Escola Paulista de Medicina

São Paulo, Brazil

Escola Paulista de Medicina

São Paulo, Brazil
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SÃO PAULO, 2 de maio de 2017 /PRNewswire/ -- A população das cidades de Coari e Tefé, no Amazonas, receberá um grupo de médicos que farão cirurgias de catarata gratuitamente. Batizada de Projetos Amazônicos – Cirurgias de Catarata do Baixo Amazonas, a ação que conta com a participação de alguns dos maiores especialistas em oftalmologia do Brasil teve início ainda na década de 1990. Neste ano, a ação acontece entre os dias 29 de Abril a 5 de Maio. "A ideia do projeto nasce da necessidade de diminuir o maior número possível de cegueiras reversíveis na região do Amazonas", afirma o idealizador da iniciativa, Dr. Jacob Cohen. O projeto da Fundapi com a Escola Paulista de Medicina conta com o apoio da ZEISS. Criada há 27 anos, cerca de 15 mil cirurgias foram realizadas no estado desde o início da ação. Nos primeiros projetos foram utilizados aviões e barcos para levar os profissionais às mais distantes comunidades. Atuando no combate às dificuldades de visão, os médicos que fazem parte do projeto, muitas vezes, atendem pessoas que nunca tiveram a oportunidade de consultar um oftalmologista. Alguns dos pacientes atendidos pela ação social estavam na fila em busca de uma cirurgia de catarata há aproximadamente dez anos.

Khalil K.H.,University of Sao Paulo | Palma J.H.,University of Sao Paulo | Simonato M.,Escola Paulista de Medicina | Dias R.R.,University of Sao Paulo | Jatene F.,University of Sao Paulo
Annals of Vascular Surgery | Year: 2017

Thoracic aneurysms can potentially cause substantial compression of adjacent structures, creating substantial symptoms. We present a case of a 56-year-old woman with fatigue and dyspnea for 6 months. We discuss her initial endovascular treatment, which was insufficient to improve symptoms, and further surgical intervention was needed to solve the issue. © 2016 Elsevier Inc.

Dias A.C.,Federal University of São Paulo | Araujo M.R.,Instituto Nacional Of Politicas Do Alcool E Drogas | Laranjeira R.,Escola Paulista de Medicina
Revista de Saude Publica | Year: 2011

Objective: To analyze the evolution of drug use among treated crack cocaine users. Methods: A cohort originally comprising 131 crack addicts admitted to a detoxification unit in the city of São Paulo, Southeastern Brazil, between 1992 and 1994 were followed up on three occasions: 1995-96, 1998-99, and 2005- 06. Variables investigated included demographical data, risky sexual behaviors, intake patterns for crack and other substances, incarceration, disappearance, and death. Statistical analysis was carried out using chi-square tests, multinomial logistic regression and Cox regression. Results: Among the patients evaluated, 43 were crack-free (12 months or longer), 22 were users, 13 were imprisoned, two were missing, and 27 were deceased. Three groups with distinct post-discharge drug use patterns were identified. Safe sexual behavior (condom use) was correlated with stable abstinence (p=0.001). Positive HIV test upon admission (p=0.046), use of snorted cocaine in the last year (p=0.001), and lifetime use of snorted cocaine (132 months or longer) (p=0.000) were associated with long term use of crack cocaine. History of intravenous cocaine use increased the probability of death at 12 years by 2.5 fold (p=0.031) (95%CI: 1.08; 5.79). Conclusions: Recurrence and persistence of crack use in the years following discharge reflect new modalities of drug use. On the other hand, stable abstinence patterns provide evidence of the feasibility of recovery from crack addiction.

Moretti A.I.S.,University of Sao Paulo | Souza Pinto F.J.P.,University of Sao Paulo | Cury V.,University of Sao Paulo | Jurado M.C.,University of Sao Paulo | And 3 more authors.
Acta Biomaterialia | Year: 2012

Prosthetic meshes are commonly used to correct abdominal wall defects. However, the inflammatory reaction induced by these devices in the peritoneum is not completely understood. We hypothesized that nitric oxide (NO), produced by nitric oxide synthase 2 (NOS2) may modulate the response induced by mesh implants in the abdominal wall and, consequently, affect the outcome of the surgical procedure. Polypropylene meshes were implanted in the peritoneal side of the abdominal wall in wild-type and NOS2-deficient (NOS2 -/-) mice. After 15 days tissues around the mesh implant were collected, and inflammatory markers (the cytokine interleukin 1β (IL-1β) and NO) and tissue remodeling (collagen and metalloproteinases (MMP) 2 and 9) were analyzed. The lack of NOS2-derived NO induced a higher incidence of visceral adhesions at the mesh implantation site compared with wild-type mice that underwent the same procedure (P < 0.05). Additionally, higher levels of IL-1β were present in the mesh-implanted NOS2 -/- animals compared with control and wild-type mice. Mesh implantation induced collagen I and III deposition, but in smaller amounts in NOS2 -/- mice. MMP-9 activity after the surgical procedure was similarly increased in both groups. Conversely, MMP-2 activity was unchanged in mesh-implanted wild-type mice, but was significantly increased in NOS2 -/- mice (P < 0.01), due to decreased S-nitrosylation of the enzyme in these animals. We conclude that NOS2-derived NO is crucial for an adequate response to and integration of polypropylene mesh implants in the peritoneum. NO deficiency results in a prolonged inflammatory reaction to the mesh implant, and reduced collagen deposition may contribute to an increased incidence of visceral adhesions. © 2011 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Forno E.,University of Pittsburgh | Gogna M.,University of Pittsburgh | Cepeda A.,Metropolitan University of Colombia | Yanez A.,Hospital Aeronautico Central | And 7 more authors.
Thorax | Year: 2015

Consistent with the diversity of Latin America, there is profound variability in asthma burden among and within countries in this region. Regional variation in asthma prevalence is likely multifactorial and due to genetics, perinatal exposures, diet, obesity, tobacco use, indoor and outdoor pollutants, psychosocial stress and microbial or parasitic infections. Similarly, non-uniform progress in asthma management leads to regional variability in disease morbidity. Future studies of distinct asthma phenotypes should follow-up well-characterised Latin American subgroups and examine risk factors that are unique or common in Latin America (eg, stress and violence, parasitic infections and use of biomass fuels for cooking). Because most Latin American countries share the same barriers to asthma management, concerted and multifaceted public health and research efforts are needed, including approaches to curtail tobacco use, campaigns to improve asthma treatment, broadening access to care and clinical trials of non-pharmacological interventions (eg, replacing biomass fuels with gas or electric stoves).

Oliveira C.R.P.,Federal University of Sergipe | Salvatori R.,Johns Hopkins University | Meneguz-Moreno R.A.,Federal University of Sergipe | Aguiar-Oliveira M.H.,Federal University of Sergipe | And 7 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2010

Background: GH deficiency (GHD) is often associated with cardiovascular risk factors, including abdominal fat accumulation, hypercholesterolemia, and increased C-reactive protein. Despite the presence of these risk factors, adults with congenital lifetime isolated GHD (IGHD) due to an inactivating mutation in the GHRH receptor gene do not have premature atherosclerosis. Objective: The aim was to study the serum levels of adiponectin and leptin (antiatherogenic and atherogenic adipokine, respectively), and the urinary albumin excretion (UAE) in these IGHD individuals. Design and Patients: We conducted a cross-sectional study of 20 IGHD individuals (seven males; age, 50.8 ± 14.6 yr) and 22 control subjects (eight males; age, 49.9 ± 11.5 yr). Main Outcome Measures: Anthropometric factors, body composition, blood pressure, serum adiponectin, leptin, and UAE were measured. Results: Adiponectin was higher [12.8 (7.1) vs. 9.7 (5) ng/ml; P = 0.041] in IGHD subjects, whereas no difference was observed in leptin [7.3 (6.3) vs. 9.3 (18.7 ng/ml] and UAE [8.6 (13.8) vs. 8.5 (11.1) μg/min]. Conclusions: Subjects with lifetime untreated IGHD have an adipokine profile with high adiponectin and normal leptin levels that may delay vascular damage and lesions of the renal endothelium. Copyright © 2010 by The Endocrine Society.

Almeida A.P.M.M.,Federal University of Minas Gerais | Dias M.O.,Federal University of Minas Gerais | Vieira C.D.A.F.,Federal University of Minas Gerais | Chavez-Olortegui C.,Federal University of Minas Gerais | And 4 more authors.
Vaccine | Year: 2014

The circumsporozoite protein (CSP), the most abundant surface antigen of sporozoites, has been extensively studied in different expression platforms as a vaccine candidate. Clinical trials have shown the necessity of broad and highly avid humoral immune responses together with high numbers of CSP-specific TCD4+ and TCD8+ cells, especially those producing IFN-γ, to induce protection. To this aim, we designed two distinct recombinant immunogens based on previously-described antigenic fragments of Plasmodium vivax CSP (PvCSP) to be used as vaccine candidates. The first one is a virus-like particle (VLP) comprising the repeat region of PvCSP (B and TCD4+ epitopes) within the loop of the hepatitis B virus core antigen (HBcAgPvCSP). The second one is a PvCSP multi-epitope polypeptide, rPvCSP-ME, designed based on antigenic regions of PvCSP recognized by lymphocytes of individuals from endemic areas.Mice immunized with 2 doses of these proteins, administered individually or combined and formulated in Montanide ISA 720 adjuvant, were able to induce strong effector and memory humoral responses with IgG titers ranging from 104 to 105 and avidity indexes toward full-length PvCSP reaching up to 66%, even 3 months after the last immunization. Furthermore, balanced Th1/Th2 responses were generated, as determined by titers of IgG subclasses and further confirmed by ELISPOT analyses, which detected that these vaccination protocols were able to elicit long-term IFN-γ and IL-2-secreting memory T-cells. Overall, these results show that our vaccine candidates generate, in mice, immune responses against regions within PvCSP that have been associated with protection against malaria in humans. © 2014 Elsevier Ltd.

Sole D.,Escola Paulista de Medicina | Camelo-Nunes I.C.,Escola Paulista de Medicina | Wandalsen G.F.,Escola Paulista de Medicina | Mallozi M.C.,Escola Paulista de Medicina
Revista Paulista de Pediatria | Year: 2014

Objective: To assess asthma among Brazilian pediatric population applying the International Study of Asthma and Allergies in Childhood (ISAAC), an internationally standardized and validated protocol. Data sources: ISAAC was conceived to maximize the value of epidemiologic studies on asthma and allergic diseases, establishing a standardized method (self-applicable written questionnaire and/or video questionnaire) capable to facilitate the international collaboration. Designed to be carried out in three successive and dependent phases, the ISAAC gathered a casuistic hitherto unimaginable in the world and in Brazil. This review included data gathered from ISAAC official Brazilian centers and others who used this method. Data synthesis: At the end of the first phase, it has been documented that the prevalence of asthma among Brazilian schoolchildren was the eighth among all centers participating all over the world. Few centers participated in the second phase and investigated possible etiological factors, especially those suggested by the first phase, and brought forth many conjectures. The third phase, repeated seven years later, assessed the evolutionary trend of asthma and allergic diseases prevalence in centers that participated simultaneously in phases I and III and in other centers not involved in phase I. Conclusions: In Brazil, the ISAAC study showed that asthma is a disease of high prevalence and impact in children and adolescents and should be seen as a Public Health problem. Important regional variations, not well understood yet, and several risk factors were found, which makes us wonder: is there only one or many asthmas in Brazil?

Herbella F.A.M.,Escola Paulista de Medicina | Patti M.G.,University of Chicago | Del Grande J.C.,Escola Paulista de Medicina
Surgical Laparoscopy, Endoscopy and Percutaneous Techniques | Year: 2011

Most surgeons believe that cruroplasty (hiatoplasty) is an essential part of antireflux operations. One of the main causes of failure after antireflux operation is gastric (wrap) herniation through the hiatus that may be attributed to breakdown of the hiatal closure or a faulty repair. Surgeons are at present faced with the dilemma of choosing between a risk of recurrence and the fear of complications of prosthetic hiatal reinforcement. We reviewed the literature to evaluate the current status of hiatal mesh repair (HMR). Indication, technique, complications, and results are shown. Available data show a small number of mesh-related complications compared with the number of patients submitted to the procedure, and better results of HMR compared with simple hiatal closure. We support the use of HMR when performed by skilled foregut surgeons, as complications described occurred more frequently in the earliest cases of the series. In addition, HMR should be probably used selectively. However, studies to identify the patients at risk of hernia recurrence or mesh-related complications are still elusive. The ideal type of mesh and the ideal technique for mesh implantation are yet to be established. © 2011 by Lippincott Williams & Wilkins.

Matas S.L.A.,Escola Paulista de Medicina
Arquivos de Neuro-Psiquiatria | Year: 2013

Diagnostic lumbar puncture is essential to the diagnosis of central nervous system infections, subarachnoid haemorrhage and others neurological diseases. Myeloradicular involvement or life-threatening adverse events due to the procedure are rare, but less severe complications are more frequent. Post-lumbar puncture headache is the most common complication, by spinal fluid leakage due to delayed closure of a dural defect. Therefore, the development of fine needles, with differentiated atraumatic bevel, has contributed to minimize that problem. These generically called atraumatic needles cause less deformation of the dura mater then the Quincke® ones. So, why don't we use these atraumatic needles?

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