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Papers by Claudia Di Lorenzo Oliveira
Revista do Instituto de Medicina Tropical de São Paulo, 2022
This is an open-access article distributed under the terms of the Creative Commons Attribution Li... more This is an open-access article distributed under the terms of the Creative Commons Attribution License.
Journal of Clinical Immunology, 2021
Cardiomyopathies are an important cause of heart failure and sudden cardiac death. Little is know... more Cardiomyopathies are an important cause of heart failure and sudden cardiac death. Little is known about the role of rare genetic variants in inflammatory cardiomyopathy. Chronic Chagas disease cardiomyopathy (CCC) is an inflammatory cardiomyopathy prevalent in Latin America, developing in 30% of the 6 million patients chronically infected by the protozoan Trypanosoma cruzi, while 60% remain free of heart disease (asymptomatic (ASY)). The cytokine interferon-γ and mitochondrial dysfunction are known to play a major pathogenetic role. Chagas disease provides a unique model to probe for genetic variants involved in inflammatory cardiomyopathy. Methods We used whole exome sequencing to study nuclear families containing multiple cases of Chagas disease. We searched for rare pathogenic variants shared by all family members with CCC but absent in infected ASY siblings and in unrelated ASY. Results We identified heterozygous, pathogenic variants linked to CCC in all tested families on 22 d...
Incidence and Predictors of Progression to Chagas Cardiomyopathy: Long-Term Follow-Up of Trypanosoma cruzi –Seropositive Individuals
Circulation, 2021
Background: There are few contemporary cohorts of Trypanosoma cruzi –seropositive individuals, an... more Background: There are few contemporary cohorts of Trypanosoma cruzi –seropositive individuals, and the basic clinical epidemiology of Chagas disease is poorly understood. Herein, we report the incidence of cardiomyopathy and death associated with T. cruzi seropositivity. Methods: Participants were selected in blood banks at 2 Brazilian centers. Cases were defined as T. cruzi –seropositive blood donors. T. cruzi –seronegative controls were matched for age, sex, and period of donation. Patients with established Chagas cardiomyopathy were recruited from a tertiary outpatient service. Participants underwent medical examination, blood collection, ECG, and echocardiogram at enrollment (2008–2010) and at follow-up (2018–2019). The primary outcomes were all-cause mortality and development of cardiomyopathy, defined as the presence of a left ventricular ejection fraction <50% or QRS complex duration ≥120 ms, or both. To handle loss to follow-up, a sensitivity analysis was performed using ...
Vox Sanguinis, 2020
Background and objectives-Incidence in first-time and repeat blood donors is an important measure... more Background and objectives-Incidence in first-time and repeat blood donors is an important measure of transfusion-transmitted HIV infection (TT-HIV) risk. This study assessed HIV incidence over time at four large blood centers in Brazil. Materials and methods-Donations were screened and confirmed using serological assays for HIV from 2007-2016, and additionally screened by nucleic acid testing from 2011 forward. Limiting antigen (LAg) avidity testing was conducted on HIV seroreactive samples from first-time donors to classify whether an infection was recently acquired. We calculated incidence in firsttime donors using the mean duration of recent infection and in repeat donors using classical methods. Time and demographic trends were assessed using Poisson regression. Results-Over the 10-year period, HIV incidence in first-time donors was highest in Recife (45.1/100,000 person-years (10 5 py)) followed by São Paulo (32.2/10 5 py) and then Belo Horizonte (23.3/10 5 py), and in repeat donors was highest in Recife (33.2/10
European Heart Journal, 2018
Assessment and intervention in tricuspid, the no longer forgotten valve / Various cardiomyopahies... more Assessment and intervention in tricuspid, the no longer forgotten valve / Various cardiomyopahies 311 years. The indication(s) for TVR were: any TR with an enlarged annulus (n=6), moderate or less TR (n=5), moderate or more (n=5), any TR (n=3). The majority of patients underwent repair with an annuloplasty ring while a minority underwent suture annuloplasty. There was no difference in 30-day/in-hospital mortality between TVR+ and TVR− (RR: 1.31 95% confidence interval (95% CI): 0.85, 2.02, p=0.25). The incidence of new permanent pacemaker implantation was higher in the TVR+ group (RR: 2.73, 95% CI: 2.57, 2.89, p<0.01). TVR+ was protective against late moderate to severe TR (IRR: 0.26, 95% CI: 0.16, 0.43; p<0.01) and severe TR (IRR: 0.32, 95% CI: 0.11, 0.91, p=0.03). There was a trend towards a lower rate of late TV reoperation in a pooled analysis of five studies (IRR: 0.36, 95% CI: 0.13,1.02; p=0.06). Overall, there was no difference in late mortality between TVR+ and TVR− (Figure-IRR: 0.87, 95% CI: 0.63, 1.20 p=0.39).
Differential Diagnostic Method and Kit for Infectious and Parasitic Diseases, Using Flow Cytometry
European journal of heart failure, 2015
The significance of detection of Trypanosoma cruzi DNA in blood of antibody-positive patients for... more The significance of detection of Trypanosoma cruzi DNA in blood of antibody-positive patients for risk of development of Chagas heart disease is not well established. The objective of this study was to compare detection of T. cruzi DNA with known clinical and laboratory markers of Chagas cardiomyopathy (CC) severity. This is a case-control study nested within a retrospective cohort developed in Brazil to understand the natural history of Chagas disease. The study enrolled 499 T. cruzi seropositive blood donors (SP-BD) and 488 frequency matched seronegative control donors (SN-BD) who had donated between 1996 and 2002, and 101 patients with clinically diagnosed CC. In 2008-2010 all enrolled subjects underwent a health questionnaire, medical examination, electrocardiograms and echocardiograms and polymerase chain reaction (PCR) analyses. A blinded panel of three cardiologists adjudicated the outcome of CC. Trypanosoma cruzi kinetoplast minicircle sequences were amplified by real-time P...
Dengue RNA among blood donors and recipients during large epidemics of DENV-4 in Rio de Janeiro and Recife, Brazil
Cadernos de Saúde Pública, 2010
Este estudo teve como objetivo descrever a distribuição espacial e temporal dos candidatos à doaç... more Este estudo teve como objetivo descrever a distribuição espacial e temporal dos candidatos à doação de sangue, do Município de Belo Horizonte, Minas Gerais, Brasil, que se apresentaram no hemocentro da Fundação Hemominas, nos anos de 1994 e 2004. Comparou no espaço e no espaço-tempo as características idade, sexo e aptidão clínica destes candidatos. As informações de 1994, obtidas de estudo transversal, e as de 2004, amostrados entre os candidatos à doação durante o ano. As amostras foram georreferenciadas através dos endereços de residência. As técnicas espaciais utilizadas foram: mapas Kernel, mapas temáticos de taxas Bayesianas empíricas e de taxas brutas e o índice de Moran global. Os resultados indicaram que a distribuição espacial de candidatos não foi aleatória. Os mapas Kernel auxiliaram na detecção de locais com maior ou menor concentração de candidatos. Os mapas temáticos descreveram a concentração de candidatos relativos à população para as diferentes categorias analisada...
Recent advances in characterization of nonviral vectors for delivery of nucleic acids: impact on their biological performance
Expert opinion on drug delivery, 2015
Nucleic acid delivery is a complex process that requires transport across numerous extracellular ... more Nucleic acid delivery is a complex process that requires transport across numerous extracellular and intracellular barriers, whose impact is often neglected during optimization studies. As such, the development of nonviral vectors for efficient delivery would benefit from an understanding of how these barriers relate to the physicochemical properties of lipoplexes and polyplexes. This review focuses on the evaluation of parameters associated with barriers to delivery such as blood and immune cells compatibility which, as a collective, may serve as a useful prescreening tool for the advancement of nonviral vectors in vivo. An outline of the most relevant rationally developed polyplexes and lipoplexes for clinical application is also given. The evaluation of scientifically recognized parameters enabled the identification of systemic delivered nonviral vectors' behavior while in blood as one of the key determinants of vectors function and activity both in vitro and in vivo. This mu...
Demographic, risk factors and motivations among blood donors with reactive serologic tests for syphilis in São Paulo, Brazil
Transfusion Medicine, 2014
To identify the demographic characteristics, risk factors and motivations for donating among bloo... more To identify the demographic characteristics, risk factors and motivations for donating among blood donors with reactive serologic tests for syphilis. Post-donation interviews with syphilis seropositive blood donors improve recruitment and screening strategies. This case-control study compares 75 Venereal Disease Research Laboratory (VDRL) &amp;gt; 8, EIA+ (enzyme immunoassay) and FTA-ABS+ (fluorescent treponemal antibody); 80 VDRL-, EIA+ and FTA-ABS+; and 34 VDRL- and EIA- donors between 2004 and 2009. Donors were assessed by their demographic characteristics, sexual behaviour, history of alcohol and illicit drugs use, and motivations to donate. Donors with VDRL &amp;gt; 8 were more likely to be divorced [AOR = 12·53; 95% confidence interval (CI) 1·30-120·81], to have had more than six sexual partners (AOR=7·1; 95% CI 1·12-44·62) and to report male-male-sex in the past 12 months (AOR=8·18; 95% CI 1·78-37·60). Donors with VDRL-, EIA+ and FTA-ABS+ were less likely to be female (AOR=0·26; 95% CI 0·07-0·96), more likely to be older (AOR=10·2; 95% CI 2·45-42·58 ≥ 39 and &amp;lt;60 years old) and to have had more than six sexual partners in the past 12 months (AOR = 8·37; 95% CI 1·49-46·91). There was no significant difference among groups regarding illicit drugs use; 30·7% (VDRL &amp;gt; 8) and 12·5% (VDRL-, EIA+ and FTA-ABS+) of donors reported that they had been at risk for HIV infection (P = 0·004). One-third of donors came to the blood bank to help a friend or a relative who needed blood. Although donors exposed to syphilis reported and recognised some high risk behaviour, most were motivated by direct appeal to donate blood. Monitoring the risk profile of blood donors can benefit public health and improve blood safety.
Prognostic Markers of Death for Chagas Disease in Remote Areas of Brazil
Revista do Instituto de Medicina Tropical de São Paulo, 2021
This is an open-access article distributed under the terms of the Creative Commons Attribution Li... more This is an open-access article distributed under the terms of the Creative Commons Attribution License.
0 0 1 227 1294 UFSJ 10 3 1518 14.0 Normal 0 false false false PT-BR JA X-NONE Objetivo: Avaliar a... more 0 0 1 227 1294 UFSJ 10 3 1518 14.0 Normal 0 false false false PT-BR JA X-NONE Objetivo: Avaliar a prevalencia da sindrome metabolica (SM) em mulheres com mais de 40 anos, comparando dois criterios internacionais. Metodos: Estudo descritivo transversal, de base populacional, envolvendo 93 mulheres, com idade entre 40 a 59 anos, acompanhadas em Unidades Basicas e Programas de Saude da Familia de Divinopolis-MG. Foram realizadas avaliacoes clinicas, antropometricas e bioquimicas. Para o diagnostico de SM foram empregados dois criterios internacionais: Adult Treatment Panel III of the National Cholesterol Education Program (NCEP/ATP III) e International Diabetes Federation (IDF), que utilizam a presenca de tres ou mais dos seguintes criterios alterados: circunferencia da cintura (CC), triglicerideos (TG), HDL, pressao arterial e glicemia. Resultados: Foram avaliadas 93 pacientes, 54 mulheres entre 40 a 49 anos (58,7%) e 39 entre 50 a 59 anos (41,3%). O parâmetro individual mais alterado...
Revista do Instituto de Medicina Tropical de São Paulo, 2021
The SaMi-Trop project is a cohort study conducted in 21 municipalities of endemic areas of Chagas... more The SaMi-Trop project is a cohort study conducted in 21 municipalities of endemic areas of Chagas disease, including 1,959 patients with chronic Chagas cardiomyopathy. In this article we updated the results of the project, adding information from the second cohort visit. Trypanosoma cruzi-seropositive patients were enrolled from the primary care Telehealth service in Minas Gerais State, Brazil. The eligibility criterium for the second visit was the participation in the baseline evaluation. Of 1,959 participants at the baseline assessment, 1,585 (79.9%) returned after two years for the second evaluation. The mortality rate was 6.7%, but varied from 0.9% to 18.2% when it was stratified by certain clinical characteristics. A lower age-adjusted NT-Pro-BNP level (less than 300) and a prior benznidazole treatment were associated with lower mortality. There was an improvement in most quality of life domain scores. Participants have also reported fewer signs and symptoms and greater use of medication. The second follow-up visit will be complete in Oct 2021.
Revista do Instituto de Medicina Tropical de São Paulo, 2021
Chagas disease (CD) is still a neglected disease. Infected individuals are diagnosed late, being ... more Chagas disease (CD) is still a neglected disease. Infected individuals are diagnosed late, being treated in worse clinical conditions. Thus, this study aimed to analyze the prevalence and the factors associated with new confirmed cases of CD identified by serological screening in an endemic region of Minas Gerais State, Brazil. This is an analytical crosssectional study with data from a project of the Research Center in Tropical Medicine of Sao Paulo-Minas Gerais (SaMi-Trop) conducted in two municipalities. Data collection included a questionnaire with closed questions, a venous blood collection and an ELISA serological test for CD. A total of 2,038 individuals with no previous diagnosis of CD participated in the study. The result of the serological test for CD was adopted as the dependent variable. The independent variables addressed personal issues, health conditions and lifetime housing. A descriptive analysis of individual variables was performed. Subsequently, a bivariate analysis was performed using the Pearson's chi-square test. Households sheltering individuals positive for CD were georeferenced, and the analysis of spatial distribution was performed using the quartic function to estimate the density of the nucleus. Among the participants, 188 (9.2 %) were positive for CD. The profile of participants with CD was associated with place of residence, age, relative/family member with CD and living conditions. It is noteworthy that there are still patients with CD who are unaware of their diagnosis in both, rural and urban areas.
PLOS Neglected Tropical Diseases, 2020
Chagas disease (CD) is a neglected tropical disease and its main consequence is chronic chagasic ... more Chagas disease (CD) is a neglected tropical disease and its main consequence is chronic chagasic cardiomyopathy (CCC). The clinical manifestations of CD can cause functional limitation and impact on the perception of quality of life (QoL). We evaluated the QoL profile of patients with CD living in remote regions, and their association with socio-demographic, behavioral, and clinical characteristics.A cross-sectional study, using the baseline of a cohort study (SaMi-Trop) was conducted in the state of Minas Gerais, Brazil, an endemic region for CD. The cohort is composed of 1959 patients with CD. The patients were interviewed, and blood collection and electrocardiogram (ECG) were performed. The WHO-QOL-BREF scale was used to assess QoL. Descriptive statistics were performed and, for the QoL scale, measures of central tendency and dispersion were calculated. Inflated beta regression models constructed using the gamlss framework were used, and fitted using R software. A significance level of 5% for all analyzes was adopted.QoL was evaluated in 625 participants. The Environment (57.66) and Social Relationships (73.17) domains presented the lowest and highest QoL score respectively. There was no statistically significant difference between QoL domains in the presence of CCC. In the multivariate analysis, the factors associated with a lower QoL were in the Physical domain age increase (OR: 0.95, CI: 0.91-0.99) and using an angiotensin converting enzyme inhibitor (OR 0.89; CI: 0.80-0.99); in the Social Relations domain a history of acute myocardial infarction (OR: 0.75; CI: 0.61-0.92); and in the Environment domain age increase (OR 0.94, CI 0.91-0.97). The factor associated with higher QoL was the use of angiotensin receptor blockers (OR: 1.15; CI 1.04-1.26).The findings of this study reinforce the importance of QoL indicators for planning care and clinical management of patients from remote regions with CD.
Association between typical electrocardiographic abnormalities and NT-proBNP elevation in a large cohort of patients with Chagas disease from endemic area
Journal of Electrocardiology, 2018
Chagas cardiomyopathy is the most harmful complication of Chagas disease. The electrocardiogram i... more Chagas cardiomyopathy is the most harmful complication of Chagas disease. The electrocardiogram is a well-studied exam and has been considered an important tool for detection and evaluation of Chagas cardiomyopathy since the first years of its description. Many of its abnormalities have been described as associated with a worse prognosis. Serum BNP levels were described as inversely related to the left ventricular ejection fraction and as an independent predictor of death. It was not reported how electrocardiographic alterations correlate to NT-proBNP and its analog. The present study aims to describe the baseline electrocardiograms of a large cohort of patients with Chagas disease from endemic area and to establish an association between the number of electrocardiogram alterations and high levels of NT-ProBNP in Chagas disease patients. This study selected 1959 Chagas disease patients in 21 municipalities within a limited region in the northern part of the State of Minas Gerais (Brazil), 1084 of them had Chagas cardiomyopathy. NT-proBNP levels were suggestive of heart failure in 11.7% of this population. One or more electrocardiographic alterations have an Odds Ratio of 9.12 (CI 95% 5.62-14.80) to have NT-proBNP elevation. Considering the association between the number of 1, 2, and 3 or more alterations in electrocardiogram and NT-proBNP elevation, the ORs were 7.11 (CI 95% 4.33-11.67); 16.04 (CI 95% 9.27-27.77) and 47.82 (CI 95% 17.98-127.20), respectively. The presence and the number of typical electrocardiographic alterations of Chagas disease are independently associated with the severity of the cardiomyopathy.
PLOS Neglected Tropical Diseases, 2018
The effectiveness of anti-parasite treatment with benznidazole in the chronic Chagas disease (ChD... more The effectiveness of anti-parasite treatment with benznidazole in the chronic Chagas disease (ChD) remains uncertain. We evaluated, using data from the NIH-sponsored SaMi-Trop prospective cohort study, if previous treatment with benznidazole is associated with lower mortality, less advanced cardiac disease and lower parasitemia in patients with chronic ChD. The study enrolled 1,959 ChD patients and abnormal electrocardiogram (ECG) from in 21 remote towns in Brazil. A total of 1,813 patients were evaluated at baseline and after two years of follow-up. Those who received at least one course of benznidazole were classified as treated group (TrG = 493) and those who were never treated as control group (CG = 1,320). The primary outcome was death after two-year follow-up; the secondary outcomes were presence at the baseline of major ChD-associated ECG abnormalities, NT-ProBNP levels suggestive of heart failure, and PCR positivity. Mortality after two years was 6.3%; it was lower in the TrG (2.8%) than the CG (7.6%); adjusted OR: 0.37 (95%CI: 0.21;0.63). The ECG abnormalities typical for ChD and high age-adjusted NT-ProBNP levels suggestive of heart failure were lower in the TrG than the CG, OR: 0.35 [CI: 0.23;0.53]. The TrG had significantly lower rates of PCR positivity, OR: 0.35 [CI: 0.27;0.45].
BMJ open, May 4, 2016
We have established a prospective cohort of 1959 patients with chronic Chagas cardiomyopathy to e... more We have established a prospective cohort of 1959 patients with chronic Chagas cardiomyopathy to evaluate if a clinical prediction rule based on ECG, brain natriuretic peptide (BNP) levels, and other biomarkers can be useful in clinical practice. This paper outlines the study and baseline characteristics of the participants. The study is being conducted in 21 municipalities of the northern part of Minas Gerais State in Brazil, and includes a follow-up of 2 years. The baseline evaluation included collection of sociodemographic information, social determinants of health, health-related behaviours, comorbidities, medicines in use, history of previous treatment for Chagas disease, functional class, quality of life, blood sample collection, and ECG. Patients were mostly female, aged 50-74 years, with low family income and educational level, with known Chagas disease for >10 years; 46% presented with functional class >II. Previous use of benznidazole was reported by 25.2% and permane...
Revista do Instituto de Medicina Tropical de São Paulo, 2022
This is an open-access article distributed under the terms of the Creative Commons Attribution Li... more This is an open-access article distributed under the terms of the Creative Commons Attribution License.
Journal of Clinical Immunology, 2021
Cardiomyopathies are an important cause of heart failure and sudden cardiac death. Little is know... more Cardiomyopathies are an important cause of heart failure and sudden cardiac death. Little is known about the role of rare genetic variants in inflammatory cardiomyopathy. Chronic Chagas disease cardiomyopathy (CCC) is an inflammatory cardiomyopathy prevalent in Latin America, developing in 30% of the 6 million patients chronically infected by the protozoan Trypanosoma cruzi, while 60% remain free of heart disease (asymptomatic (ASY)). The cytokine interferon-γ and mitochondrial dysfunction are known to play a major pathogenetic role. Chagas disease provides a unique model to probe for genetic variants involved in inflammatory cardiomyopathy. Methods We used whole exome sequencing to study nuclear families containing multiple cases of Chagas disease. We searched for rare pathogenic variants shared by all family members with CCC but absent in infected ASY siblings and in unrelated ASY. Results We identified heterozygous, pathogenic variants linked to CCC in all tested families on 22 d...
Incidence and Predictors of Progression to Chagas Cardiomyopathy: Long-Term Follow-Up of Trypanosoma cruzi –Seropositive Individuals
Circulation, 2021
Background: There are few contemporary cohorts of Trypanosoma cruzi –seropositive individuals, an... more Background: There are few contemporary cohorts of Trypanosoma cruzi –seropositive individuals, and the basic clinical epidemiology of Chagas disease is poorly understood. Herein, we report the incidence of cardiomyopathy and death associated with T. cruzi seropositivity. Methods: Participants were selected in blood banks at 2 Brazilian centers. Cases were defined as T. cruzi –seropositive blood donors. T. cruzi –seronegative controls were matched for age, sex, and period of donation. Patients with established Chagas cardiomyopathy were recruited from a tertiary outpatient service. Participants underwent medical examination, blood collection, ECG, and echocardiogram at enrollment (2008–2010) and at follow-up (2018–2019). The primary outcomes were all-cause mortality and development of cardiomyopathy, defined as the presence of a left ventricular ejection fraction <50% or QRS complex duration ≥120 ms, or both. To handle loss to follow-up, a sensitivity analysis was performed using ...
Vox Sanguinis, 2020
Background and objectives-Incidence in first-time and repeat blood donors is an important measure... more Background and objectives-Incidence in first-time and repeat blood donors is an important measure of transfusion-transmitted HIV infection (TT-HIV) risk. This study assessed HIV incidence over time at four large blood centers in Brazil. Materials and methods-Donations were screened and confirmed using serological assays for HIV from 2007-2016, and additionally screened by nucleic acid testing from 2011 forward. Limiting antigen (LAg) avidity testing was conducted on HIV seroreactive samples from first-time donors to classify whether an infection was recently acquired. We calculated incidence in firsttime donors using the mean duration of recent infection and in repeat donors using classical methods. Time and demographic trends were assessed using Poisson regression. Results-Over the 10-year period, HIV incidence in first-time donors was highest in Recife (45.1/100,000 person-years (10 5 py)) followed by São Paulo (32.2/10 5 py) and then Belo Horizonte (23.3/10 5 py), and in repeat donors was highest in Recife (33.2/10
European Heart Journal, 2018
Assessment and intervention in tricuspid, the no longer forgotten valve / Various cardiomyopahies... more Assessment and intervention in tricuspid, the no longer forgotten valve / Various cardiomyopahies 311 years. The indication(s) for TVR were: any TR with an enlarged annulus (n=6), moderate or less TR (n=5), moderate or more (n=5), any TR (n=3). The majority of patients underwent repair with an annuloplasty ring while a minority underwent suture annuloplasty. There was no difference in 30-day/in-hospital mortality between TVR+ and TVR− (RR: 1.31 95% confidence interval (95% CI): 0.85, 2.02, p=0.25). The incidence of new permanent pacemaker implantation was higher in the TVR+ group (RR: 2.73, 95% CI: 2.57, 2.89, p<0.01). TVR+ was protective against late moderate to severe TR (IRR: 0.26, 95% CI: 0.16, 0.43; p<0.01) and severe TR (IRR: 0.32, 95% CI: 0.11, 0.91, p=0.03). There was a trend towards a lower rate of late TV reoperation in a pooled analysis of five studies (IRR: 0.36, 95% CI: 0.13,1.02; p=0.06). Overall, there was no difference in late mortality between TVR+ and TVR− (Figure-IRR: 0.87, 95% CI: 0.63, 1.20 p=0.39).
Differential Diagnostic Method and Kit for Infectious and Parasitic Diseases, Using Flow Cytometry
European journal of heart failure, 2015
The significance of detection of Trypanosoma cruzi DNA in blood of antibody-positive patients for... more The significance of detection of Trypanosoma cruzi DNA in blood of antibody-positive patients for risk of development of Chagas heart disease is not well established. The objective of this study was to compare detection of T. cruzi DNA with known clinical and laboratory markers of Chagas cardiomyopathy (CC) severity. This is a case-control study nested within a retrospective cohort developed in Brazil to understand the natural history of Chagas disease. The study enrolled 499 T. cruzi seropositive blood donors (SP-BD) and 488 frequency matched seronegative control donors (SN-BD) who had donated between 1996 and 2002, and 101 patients with clinically diagnosed CC. In 2008-2010 all enrolled subjects underwent a health questionnaire, medical examination, electrocardiograms and echocardiograms and polymerase chain reaction (PCR) analyses. A blinded panel of three cardiologists adjudicated the outcome of CC. Trypanosoma cruzi kinetoplast minicircle sequences were amplified by real-time P...
Dengue RNA among blood donors and recipients during large epidemics of DENV-4 in Rio de Janeiro and Recife, Brazil
Cadernos de Saúde Pública, 2010
Este estudo teve como objetivo descrever a distribuição espacial e temporal dos candidatos à doaç... more Este estudo teve como objetivo descrever a distribuição espacial e temporal dos candidatos à doação de sangue, do Município de Belo Horizonte, Minas Gerais, Brasil, que se apresentaram no hemocentro da Fundação Hemominas, nos anos de 1994 e 2004. Comparou no espaço e no espaço-tempo as características idade, sexo e aptidão clínica destes candidatos. As informações de 1994, obtidas de estudo transversal, e as de 2004, amostrados entre os candidatos à doação durante o ano. As amostras foram georreferenciadas através dos endereços de residência. As técnicas espaciais utilizadas foram: mapas Kernel, mapas temáticos de taxas Bayesianas empíricas e de taxas brutas e o índice de Moran global. Os resultados indicaram que a distribuição espacial de candidatos não foi aleatória. Os mapas Kernel auxiliaram na detecção de locais com maior ou menor concentração de candidatos. Os mapas temáticos descreveram a concentração de candidatos relativos à população para as diferentes categorias analisada...
Recent advances in characterization of nonviral vectors for delivery of nucleic acids: impact on their biological performance
Expert opinion on drug delivery, 2015
Nucleic acid delivery is a complex process that requires transport across numerous extracellular ... more Nucleic acid delivery is a complex process that requires transport across numerous extracellular and intracellular barriers, whose impact is often neglected during optimization studies. As such, the development of nonviral vectors for efficient delivery would benefit from an understanding of how these barriers relate to the physicochemical properties of lipoplexes and polyplexes. This review focuses on the evaluation of parameters associated with barriers to delivery such as blood and immune cells compatibility which, as a collective, may serve as a useful prescreening tool for the advancement of nonviral vectors in vivo. An outline of the most relevant rationally developed polyplexes and lipoplexes for clinical application is also given. The evaluation of scientifically recognized parameters enabled the identification of systemic delivered nonviral vectors' behavior while in blood as one of the key determinants of vectors function and activity both in vitro and in vivo. This mu...
Demographic, risk factors and motivations among blood donors with reactive serologic tests for syphilis in São Paulo, Brazil
Transfusion Medicine, 2014
To identify the demographic characteristics, risk factors and motivations for donating among bloo... more To identify the demographic characteristics, risk factors and motivations for donating among blood donors with reactive serologic tests for syphilis. Post-donation interviews with syphilis seropositive blood donors improve recruitment and screening strategies. This case-control study compares 75 Venereal Disease Research Laboratory (VDRL) &amp;gt; 8, EIA+ (enzyme immunoassay) and FTA-ABS+ (fluorescent treponemal antibody); 80 VDRL-, EIA+ and FTA-ABS+; and 34 VDRL- and EIA- donors between 2004 and 2009. Donors were assessed by their demographic characteristics, sexual behaviour, history of alcohol and illicit drugs use, and motivations to donate. Donors with VDRL &amp;gt; 8 were more likely to be divorced [AOR = 12·53; 95% confidence interval (CI) 1·30-120·81], to have had more than six sexual partners (AOR=7·1; 95% CI 1·12-44·62) and to report male-male-sex in the past 12 months (AOR=8·18; 95% CI 1·78-37·60). Donors with VDRL-, EIA+ and FTA-ABS+ were less likely to be female (AOR=0·26; 95% CI 0·07-0·96), more likely to be older (AOR=10·2; 95% CI 2·45-42·58 ≥ 39 and &amp;lt;60 years old) and to have had more than six sexual partners in the past 12 months (AOR = 8·37; 95% CI 1·49-46·91). There was no significant difference among groups regarding illicit drugs use; 30·7% (VDRL &amp;gt; 8) and 12·5% (VDRL-, EIA+ and FTA-ABS+) of donors reported that they had been at risk for HIV infection (P = 0·004). One-third of donors came to the blood bank to help a friend or a relative who needed blood. Although donors exposed to syphilis reported and recognised some high risk behaviour, most were motivated by direct appeal to donate blood. Monitoring the risk profile of blood donors can benefit public health and improve blood safety.
Prognostic Markers of Death for Chagas Disease in Remote Areas of Brazil
Revista do Instituto de Medicina Tropical de São Paulo, 2021
This is an open-access article distributed under the terms of the Creative Commons Attribution Li... more This is an open-access article distributed under the terms of the Creative Commons Attribution License.
0 0 1 227 1294 UFSJ 10 3 1518 14.0 Normal 0 false false false PT-BR JA X-NONE Objetivo: Avaliar a... more 0 0 1 227 1294 UFSJ 10 3 1518 14.0 Normal 0 false false false PT-BR JA X-NONE Objetivo: Avaliar a prevalencia da sindrome metabolica (SM) em mulheres com mais de 40 anos, comparando dois criterios internacionais. Metodos: Estudo descritivo transversal, de base populacional, envolvendo 93 mulheres, com idade entre 40 a 59 anos, acompanhadas em Unidades Basicas e Programas de Saude da Familia de Divinopolis-MG. Foram realizadas avaliacoes clinicas, antropometricas e bioquimicas. Para o diagnostico de SM foram empregados dois criterios internacionais: Adult Treatment Panel III of the National Cholesterol Education Program (NCEP/ATP III) e International Diabetes Federation (IDF), que utilizam a presenca de tres ou mais dos seguintes criterios alterados: circunferencia da cintura (CC), triglicerideos (TG), HDL, pressao arterial e glicemia. Resultados: Foram avaliadas 93 pacientes, 54 mulheres entre 40 a 49 anos (58,7%) e 39 entre 50 a 59 anos (41,3%). O parâmetro individual mais alterado...
Revista do Instituto de Medicina Tropical de São Paulo, 2021
The SaMi-Trop project is a cohort study conducted in 21 municipalities of endemic areas of Chagas... more The SaMi-Trop project is a cohort study conducted in 21 municipalities of endemic areas of Chagas disease, including 1,959 patients with chronic Chagas cardiomyopathy. In this article we updated the results of the project, adding information from the second cohort visit. Trypanosoma cruzi-seropositive patients were enrolled from the primary care Telehealth service in Minas Gerais State, Brazil. The eligibility criterium for the second visit was the participation in the baseline evaluation. Of 1,959 participants at the baseline assessment, 1,585 (79.9%) returned after two years for the second evaluation. The mortality rate was 6.7%, but varied from 0.9% to 18.2% when it was stratified by certain clinical characteristics. A lower age-adjusted NT-Pro-BNP level (less than 300) and a prior benznidazole treatment were associated with lower mortality. There was an improvement in most quality of life domain scores. Participants have also reported fewer signs and symptoms and greater use of medication. The second follow-up visit will be complete in Oct 2021.
Revista do Instituto de Medicina Tropical de São Paulo, 2021
Chagas disease (CD) is still a neglected disease. Infected individuals are diagnosed late, being ... more Chagas disease (CD) is still a neglected disease. Infected individuals are diagnosed late, being treated in worse clinical conditions. Thus, this study aimed to analyze the prevalence and the factors associated with new confirmed cases of CD identified by serological screening in an endemic region of Minas Gerais State, Brazil. This is an analytical crosssectional study with data from a project of the Research Center in Tropical Medicine of Sao Paulo-Minas Gerais (SaMi-Trop) conducted in two municipalities. Data collection included a questionnaire with closed questions, a venous blood collection and an ELISA serological test for CD. A total of 2,038 individuals with no previous diagnosis of CD participated in the study. The result of the serological test for CD was adopted as the dependent variable. The independent variables addressed personal issues, health conditions and lifetime housing. A descriptive analysis of individual variables was performed. Subsequently, a bivariate analysis was performed using the Pearson's chi-square test. Households sheltering individuals positive for CD were georeferenced, and the analysis of spatial distribution was performed using the quartic function to estimate the density of the nucleus. Among the participants, 188 (9.2 %) were positive for CD. The profile of participants with CD was associated with place of residence, age, relative/family member with CD and living conditions. It is noteworthy that there are still patients with CD who are unaware of their diagnosis in both, rural and urban areas.
PLOS Neglected Tropical Diseases, 2020
Chagas disease (CD) is a neglected tropical disease and its main consequence is chronic chagasic ... more Chagas disease (CD) is a neglected tropical disease and its main consequence is chronic chagasic cardiomyopathy (CCC). The clinical manifestations of CD can cause functional limitation and impact on the perception of quality of life (QoL). We evaluated the QoL profile of patients with CD living in remote regions, and their association with socio-demographic, behavioral, and clinical characteristics.A cross-sectional study, using the baseline of a cohort study (SaMi-Trop) was conducted in the state of Minas Gerais, Brazil, an endemic region for CD. The cohort is composed of 1959 patients with CD. The patients were interviewed, and blood collection and electrocardiogram (ECG) were performed. The WHO-QOL-BREF scale was used to assess QoL. Descriptive statistics were performed and, for the QoL scale, measures of central tendency and dispersion were calculated. Inflated beta regression models constructed using the gamlss framework were used, and fitted using R software. A significance level of 5% for all analyzes was adopted.QoL was evaluated in 625 participants. The Environment (57.66) and Social Relationships (73.17) domains presented the lowest and highest QoL score respectively. There was no statistically significant difference between QoL domains in the presence of CCC. In the multivariate analysis, the factors associated with a lower QoL were in the Physical domain age increase (OR: 0.95, CI: 0.91-0.99) and using an angiotensin converting enzyme inhibitor (OR 0.89; CI: 0.80-0.99); in the Social Relations domain a history of acute myocardial infarction (OR: 0.75; CI: 0.61-0.92); and in the Environment domain age increase (OR 0.94, CI 0.91-0.97). The factor associated with higher QoL was the use of angiotensin receptor blockers (OR: 1.15; CI 1.04-1.26).The findings of this study reinforce the importance of QoL indicators for planning care and clinical management of patients from remote regions with CD.
Association between typical electrocardiographic abnormalities and NT-proBNP elevation in a large cohort of patients with Chagas disease from endemic area
Journal of Electrocardiology, 2018
Chagas cardiomyopathy is the most harmful complication of Chagas disease. The electrocardiogram i... more Chagas cardiomyopathy is the most harmful complication of Chagas disease. The electrocardiogram is a well-studied exam and has been considered an important tool for detection and evaluation of Chagas cardiomyopathy since the first years of its description. Many of its abnormalities have been described as associated with a worse prognosis. Serum BNP levels were described as inversely related to the left ventricular ejection fraction and as an independent predictor of death. It was not reported how electrocardiographic alterations correlate to NT-proBNP and its analog. The present study aims to describe the baseline electrocardiograms of a large cohort of patients with Chagas disease from endemic area and to establish an association between the number of electrocardiogram alterations and high levels of NT-ProBNP in Chagas disease patients. This study selected 1959 Chagas disease patients in 21 municipalities within a limited region in the northern part of the State of Minas Gerais (Brazil), 1084 of them had Chagas cardiomyopathy. NT-proBNP levels were suggestive of heart failure in 11.7% of this population. One or more electrocardiographic alterations have an Odds Ratio of 9.12 (CI 95% 5.62-14.80) to have NT-proBNP elevation. Considering the association between the number of 1, 2, and 3 or more alterations in electrocardiogram and NT-proBNP elevation, the ORs were 7.11 (CI 95% 4.33-11.67); 16.04 (CI 95% 9.27-27.77) and 47.82 (CI 95% 17.98-127.20), respectively. The presence and the number of typical electrocardiographic alterations of Chagas disease are independently associated with the severity of the cardiomyopathy.
PLOS Neglected Tropical Diseases, 2018
The effectiveness of anti-parasite treatment with benznidazole in the chronic Chagas disease (ChD... more The effectiveness of anti-parasite treatment with benznidazole in the chronic Chagas disease (ChD) remains uncertain. We evaluated, using data from the NIH-sponsored SaMi-Trop prospective cohort study, if previous treatment with benznidazole is associated with lower mortality, less advanced cardiac disease and lower parasitemia in patients with chronic ChD. The study enrolled 1,959 ChD patients and abnormal electrocardiogram (ECG) from in 21 remote towns in Brazil. A total of 1,813 patients were evaluated at baseline and after two years of follow-up. Those who received at least one course of benznidazole were classified as treated group (TrG = 493) and those who were never treated as control group (CG = 1,320). The primary outcome was death after two-year follow-up; the secondary outcomes were presence at the baseline of major ChD-associated ECG abnormalities, NT-ProBNP levels suggestive of heart failure, and PCR positivity. Mortality after two years was 6.3%; it was lower in the TrG (2.8%) than the CG (7.6%); adjusted OR: 0.37 (95%CI: 0.21;0.63). The ECG abnormalities typical for ChD and high age-adjusted NT-ProBNP levels suggestive of heart failure were lower in the TrG than the CG, OR: 0.35 [CI: 0.23;0.53]. The TrG had significantly lower rates of PCR positivity, OR: 0.35 [CI: 0.27;0.45].
BMJ open, May 4, 2016
We have established a prospective cohort of 1959 patients with chronic Chagas cardiomyopathy to e... more We have established a prospective cohort of 1959 patients with chronic Chagas cardiomyopathy to evaluate if a clinical prediction rule based on ECG, brain natriuretic peptide (BNP) levels, and other biomarkers can be useful in clinical practice. This paper outlines the study and baseline characteristics of the participants. The study is being conducted in 21 municipalities of the northern part of Minas Gerais State in Brazil, and includes a follow-up of 2 years. The baseline evaluation included collection of sociodemographic information, social determinants of health, health-related behaviours, comorbidities, medicines in use, history of previous treatment for Chagas disease, functional class, quality of life, blood sample collection, and ECG. Patients were mostly female, aged 50-74 years, with low family income and educational level, with known Chagas disease for >10 years; 46% presented with functional class >II. Previous use of benznidazole was reported by 25.2% and permane...