES), UFBA, Salvador, Brazil.
(14) Departamento de Medicina Interna, Faculdade de Medicina da Bahia, Salvador, Brazil.
Resumo: PURPOSE: Previous research indicates a higher prevalence of glaucoma in Black individuals of African descent. However, the association between race and glaucoma in Brazil's multiracial population remains underexplored. This study examines this association and seeks to identify preventable factors potentially influencing prevalence differences among racial groups in Brazil, should such difference be found. METHODS: Employing a cross-sectional design, data were analyzed from 10,696 participants in the multicenter Brazilian Longitudinal Study of Adult Health (2008-2010) who self-identified their race as White, Black, mixed race (pardo), Asian, or Indigenous and completed an ophthalmological questionnaire including their self-reported glaucoma status (yes or no). Poisson regression was used to estimate prevalence ratios (PRs) with robust SEs and adjustments for sociodemographic characteristics and the presence of diabetes, hypertension, and obesity. RESULTS: The prevalence of glaucoma was 5.8% in Black (86/1483), 3.8% in mixed race (101/2688), 3.8% in indigenous (4/106), 3.5% in Asian (10/288), and 2.4% in White (145/6131) populations. Compared with Whites, Blacks and mixed-race individuals were younger. Age-adjusted prevalence was 175% higher in Black individuals (PR=2.75, 95% confidence interval [CI]: 2.12, 3.56) and 85% higher in mixed-race individuals (PR=1.85, 95% CI: 1.44, 2.36) compared with Whites. The strength of these associations was reduced in models including the comorbidities of obesity, hypertension, and diabetes, which are more prevalent in Black and mixed-race individuals. CONCLUSIONS: Our results reveal a higher prevalence of self-reported glaucoma in non-White groups, especially among Black and mixed-race individuals. Although causality cannot be conclusively established, our data suggest that the increased prevalence of glaucoma in these groups, compared with their White peers, is partially influenced by preventable health conditions.
37. Balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension: short- and long-term results from a cohort in Brazil. J Bras Pneumol. 2025 Jan 13;50(6):e20240147. doi: 10.36416/1806-3756/e20240147. eCollection 2025.
Souza FSF(1)(2), Ferreira MG(1)(2), Melo IA(3), Sá MFL(4), Loureiro CMC(4)(5), Abreu R(5), Carvalho PHA(6), Viana MDS(1)(2)(7), Oliveira V Jr(2), Ritt LEF(2)(7).
Afiliação:
(1) Unidade de Intervenção Cardiovascular, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador (BA) Brasil.
(2) Instituto D'Or de Pesquisa e Ensino - IDOR - Hospital Cárdio-Pulmonar, Rede D'Or, Salvador (BA) Brasil.
(3) Clínica de Cirurgia Torácica - Cirtorax - Salvador (BA) Brasil.
(4) Centro de Referência de Hipertensão Pulmonar, Hospital Especializado Octávio Mangabeira, Salvador (BA) Brasil.
(5) Serviço de Pneumologia, Hospital Santa Izabel, Santa Casa da Misericórdia, Salvador (BA) Brasil.
(6) Serviço de Anestesiologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador (BA) Brasil.
(7) Escola Bahiana de Medicina e Saúde Publica, Salvador (BA) Brasil.
Resumo: OBJECTIVE: A significant number of patients with chronic thromboembolic pulmonary hypertension (CTEPH) are not eligible for pulmonary endarterectomy and may be treated with balloon pulmonary angioplasty (BPA). Although BPA programs have recently been developed in Brazil, no results have yet been published. The objective of this study was to assess the clinical and hemodynamic progression of the first patients treated with BPA at our center. METHODS: This was an observational study of 23 patients with CTEPH enrolled in the BPA program of a specialized center in Brazil between 2015 and 2020. RESULTS: After a mean of 5.6 ± 1.3 sessions and 11 ± 2.8 treated segments/patient (at a mean of 6.7 ± 2.9 months post-BPA), there was a 26% decrease in mean pulmonary artery pressure (51 ± 11 vs. 38 ± 11 mmHg; p < 0.0001), a 43% decrease in pulmonary vascular resistance (10 ± 3.7 vs. 5.7 ± 3.3 WU; p < 0.0001), and a 22.5% increase in the cardiac index (2.38 ± 0.6 vs. 2.95 ± 0.6 L/min/m2; p < 0.0001). There was an increase in the six-minute walk distance and an improvement in functional class. Acute lung injury with clinical manifestations was observed after 7% of the BPA sessions. None of the patients required intubation. During a mean outpatient follow-up period of 38 ± 22 months, two patients were referred for additional BPA sessions due to clinical worsening and new hospitalizations. Two deaths were recorded (due to CTEPH progression and astrointestinal bleeding, respectively). CONCLUSIONS: Among this first group of patients treated with BPA in Brazil, there was significant short- and long-term clinical improvement, together with a low frequency of complications.
38. Clinical outcomes of COVID-19 in patients with liver cirrhosis - a propensity-matched analysis from a multicentric Brazilian cohort. BMC Infect Dis. 2025 Jan 15;25(1):68. doi: 10.1186/s12879-024-10424-x.
Menezes LSM(#)(1)(2), da Cunha PFS(#)(3), Pires MC(#)(4), Valle LR(#)(4), Costa FCC(#)(5), Ferreira MAP(#)(6), Guimarães Júnior MH(#)(7), Francisco SC(#)(8), Carneiro M(#)(9), Silveira DV(#)(10), Aranha FG(#)(11), de Carvalho RLR(#)(12)(13)(14), de Abreu Ferrari TC(#)(4), Marcolino MS(#)(4)(3).
Afiliação:
(1) Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Minas Gerais, Brazil.
(2) Hospital Metropolitano Odilon Behrens, R. Formiga, 50, Belo Horizonte, Brazil.
(3) Hospital Metropolitano Odilon Behrens, R. Formiga, 50, Belo Horizonte, Brazil.
(4) Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Minas Gerais, Brazil.
(5) Hospitais da Rede Mater Dei, Av. do Contorno, 9000, Belo Horizonte, Brazil.
(6) Hospital de Clínicas de Porto Alegre, R. Ramiro Barcelos, 2350, Porto Alegre, Brazil.
(7) Hospital Márcio Cunha, Av. Kiyoshi Tsunawaki, 48, Ipatinga, Brazil.
(8) Hospital Metropolitano Doutor Célio de Castro, Rua Dona Luiza, 311, Belo Horizonte, Brazil.
(9) Hospital Santa Cruz, R. Fernando Abott, 174, Santa Cruz do Sul, Brazil.
(10) Hospital Unimed BH, Av. do Contorno, 3097, Belo Horizonte, Brazil.
(11) Hospital SOS Cárdio, Rodovia SC-401, 121, Florianópolis, Brazil.
(12) Hospital Universitário Professor Edgard Santos, R. Dr. Augusto Viana, s/n - Canela, Salvador, Brazil.
(13) Escola de Enfermagem da Universidade Federal da Bahia, Rua Basilio da Gama, 241, Salvador, Bahia, Brasil.
(14) Institute for Health Technology Assessment (IATS/ CNPq), Porto Alegre, Brazil.
Resumo: BACKGROUND: Cirrhosis has been pointed out as a clinical entity that leads to worse clinical prognosis in COVID-19 patients. However, this concept is controversial in the literature. We aimed to evaluate clinical outcomes by comparing patients with cirrhosis to those without cirrhosis in a Brazilian cohort. METHODS: Data from 20,164 COVID-19 inpatients were collected from 41 hospitals in Brazil between March to September 2020 and March 2021 to August 2022. We compared 117 patients with cirrhosis to 632 matched controls. A propensity score model was used to adjust for potential confounding variables, incorporating some predictors: age, sex at birth, number of comorbidities, hospital of admission, whether it was an in-hospital clinical manifestation of COVID-19, and admission year. Closeness was defined as being within 0.16 standard deviations of the logit of the propensity score. RESULTS: The median age was 61 (IQR 50-70) years old, and 63.4% were men. There were no significant differences in the self-reported symptoms. Patients with cirrhosis had lower median hemoglobin levels (10.8 vs. 13.1 g/dl), lower platelets (127,000 vs. 200,000 cells/mm3), and leukocyte counts, as well as lower median C-reactive protein (63.0 vs. 76.0 p = 0.044) when compared to controls. They also had higher mortality compared to matched controls (51.3% vs. 21.7%, p < 0.001). They also had higher frequencies of admission in an intensive care unit (51.3% vs. 38.0%, p = 0.007), invasive mechanical ventilation (43.9% vs. 26.6%, p < 0.001), dialysis (17.9% vs. 11.1%, p = 0.038), septic shock (23.9% vs. 14.9%; p = 0.015) and institution of palliative care (19.7% vs. 7.4%; p < 0.001). CONCLUSIONS: This study has shown that COVID-19 inpatients with cirrhosis had significantly higher incidence of severe outcomes, as well as higher frequency of institution of palliative care when compared to matched controls. Our findings underscore the need for these patients to receive particular attention from healthcare teams and allocated resources.
39. Clinical, Functional, and Hemodynamic Profile of Schistosomiasis-Associated Pulmonary Arterial Hypertension Patients in Brazil: Systematic Review and Meta-Analysis. Infect Dis Rep. 2025 Mar 4;17(2):22. doi: 10.3390/idr17020022.
Loureiro CMC(1)(2), Scheibler Filho AL(3), Menezes VMAS(1), Correa RA(4), Oliveira RKF(5), Mickael C(6), Hilton JF(7), Graham BB(8).
Afiliação:
(1) Pulmonary Medicine, Santa Casa da Bahia, Salvador 40050-001, BA, Brazil.
(2) Department of Medicine, Federal University of Bahia, Salvador 40170-110, BA, Brazil.
(3) Intensive Care Unit, Hospital Universitário Professor Edgard Santos, Salvador 40110-060, BA, Brazil.
(4) Department of Internal Medicine/Pulmonary Division, Federal University of Minas Gerais, Belo Horizonte 31270-901, MG, Brazil.
(5) Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo, Sao Paulo 04021-001, SP, Brazil.
(6) Department of Medicine, University of Colorado, Aurora, CO 80045, USA.
(7) Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA.
(8) Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA.
Resumo: BACKGROUND: Schistosoma-associated pulmonary arterial hypertension (Sch-PAH), a complication of hepatosplenic schistosomiasis, is still underdiagnosed and undertreated. Sch-PAH is the third-most common cause of pulmonary arterial hypertension (PAH) in Brazil, and it is estimated that there are around 60,000 afflicted individuals. However, there is a lack of data on these patients, especially in endemic areas. Therefore, this study aimed to describe baseline demographic data, hemodynamic severity of disease, and functional impairment of Sch-PAH patients at diagnosis. METHODS: For this systematic review, five databases (Embase, PubMed, SciELO, LILACS, and Cochrane) were searched to identify candidate publications reporting clinical, hemodynamic, and functional data at diagnosis of Sch-PAH patients referred to a PAH reference center in Brazil. Studies were excluded if they enrolled patients under the age of 18, the diagnosis was not confirmed by right heart catheterization (RHC), consisted of case reports, or did not report original data. Risk of bias was assessed using the Newcastle-Ottawa Scale and an adapted version for cross-sectional studies. Single-arm meta-analysis with a random-effect model was performed for each variable. RESULTS: From 459 studies identified through systematic database searching, five studies were selected for this meta-analysis. The majority of the included patients were women (67%), New York Heart Association (NYHA) functional class III/IV (57%), mean age 49 years (95% confidence interval [95% CI], 46-52), 6 min walk distance 392 m (95% CI, 291-493), mean pulmonary arterial pressure (mPAP) 59 mmHg (95% CI, 56-61), pulmonary vascular resistance (PVR) 12 WU (95% CI, 11-13) and cardiac index (CI) 2.57 L/min/m2 (95% CI, 2.25-2.88). CONCLUSIONS: In summary, Sch-PAH has clinical characteristics similar to other forms of PAH, including connective tissue disease and idiopathic PAH. Additional studies or a unified registry would be essential for a better understanding of this relevant disease in Brazil.
40. Proteophosphoglycan functional motifs display genetic polymorphism in a natural population of Leishmania (Viannia) braziliensis. Acta Trop. 2025 May;265:107606. doi: 10.1016/j.actatropica.2025.107606.
Carvalho PP(1), Souza M(1), Medina L(1), Muñoz M(2), Schriefer A(3).
Afiliação:
(1) Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Brazil; Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, UFBA, Brazil.
(2) Departments of Internal Medicine and Microbiology, University of Iowa, Iowa City, IA, USA.
(3) Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Brazil; Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, UFBA, Brazil; Departamento de Ciências da Biointeração, Instituto de Ciências da Saúde, UFBA, Brazil.
Resumo: Leishmaniasis causes 3.5 M DALYs. Treatment often requires parenteral administration and causes debilitating side effects. Vaccines to prevent the most dramatic outcomes would be most welcome. The Proteophosphoglycan (PPG) is encoded by ppg1 to ppg4 and mediates interaction of Leishmania spp. with macrophages employing two motifs: leucine-rich (LRR), and alanine, proline, and serine repeats (APS). We PCR amplified, cloned, sequenced, and assessed the conservation of LRR and APS of ppg3 and ppg4 in L. braziliensis of 24 patients from Northeast Brazil, then compared them to Leishmania spp. from Genebank. Evolutionary divergencies (ED) between ppg alleles were calculated by Maximum Composite Likelihood. The amplification success of ppg3-lrr was 87.5 %; ppg3-aps was 58.3 %; and ppg4-lrr was 62.5 %. ppg3-lrr presented two conserved alleles of equal frequencies, similar to reference strain's (ED = 0.000). ppg4-lrr presented three alleles with overall lower conservation (ED = 48.820). Conservation was high for two of the alleles (ED = 0.003) present in 87.5 % of isolates. Three alleles of ppg3-aps were observed (overall ED = 0.730). One occurred in three L. braziliensis isolates being similar to reference strain's (ED = 0.009). The other two were present in 70 % of the isolates, substantially deviating from the reference L. braziliensis (ED > 1.000). Phylogeny employing ppg3-lrr, ppg3-aps or ppg4-lrr clustered L. braziliensis reference and test isolates with the other subgenus Viannia species, segregating them from species of other New and Old-World subgenera. Overall, moderate polymorphism affected functional PPG motifs, opening the possibility of their consideration in eventual subunit vaccines against leishmaniasis.
41. Phase 2 trial of daratumumab, cyclophosphamide, thalidomide, and dexamethasone in newly diagnosed multiple myeloma. Blood Neoplasia. 2025 Mar 3;2(3):100081. doi: 10.1016/j.bneo.2025.100081.
de Queiroz Crusoé E(1)(2), Leal Ribeiro Dos Santos JS(2), de Andrade Santos J(1)(2), de Melo Santos HH(1)(3), de Souza Santos A(3), Lucas LF(2), Requião de Pinna CA(1)(2), Caldas Freire PN(2), Araujo de Jesus A(2), de Moura Almeida A(1), Dutra DD(1), Chaves MF(1), Nicanor JS(1), Salvino MA(1), Bomfim Arruda MDG(2), Hungria V(4); GBRAM.
Afiliação:
(1) Hospital Universitário Professor Edgar Santos, Federal University of Bahia, Hematology and Hemotherapy Department, Salvador, Brazil.
(2) Rede D'or Oncologia, Hematology Division, Salvador, Brazil.
(3) Immunology, Molecular and Cytometry Laboratory, Instituto de Ciências da Saúde, Federal University of Bahia, Salvador, Brazil.
(4) Department of Hematology and Oncology, Clínica São Germano, São Paulo, Brazil.
Resumo: Anti-CD38 monoclonal antibodies have been successfully combined with immunomodulatory agents, proteasome inhibitors (PIs), alkylators, and corticosteroids in newly diagnosed multiple myeloma (NDMM). We assessed a regimen of daratumumab, cyclophosphamide, thalidomide, and dexamethasone (Dara-CTD) for patients with NDMM eligible to autologous stem cell transplantation (ASCT). Patients received 4 28-day cycles of induction therapy with Dara-CTD followed by ASCT, 4 cycles of consolidation Dara-TD, and single-agent daratumumab maintenance until progression or limiting toxicity. The primary end point was the percentage of patients achieving at least a very good partial response (VGPR) after the second cycle of consolidation. A key secondary end point was progression-free survival (PFS). We enrolled 24 patients, with a median age of 59.5 years, 62.5% of whom were female. Patients received a median of 28 treatment cycles. The rate of VGPR or better was 75.0% (95% confidence interval, 68.3-98.7); of 18 responding patients, 3 had a complete and 15 had a VGPR. The response duration varied between 9.5 and 41.9 months (median not reached). The estimated PFS rate at 36 months was 65%, and the overall survival rate at 48 months was 70%. The most frequent toxicity was constipation, febrile neutropenia, lymphopenia, neutropenia, peripheral neuropathy, and stomatitis. There were 7 documented cases of coronavirus disease 2019, 2 of which fatal. Two patients had permanent treatment discontinuation due to toxicity, 1 case each attributed to cyclophosphamide and daratumumab. Dara-CTD is an active, PI-free, quadruplet regimen with an acceptable safety profile for patients with ASCT-eligible NDMM. This trial was registered at www.ClinicalTrials.gov as
42. Multicenter cross-sectional study of HTLV-1 prevalence and associated risk factors in epidemiologically relevant groups across Brazil. Front Public Health. 2025 Mar 3;13:1511374. doi: 10.3389/fpubh.2025.1511374. eCollection 2025.
Brites C(#)(1), Tonto PB(#)(2)(3), Vallinoto AC(4et al.
Afiliação:
(1) Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.
(2) Department of Medicine, Division of Allergy, Immunology, and Infectious Diseases, and Child Health Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States.
(3) Rutgers Global Health Institute, Rutgers University, New Brunswick, NJ, United States.
...
Resumo: BACKGROUND: Human T cell lymphotropic virus type 1 (HTLV-1) is highly ndemic in Brazil, necessitating surveillance studies to understand its epidemiology. While previous research has focused on either specific cities or populations, there is a need for multicenter studies encompassing epidemiologically relevant populations to ascertain more accurate prevalence rates and predictors of HTLV-1 infection in the country. METHODS: We conducted a multicenter, cross-sectional study involving 3,184 participants across seven cities and five study populations in Brazil. Blood samples were collected, and the prevalence of HTLV-1 infection was determined by enzyme-linked immunosorbent assay (ELISA) and Western blot. Binary logistic regression analysis was used to determine risk factors of HTLV-1 infection. RESULTS: Among the total study population, 1,135 (35.7%) were aged >40 years and 1,704 (53.5%) were female. The overall prevalence of HTLV-1 infection was 0.5% (95% CI: 0.3-0.8), with variation observed among the cities or study populations. Factors associated with HTLV-1 infection included age > 40 years (OR, 8.867; 95% CI: 1.824-43.099), female gender (OR, 4.604; 95% CI: 1.184-17.903), and Hepatitis C virus (HCV) infection (OR, 13.995; 95% CI: 2.374-82.506). The identification of older age and female gender, coupled with the high prevalence of HTLV-1 in HIV-positive patients, suggests sexual transmission as the primary route of HTLV-1 infection. CONCLUSION: Our study reveals varied prevalence rates of HTLV-1 infection across diverse populations and cities in Brazil. The association of older age, female gender, and HCV, emphasizes the need for tailored interventions to prevent HTLV-1 transmission.
43. Methotrexate for atopic dermatitis: The right dosing and best-performance administration route. J Eur Acad Dermatol Venereol. 2025 Feb;39(2):249-250. doi: 10.1111/jdv.20501.
Nosbaum A(1)(2), Machado G(2)(3).
Afiliação:
(1) Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud Service d'Allergologie et Immunologie Clinique, Pierre-Bénite Cedex, France.
(2) CIRI (International Center for Infectiology Research) INSERM U1111, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1 CNRS UMR5308, Lyon, France.
(3) Federal University of Bahia (UFBa), Professor Edgard Santos University Hospital, Immunology Service, Salvador, Bahia, Brazil.
Sem resumo.
44. A Comprehensive Molecular and Serological Investigation of Hepatitis A Virus Among Patients With Suspected Acute Hepatitis: A Brazilian Study. J Med Virol. 2025 Jun;97(6):e70449. doi: 10.1002/jmv.70449.
de Oliveira KG(1)(2), Vasconcelos MPA(3), Ton JT(3), Uehara SNO(4), Sitnik R(1), Ornelas Pereira Salvador de Oliveira D(1), Castberg L(1), Siqueira RA(1), Robinson PJ(1), Domingues TSP(1), Panico CT(1), Inoue CA(1), Maluf MM(1), de Mello Malta F(1), Amgarten D(1), Dorlass E(1), Sebe P(1), Pinto AS(5), Lobato CMDO(6), Ferreira A(7), Hyppolito E(8), Paraná R(9), Schinoni MI(9), Lopes EPA(10), Luiz MC(11), et al.
Afiliação:
(1) Laboratório de Patologia Clínica e de Anatomia Patológica, Hospital Israelita Albert Einstein, São Paulo, Brazil.
(2) LIM07, Instituto de Medicina Tropical, Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
(3) Centro de Pesquisa em Medicina Tropical, Secretaria de Estado da Saúde de Rondônia, Porto Velho, Rondônia, Brazil.
(4) Hospital Dia Esterina Corsini de Campo Grande, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil.
(5) Fundação de Medicina Tropical Dr. Vieira Machado de Manaus, Secretaria de Estado da Saúde do Amazonas, Manaus, Amazonas, Brazil.
(6) Unidade de Saúde de Referência de Doença de Rio Branco, Secretaria Municipal da Saúde, Rio Branco, Acre, Brazil.
(7) Departamento de Medicina, Universidade Federal do Maranhão, São Luís, Maranhão, Brazil.
(8) Hospital São José das Doenças Infecciosas de Fortaleza, Serviço de Transplante de Fígado do Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.
(9) Hospital Universitário Professor Edgar Santos de Salvador, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Bahia, Brazil.
(10) Hospital de Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
(11) Hospital Nereu Ramos, Secretaria de Estado da Saúde, Florianópolis, Santa Catarina, Brazil.
...
Resumo: Hepatitis A Virus (HAV) infects millions of individuals annually and is a major cause of acute viral hepatitis worldwide. This study aims to (1) assess HAV infection in suspected acute hepatitis patients at public healthcare institutions in Brazil; (2) evaluate the proportion of immunized individuals against HAV; (3) identify HAV genotypes; (4) examine the association between HAV infection and demographic data, as well as exposure to risk factors. This is a prospective, observational multicenter study conducted in primary health services in Brazil from October 2019 to May 2023, involving 1721 patients with suspected acute hepatitis. Acute HAV infection was identified in 108 (6.3%) patients, predominantly in young men (80%) and from South and Southeast regions of Brazil (97%). Anti-HAV IgG, indicating previous exposure or vaccination, was detected in 78.6% of individuals (74% in the South to 91% in the North). Genotype I.A was found in all cases and approximately 450 mutations were identified, most of them in the structural proteins VP1-3. Two viral groups were identified and related to two introductions of the virus: cosmopolitan sequences from North America, South America, and Europe, and a minor group of Brazilian sequences similar to Asian and South American ones. The high incidence of acute HAV infections highlights the need for targeted prevention and vaccination strategies. The characterization of HAV genetic diversity and molecular epidemiology contributes to monitoring and identifying emerging outbreaks.
45. Challenges in the integration of palliative care for patients with hematologic malignancies: an analysis of the surprise question in a prospective cohort study. Sao Paulo Med J. 2025 May 2;143(3):e2024263. doi: 10.1590/1516-3180.2024.0263.29012025. eCollection 2025.
Silva AMOP(1), Miranda DLP(1), Ferreira DP(2), Campos CCAP(1), Crusoé EQ(3), Gomes FF(4), Favano T(5), Salvino MA(6).
Afiliação:
(1) Postgraduate Program in Medicine and Heath, Professor Edgard Santos University Hospital, Medical School, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
(2) Medical School, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
(3) Edgard Santos University Hospital, Universidade Federal da Bahia (HUPES-UFBA), Salvador (BA), Brazil.
(4) Postgraduate Program in Medicine and Heath, Faculty of Pharmacy, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
(5) School of Pharmaceutical Sciences (FCF), Universidade de São Paulo (USP), São Paulo (SP), Brazil. Mink Therapeutics, USA.
(6) Postgraduate Program in Medicine and Heath, Medical School, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
Resumo: BACKGROUND: The Surprise Question (SQ), "Would I be surprised if this patient were to die in the next 12 months?", identifies patients at high risk of death who might benefit from palliative care (PC). However, little is known about its application in oncohematology. OBJECTIVES: To evaluate the performance of the SQ among inpatients with hematologic malignancies. DESIGN AND SETTING: A prospective cohort study was conducted between September and December 2021, including patients admitted to the Hematology Ward of the University Hospital in Salvador, Brazil. METHODS: Physicians answered the SQ (not surprised (SQ+) or surprised (SQ-)). Mortality data were assessed after one year. RESULTS: Eighty-one patients were included (56% SQ+ and 44% SQ-). At study closure, 36 patients (44%) had died. Median survival was 10.8 months (95%CI = 9.7-11.8) for SQ- and 5.6 months (95%CI = 4.1-7.1) for SQ+. Sensitivity was 86.1%, specificity 68.9%, positive predictive value 68.8%, negative predictive value 86.1%, and accuracy 76.5%. At the time of the interview, only 15 (18.5%) patients had consulted a PC specialist. By the study's end, 48% had been referred to PC. These patients had poorer performance status (82% vs. 40%, P < 0.001) and more advance care planning records (87% vs. 14%, P < 0.001). CONCLUSIONS: Despite the prognostic uncertainty of hematologic malignancies, the SQ effectively estimates mortality and serves as a valuable tool for early PC integration in oncohematology.
46. Does the intensity of dissociation predict antidepressant effects 24 hours after infusion of racemic ketamine or esketamine in treatment-resistant depression? A secondary analysis from a randomized controlled trial. Trends Psychiatry Psychother. 2025;47:e20220593. doi: 10.47626/2237-6089-2022-0593.
Echegaray MVF(1), Mello RP(2), Magnavita GM(1), Leal GC(2), Correia-Melo FS(2), Jesus-Nunes AP(2), Vieira F(2), Bandeira ID(2), Caliman-Fontes AT(1), Telles M(2), Guerreiro-Costa LNF(2), Marback RF(2), Souza-Marques B(2), Lins-Silva DH(1), Santos-Lima C(2), Cardoso TA(3), Kapczinski F(3), Lacerda ALT(4), Quarantini LC(5).
Afiliação:
(1) Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.
(2) Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil. Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, UFBA, Salvador, BA, Brazil.
(3) Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Canada.
(4) Laboratório Interdisciplinar de Neurociências Clínicas, Universidade Federal de São Paulo, São Paulo, SP, Brazil. Instituto Sinapse de Neurociências Clínicas, Campinas, SP, Brazil.
(5) Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil. Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, UFBA, Salvador, BA, Brazil. Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, UFBA, Salvador, BA, Brazil.
Resumo: OBJECTIVE: Ketamine and esketamine have both shown significant antidepressant effects in treatment-resistant depression (TRD) and conflicting evidence suggests that dissociation induced by these drugs could be a clinical predictor of esketamine/ketamine's efficacy. METHODS: This study is a secondary analysis of data from a two-center, randomized, controlled trial. Participants were randomly assigned 1:1 to receive an IV infusion of either esketamine (0.25 mg/kg) or racemic ketamine (0.50 mg/kg) over 40 minutes. Dissociative symptoms were assessed using the Clinician-Administered Dissociative State Scale (CADSS) 40 minutes following the beginning of the infusion. Variations in depression scores were measured with the Montgomery-Åsberg Depression Rating Scale (MADRS), which was administered before the intervention as a baseline measure and 24 hours, 72 hours, and 7 days following infusion. RESULTS: Sixty-one patients were included in the analysis. Examining CADSS scores of 15 or below, for every 1-point increment in the CADSS score, there was a mean change of -0.5 (standard deviation [SD] = 0.25; p = 0.04) of predicted MADRS score from baseline to 24 hours. The results for 72 hours and 7 days following infusion were not significant. Since the original trial was not designed to assess the relationship between ketamine or esketamine-induced dissociation and antidepressant effects as the main outcome, confounding variables for this relationship were not controlled. CONCLUSION: We suggest a positive relationship between dissociation intensity measured with the CADSS and the antidepressant effects of ketamine and esketamine 24 hours after infusion for CADSS scores of up to 15 points.
47. Complete therapeutic response to upadacitinib as a continued treatment for alopecia areata universalis. Eur J Dermatol. 2025 Apr 1;35(2):138-139. doi: 10.1684/ejd.2025.4862.
Machado GU(1), Silverio MS(2), Duarte GV(3), Machado PR(3), Nosbaum A(4).
Afiliação:
(1) Federal University of Bahia, Professor Edgard Santos University Hospital, Immunology Service, Salvador, Bahia, Brazil, INSERM U1111, CIRI, Centre International de Recherche en Infectiologie, (Team Epidermal Immunity and Allergy); Université Lyon 1; CNRS, Lyon F-69007.
(2) University Santo Amaro, Dermatology Service - Sao Paulo, Brazil.
(3) Federal University of Bahia, Professor Edgard Santos University Hospital, Immunology Service, Salvador, Bahia, Brazil.
(4) INSERM U1111, CIRI, Centre International de Recherche en Infectiologie, (Team Epidermal Immunity and Allergy); Université Lyon 1; CNRS, Lyon F-69007, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Allergologie et Immunologie clinique, Pierre Bénite cedex F-69495 France.
Sem resumo.