Raymundo S Azevedo | Universidade de São Paulo (original) (raw)

Papers by Raymundo S Azevedo

Medicine, 2020

Abstract In a hepatitis C virus (HCV)/HIV-positive Brazilian cohort, evaluate the safety and effi... more Abstract In a hepatitis C virus (HCV)/HIV-positive Brazilian cohort, evaluate the safety and efficacy of HCV DAAs, the frequency of resistance substitutions in the HCV NS5A and NS5B genes and identify predictors of treatment failure. Retrospective multicenter study of HCV/HIV patients treated with sofosbuvir (SOF)-based regimens at 10 reference centers in Brazil. Clinical and virological data were collected. Genetic diversity in the NS5A and NS5B genes was assessed by direct nucleotide sequencing. The primary outcome was sustained virological response (SVR) 12 weeks after DAA completion. Of 643 HCV/HIV patients analyzed, 74.7% were male, median CD4+ T cell count was 617 cells/mm3, 90% had an undetectable HIV viral load. HCV genotype 1 was detected in 80.2%, and 60% were taking at least 1 medication other than antiretroviral drugs during their DAA therapy. Cirrhosis was present in 42%. An SOF/daclatasvir (DCV) regimen was used in most patients (98%). The frequency of NS5A polymorphisms associated with clinically relevant resistance to DCV was 2%; no relevant NS5B variants were identified. The SVR12 rate was 92.8% in an intention to treat (ITT) analysis and 96% in a modified ITT (m-ITT) analysis. AE occurred in 1.6% of patients. By multivariate analysis, therapeutic failure was associated, in the m-ITT analysis, with concomitant use of anticonvulsant drugs (P = .001), age (P = .04), and female gender (P = .04). SOF/DCV regimens were associated with a high SVR rate in an HCV/HIV population. The use of concurrent anticonvulsant drugs and DAAs decreases the chances of achieving an SVR.

Jornal de Pediatria, 2019

Objective: To determine decision limits for total cholesterol, LDL-cholesterol, non-HDL cholester... more Objective: To determine decision limits for total cholesterol, LDL-cholesterol, non-HDL cholesterol, HDL-cholesterol, and triglycerides in healthy children and adolescents from Cuiabá, Brazil. Methods: This was a cross-sectional study of 1866 healthy children and adolescents randomly selected from daycare centers and public schools in Cuiabá. The desirable levels of serum lipids were defined using the classic criteria, i.e., total cholesterol, LDL-cholesterol, non-HDL cholesterol, and triglycerides levels below the P75 percentile, and HDL-c above the P10 percentile. Results: For CT, P75 was: 160 mg/dL for the age range of 1 to <3 years, 170 mg/dL for ≥3 to <9 years, and 176 mg/dL for ≥9 to <13 years. For non-HDL cholesterol, it was 122 mg/dL for the age range of 1 to <13 years. For LDL-c, it was 104 mg/dL at the age range of 1 to <9 years and 106 mg/dL from ≥9 to <13 years. For TG, it was 127 mg/dL from 1 to <2 years; 98 mg/dL from ≥2 to <6 years; and 92 mg/dL from ≥6 to <13 years. As for HDL-cholesterol, P10 was 24 mg/dL, 28 mg/dL, 32 mg/dL, and 36 mg/dL, for the age ranges of 1 to <2 years, ≥2 to <3 years, ≥3 to <4 years, and ≥4 to <13 years, respectively. Conclusion: The decision limits for the serum lipid levels defined in this study differed from those observed in the current Brazilian and North-American guidelines, especially because it ଝ Please cite this article as: Slhessarenko N, Fontes CJ, Slhessarenko ME, Azevedo RS, Andriolo A. Proposition of decision limits for serum lipids in Brazilian children aged one to 13 years.

Gastrointestinal Endoscopy, 2017

Breeders of Cockatiels, Lovebirds, and Zebra Finches "B IRDSÕ F ALL I(INDS \\ h • and d' everyt 1... more Breeders of Cockatiels, Lovebirds, and Zebra Finches "B IRDSÕ F ALL I(INDS \\ h • and d' everyt 109 you nee 10 bird supplies •~E SHIP BIRDS • Sen'd stamped, self•addressed envelope for prices. Hours: 9 a.m. to 5 p.m. Closed Mon.

Dst J Bras Doencas Sex Transm, 2003

Journal of Rehabilitation Medicine Official Journal of the Uems European Board of Physical and Rehabilitation Medicine, Oct 1, 2010

This should read: Interestingly, Martin et al. (41) selected similar acupuncture points to those ... more This should read: Interestingly, Martin et al. (41) selected similar acupuncture points to those used in our study (LI4, SP6 and PC6). We did not use ST36, H7 and LR2. We selected GB34, LR3 and Ex-HN-3 instead.

American Journal of Clinical Pathology, 1999

With the goal of reducing false-positive results in enzyme-linked immunosorbent assay (ELISA) ser... more With the goal of reducing false-positive results in enzyme-linked immunosorbent assay (ELISA) serodiagnosis of hepatitis C virus in clinical practice, a study was undertaken to establish better cutoff values. We examined 277 serum samples from patients with hepatitis (non-A, non-B; B; autoimmune); subjects with antinuclear antibodies or rheumatoid factor, anticytomegalovirus or Epstein-Barr virus IgG or IgM antibodies, or parasitic disease (Chagas disease, leishmaniasis); and healthy volunteers. Concordant positive results in 2 different immunoblot assays in 250 samples were taken as indicative of true-positive, and when negative, of absence of infection. Reactivity in 3 ELISA tests were evaluated for the manufacturer recommended cutoff (CO) andfor2CO, 3CO, and 4CO; and corresponding sensitivity and specificity were calculated for single or combined pairs of ELISA tests. Although CO is adequate for blood bank screening, because it provides maximal sensitivity, the frequently observed false-positive results could be significantly reduced by increasing the cutoff value to 2CO, with no significant loss in sensitivity either in relation to pairs of immunoenzymatic tests or to a single ELISA.

Clinics, 2012

OBJECTIVES: To determine the frequency of medical adverse events in elderly patients admitted to ... more OBJECTIVES: To determine the frequency of medical adverse events in elderly patients admitted to an acute care geriatric unit, the predictive factors of occurrence, and the correlation between adverse events and hospital mortality rates. METHODS: This prospective study included 171 admissions of patients aged 60 years and older in the acute care geriatric unit in a teaching hospital in Brazil between 2007 and 2008. The following variables were assessed at admission: the patient age, gender, number of prescription drugs, geriatric syndromes (e.g., immobility, postural instability, dementia, depression, delirium, and incontinence), comorbidities, functional status (evaluated with the Katz Index of Independence in Activities of Daily Living), and severity of illness (evaluated with the Simplified Acute Physiology Score II). The incidence of delirium, infection, mortality, and the prescription of potentially inappropriate medications (based on the Beers criteria) were assessed during hospitalization. An observer who was uninvolved in patient care reported the adverse events. RESULTS: The mean age of the sample was 78.12 years. A total of 187 medical adverse events occurred in 94 admissions (55%). The predictors of medical adverse events were undetermined. Compared with the patients with no adverse events, the patients with medical adverse events had a significantly longer hospital stay (21.41¡15.08 days versus 10.91¡7.21 days) and a higher mortality rate (39 deaths [41.5%] versus 17 deaths [22.1%]). Mortality was significantly predicted by the Simplified Acute Physiology Score II score (odds ratio [OR] = 1.13, confidence interval [CI] 95%, 1.07 to 1.20), the Katz score (OR = 1.47, CI 95%, 1.18 to 1.83), and medical adverse events (OR = 3.59, CI 95%, 1.55 to 8.30). CONCLUSION: Medical adverse events should be monitored in every elderly hospitalized patient because there is no risk profile for susceptible patients, and the consequences of adverse events are serious, sometimes leading to longer hospital stays or even death.

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Introduction: There is not so revealable in the society than his diseases history meanly the “soc... more Introduction: There is not so revealable in the society than his diseases history meanly the “social diseases” as alcoholism tuberculosis and syphilis among others. Add aids to this group on the earlier 80’s. We also observed the incarcerated population run high -risk DST/aids infections due their high vulnerability. The arrest condition could be unique to self-care concern. Objective: estimate this population vulnerability identifying their risk behaviour and DST/aids knowledge Methods: To access HIV and anti-pallidum serology and interview 290 female prisoners about their age formal education race sexual behaviour habits and DST/aids knowledge. It was carried out safe-sex workshops based on Paulo Freire’s methods also named “oppressed pedagogy” that it gives a preference to the movements against social exclusion. Results: Prevalence were related to risk behaviour trough contingency tables to obtain OR and chi-square and Fisher tests were performed in order to estimate the statistics significance. The HIV and syphilis prevalence were 13.9% and 22.8% respectively. Conclusion: The high prevalence and the sexual behaviour risk infection associated found in this specific population suggest the sexual route as huge importance. Preventions DST/aids program and other specially aimed to prisoners necessity to women living recluse in the Penal System are highly recommended. Syphilis history has to be reminding as an alert to the society behaviour in order to avoid mistakes that has been done in the past. (authors)

BMC Public Health, 2015

Background: Demographic, geographic, environmental and genetic factors influence lipids. In many ... more Background: Demographic, geographic, environmental and genetic factors influence lipids. In many countries, the normal lipid ranges for laboratory tests are based on references from American children and adolescents. In this work, we determined the reference intervals (RIs) for total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), non-high-density lipoprotein cholesterol (nHDL-c), low-density lipoprotein cholesterol (LDL-c) and triglycerides (TG) in Brazilian healthy children and adolescents. Methods: A cross-sectional study was conducted of 1,866 randomly sampled healthy children and adolescents from kindergartens and schools. Blood samples were collected after a variable period of fasting based on the age of the participant. The upper cutoff points were the 75 th and 95 th percentiles for TC, nHDL-c, LDL-c and TG. The 10 th percentile (low) was used as the bottom level for HDL-c. Non-parametric tests were used for statistical analyses. Results: The following RI and 75 th and 95 th percentiles were observed for each age interval. The 95 th percentile values obtained for TC were: 1 to 2 years, 189 mg/dL, 3 to 8 years, 199 mg/dL; 9 to 12 years, 205 mg/dL. For the nHDL c, the only age group 1 to 12 years, this percentile value was 150 mg/dL. For the LDL-cholesterol, the values corresponding to the percentiles above, aged 1 to 8 years and 9 to 12 years, were 132 mg/dL 139 mg/dL, respectively. For the triglycerides, the values corresponding to 95 th percentile were: 1 year, 189 mg/dL; 2 to 5 years, 139 mg/dL; 6 to 12 years, 139 mg/dL. The 10 th percentiles for HDL-c were 24 mg/dL, 28 mg/dL, 32 mg/dL and 36 mg/dL for children 1, 2, 3 and 4-12 years old, respectively. Conclusions: The lipid reference intervals defined in the studied Brazilian children and adolescents differ from those recommended by the international literature and should be used for clinical decisions contributing to improve the diagnosis in this particular group in our country.

American Journal of Neuroradiology, 2015

BACKGROUND AND PURPOSE: Because evidence-based articles are difficult to recognize among the larg... more BACKGROUND AND PURPOSE: Because evidence-based articles are difficult to recognize among the large volume of publications available, some journals have adopted evidence-based medicine criteria to classify their articles. Our purpose was to determine whether an evidence-based medicine classification used by a subspecialty-imaging journal allowed consistent categorization of levels of evidence among different raters. MATERIALS AND METHODS: One hundred consecutive articles in the American Journal of Neuroradiology were classified as to their level of evidence by the 2 original manuscript reviewers, and their interobserver agreement was calculated. After publication, abstracts and titles were reprinted and independently ranked by 3 different radiologists at 2 different time points. Interobserver and intraobserver agreement was calculated for these radiologists. RESULTS: The interobserver agreement between the original manuscript reviewers was Ϫ0.2283 (standard error ϭ 0.0000; 95% CI, Ϫ0.2283 to Ϫ0.2283); among the 3 postpublication reviewers for the first evaluation, it was 0.1899 (standard error ϭ 0.0383; 95% CI, 0.1149-0.2649); and for the second evaluation, performed 3 months later, it was 0.1145 (standard error ϭ 0.0350; 95% CI, 0.0460-0.1831). The intraobserver agreement was 0.2344 (standard error ϭ 0.0660; 95% CI, 0.1050-0.3639), 0.3826 (standard error ϭ 0.0738; 95% CI, 0.2379-0.5272), and 0.6611 (standard error ϭ 0.0656; 95% CI, 0.5325-0.7898) for the 3 postpublication evaluators, respectively. These results show no-to-fair interreviewer agreement and a tendency to slight intrareviewer agreement. CONCLUSIONS: Inconsistent use of evidence-based criteria by different raters limits their utility when attempting to classify neuroradiology-related articles.

Revista da Associação Médica Brasileira, 2008

Revista da Associação Médica Brasileira, 2009

Clinical Interventions in Aging, 2014

Concentration of cytokines in patients with osteoarthritis of the knee and fibromyalgia Introduct... more Concentration of cytokines in patients with osteoarthritis of the knee and fibromyalgia Introduction: Fibromyalgia and osteoarthritis may present a relationship with the concentration of cytokines. The aim of this study was to compare the serum concentrations of IL-12p70, tumor necrosis factor, IL-10, IL-6, IL-1β, and IL-8 in patients with knee osteoarthritis and fibromyalgia. Materials and methods: The study included 53 women (71.2±7.6 years old) diagnosed with knee osteoarthritis with moderate-to-severe pain (visual analog scale 4) for at least 3 months. Sixty women (54.1±8.1 years old) diagnosed with fibromyalgia according to the American College of Rheumatology criteria and with moderate-to-severe pain (visual analog scale 4) also participated in this study. For the dosage of cytokines, blood was collected in the morning: 5 mL from the cubital vein. The material was centrifuged at 4°C, separated into 100 μL aliquots and stored at-80°C until processing. Serum concentrations of the studied cytokines were assessed using the BD Cytometric Bead Array method. Data were analyzed with Student's t-test and the Mann-Whitney U test. Results: We found higher levels of IL-6, IL-10, and IL-1β in fibromyalgia patients. After adjustment of age as a covariate, there was no statistically significant difference in the concentration of any cytokine between fibromyalgia and knee osteoarthritis patients. Conclusion: Patients with knee osteoarthritis and fibromyalgia with the same duration and intensity of pain demonstrate similar concentrations of cytokines. Aging may play a role in cytokine profile, a finding not so extensively addressed in the literature and one that should be further investigated.

Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 2014

To evaluate the frequency of obesity in postmenopausal women and assess the potential effects of ... more To evaluate the frequency of obesity in postmenopausal women and assess the potential effects of increased body mass index (BMI) on lipoprotein profile and on risk factors for arterial hypertension and diabetes. A cross-sectional study was conducted with 5027 postmenopausal Brazilian women. Analyses were performed of BMI and cardiovascular factors (systemic blood pressure [BP], total cholesterol, low-density lipoprotein, high-density lipoprotein [HDL-C], triglyceride, and fast glucose). The statistical analysis included the chi-square and Mann-Whitney tests. The significance level was set at 5%. Obesity (BMI >30) in our study characterized approximately 30% of the 5027 postmenopausal women. The comparison of patients with normal BMI and those with high BMI showed that high BMI had a significant negative effect on BP, as evidenced by the increased frequency of hypertension in overweight and obese patients (>25) (p < 0.001), that it also negatively and significantly affected ...

PLoS ONE, 2014

Background: This study aimed to identify the transmission pattern of hepatitis A (HA) infection b... more Background: This study aimed to identify the transmission pattern of hepatitis A (HA) infection based on a primary dataset from the Brazilian National Hepatitis Survey in a pre-vaccination context. The national survey conducted in urban areas disclosed two epidemiological scenarios with low and intermediate HA endemicity. Methods: A catalytic model of HA transmission was built based on a national seroprevalence survey (2005 to 2009). The seroprevalence data from 7,062 individuals aged 5-69 years from all the Brazilian macro-regions were included. We built up three models: fully homogeneous mixing model, with constant contact pattern; the highly assortative model and the highly assortative model with the additional component accounting for contacts with infected food/water. Curves of prevalence, force of infection (FOI) and the number of new infections with 99% confidence intervals (CIs) were compared between the intermediate (North, Northeast, Midwest and Federal District) and low (South and Southeast) endemicity areas. A contour plot was also constructed. Results: The anti-HAV IgG seroprevalence was 68.8% (95% CI, 64.8%-72.5%) and 33.7% (95% CI, 32.4%-35.1%) for the intermediate and low endemicity areas, respectively, according to the field data analysis. The models showed that a higher force of infection was identified in the 10-to 19-year-old age cohort (,9,000 infected individuals per year per 100,000 susceptible persons) in the intermediate endemicity area, whereas a higher force of infection occurred in the 15-to 29-yearold age cohort (,6,000 infected individuals per year per 100,000 susceptible persons) for the other macro-regions. Conclusion: Our findings support the shift of Brazil toward intermediate and low endemicity levels with the shift of the risk of infection to older age groups. These estimates of HA force of infection stratified by age and endemicity levels are useful information to characterize the pre-vaccination scenario in Brazil.

Vaccine, 2012

This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.

Vaccine, 2010

The immunogenicity and tolerability of virosome and of split influenza vaccines in patients with ... more The immunogenicity and tolerability of virosome and of split influenza vaccines in patients with sickle cell anemia (SS) were evaluated. Ninety SS patients from 8 to 34 years old were randomly assigned to receive either virosome (n = 43) or split vaccine (n = 47). Two blood samples were collected, one before and one 4-6 weeks after vaccination. Antibodies against viral strains (2006) A/New Caledonia (H1N1), A/California (H3N2), B/Malaysia were determined using the hemagglutinin inhibition test. Post-vaccine reactions were recorded over 7 days. Seroconversion rates for H1N1, H3N2 and B were 65.1%, 60.4% and 83.7% for virosome vaccine, and 68.0%, 61.7% and 68.0% for split vaccine. Seroprotection rates for H1N1, H3N2 e B were 100%, 97.6% and 69.7% for virosome, and 97.8%, 97.8% and 76.6% for split vaccine. No severe adverse reactions were recorded. Virosome and split vaccines in patients with sickle cell anemia were equally immunogenic, with high seroconversion and seroprotection rates. Both vaccines were well tolerated.

Movement Disorders, 2006

We describe the neurological manifestations of 119 patients with WD (93 index cases and 26 affect... more We describe the neurological manifestations of 119 patients with WD (93 index cases and 26 affected family members) seen between 1963 and 2004. The mean age at symptoms onset was 19.6 years (range, 7-37 years). Medical records were reviewed for the patient's first neurological examination. The most frequent neurological manifestations observed were dysarthria (91%), gait disturbance (75%), risus sardonicus (72%), dystonia (69%), rigidity (66%), tremor (60%), and dysphagia (50%). Less frequent manifestations were chorea (16%) and athetosis (14%). Rare neurological presentations were seizures (4.2%), and pyramidal signs (3%).

Gynecological Endocrinology, 2012

To assess the relationship of onset of menopause and body mass on the menopausal symptoms in post... more To assess the relationship of onset of menopause and body mass on the menopausal symptoms in post-menopausal Brazilian women. Observational study conducted by the selection and inclusion of 5968 Brazilian women after menopause. The following variables were analyzed in this study: time at menopause; the relationship between age at menarche and age at menopause; vasomotor symptoms compared with age at the time of menopause and the time of menopause; Kupperman menopausal index (KMI) versus total time of menopause; body mass index (BMI) compared to the time of menopause, vasomotor symptoms, and KMI total score. We used the Chi-square test, and the significance level was set at 5%. The age at natural menopause ranged from 41 to 62 years (mean 48.1 ± 4.07 years). A younger age at menopause was associated with a high intensity of vasomotor symptoms. These symptoms were more intense in the first 5 years of menopause and decreased with time. The KMI total also decreased with time after menopause, with the exception of arthralgia, myalgia, and insomnia, which did not tend to improve over time. In addition, the vasomotor symptoms and total KMI were more frequent with increasing BMI. Our results suggested that the age of menopause and BMI may influence the intensity of vasomotor symptoms.