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Fragoso Y.D.,Metropolitan University of Santos | Finkelsztejn A.,Hospital de Clnicas de Porto Alegre | Kaimen-Maciel D.R.,State University Londrina | Grzesiuk A.K.,Instituto Neurologico e da Coluna Vertebral | And 4 more authors.
CNS Drugs | Year: 2010

Background: Glatiramer acetate is a US FDA category B drug with regard to use by pregnant women with multiple sclerosis (MS). There are no data currently available for the continuous use of glatiramer acetate during pregnancy. Objective: To assess the risks and benefits of glatiramer acetate used throughout pregnancy among women with active MS. Design: Retrospective and multicentre case series. Settings: Outpatient services of academic and private institutions caring for patients with MS in Brazil. Patients: Eleven women with MS and their children were assessed. Intervention: Retrospective evaluation of women with MS who received glatiramer acetate continuously for at least 7 months during pregnancy. This evaluation was performed by the neurologist responsible for the patient. Children aged 1 year and over, born to mothers who received glatiramer acetate during pregnancy, were assessed using the Denver II developmental screening test. Main Outcome Measurements: Obstetric, neonatal and developmental outcomes. Results: No drug-related obstetric complications were observed. No specific drug-related malformations, neonatal complications or developmental abnormalities were observed in the children. Postnatal MS relapse rates remained significantly lower than antenatal rates in these patients. Conclusions: No deleterious effects from glatiramer acetate were observed in these pregnant women with MS or in their offspring. No increment in postnatal relapse rate was observed. However, the use of glatiramer acetate during pregnancy should be restricted to the most difficult cases, in which the benefits clearly outweigh the risks. © 2010 Adis Data Information BV. All rights reserved.

Zanatta C.M.,Federal University of Rio Grande do Sul | Verionese F.V.,Hospital de Clinicas de Porto Alegre | Da Silva Loreto M.,Hospital de Clinicas de Porto Alegre | Sortica D.A.,Hospital de Clnicas de Porto Alegre | And 6 more authors.
Renal Failure | Year: 2012

Background: Endothelin-1 (ET-1) is associated with progression of renal disease, acting as a vasoconstrictor and growth factor for mesangial cells. ET-1 and endothelin A receptor (ET-RA) might have a role in the development of diabetic nephropathy (DN). The aims of this study were to determine ET-1 and ET-RA expressions in patients with DN and to correlate these expressions with renal function and proteinuria. Materials and methods: This is a cross-sectional study comprising 13 patients with type 2 diabetes mellitus and DN, 10 patients with proteinuric IgA nephropathy, and 13 samples of normal kidney from tumor nephrectomies. Demographic and selected data were collected from medical charts. The distribution and intensity of ET-1 and ET-RA immunostaining in renal biopsies were determined by immunohistochemistry and these correlated with the estimated glomerular filtration rate (eGFR) and proteinuria. Results: Patients with DN and IgA nephropathy on biopsy had markedly increased staining for ET-1 in endothelial cells of glomerular and peritubular capillaries when compared with controls (p < 0.001). ET-RA staining was also more intense and more diffuse in DN and IgA nephropathy than in controls (p = 0.019) and was restricted to tubular epithelial cells. A positive correlation was observed between ET-1 expression and proteinuria (r = 0.634, p = 0.027), but both ET-1 and ET-RA expressions did not correlate with eGFR. Conclusion: In this preliminary report, the higher expressions of ET-1 and ET-RA found in both DN and IgA nephropathy suggest a potential role for the endothelin system in DN as well as in other nondiabetic glomerular diseases. © 2012 Informa Healthcare USA, Inc.

Garces E.O.,Federal University of Rio Grande do Sul | Victorino J.A.,Hospital de Clnicas de Porto Alegre | Thome F.S.,Federal University of Rio Grande do Sul | Rohsig L.M.,Medical Cryobiology Unit | And 5 more authors.
Renal Failure | Year: 2010

Aim: In this study we aimed to compare the efficacy and safety of enoxaparin with unfractioned heparin (UFH) as anticoagulant for continuous venovenous hemodialysis (CVVHD). Methods: An open-label randomized controlled trial was carried out in an intensive care unit (ICU) where 40 patients with acute renal failure (ARF) who needed continuous renal replacement therapy were randomized to receive UFH (n 21) or enoxaparin (n 19). Coagulation parameters were evaluated, and antithrombotic activity of UFH was measured by activated partial thromboplastin time (aPTT) and for enoxaparin by anti-factor Xa activity. Primary outcomes were thrombosis of the extracorporeal circuit and bleeding, classified as major or minor. Results: Minor bleeding episodes were observed only in patients anticoagulated with enoxaparin (26 vs. 0, p 0.018). Comparing patients with or without bleeding after 24 hours of therapy, the level of anticoagulation tended to be higher (anti-factor Xa: 1.62 vs. 1.13 IUmL, p 0.09) and the platelet count to be lower [107 ± 53 vs. 229 ± 84 (×10 3μL), p 0.09] in patients who bled, but without statistical difference. Filter life span of enoxaparin and UFH groups was similar (43 ± 15 vs. 52 ± 18 hr, p 0.10), as well as the proportion of circuit clotting. Conclusion: Weight-unadjusted enoxaparin in patients with ARF in CVVHD was associated with an increased rate of bleeding, a finding that addresses the need to adjust drug dose and to monitor anti-factor Xa activity during dialysis. No benefit to prolong dialysis circuit survival was found with enoxaparin. In patients who do not present contraindication for systemic anticoagulation, UFH remains an effective and low-cost option. © 2010 Informa UK, Ltd.

Lazzaretti R.K.,Hospital de Clnicas de Porto Alegre | Kuhmmer R.,Hospital de Clnicas de Porto Alegre | Sprinz E.,Hospital de Clnicas de Porto Alegre | Sprinz E.,Federal University of Rio Grande do Sul | And 4 more authors.
Journal of the American College of Cardiology | Year: 2012

Objectives: The purpose of this study was to evaluate the efficacy of dietary intervention on blood lipids of human immunodeficiency virus (HIV)-1infected patients who are started on highly active antiretroviral therapy (HAART). Background: Current guidelines recommend diet as first-step intervention for HIV-1infected individuals with HAART-related dyslipidemia, but there is no evidence from randomized trials to support this recommendation. Methods: Eighty-three HIV-1infected patients, naive from HAART, were randomly assigned to HAART with dietary intervention (diet group, n = 43) or HAART without dietary intervention (control group, n = 40) for 12 months. Diet, according to the National Cholesterol Education Program, was given every 3 months. Before and after intervention, 24-h food records and lipid profile were obtained. Data were analyzed by intention to treat, using mixed-effects models. Results: Diet resulted in reduction of percentage of fat intake (from 31 ± 7% to 21 ± 3% of calories), while controls presented no change in percentage of fat intake. Plasma cholesterol (from 151 ± 29 mg/dl to 190 ± 33 mg/dl) and low-density lipoprotein cholesterol (from 85 ± 24 mg/dl to 106 ± 31 mg/dl) increased in the control group and were unchanged in the diet group. Plasma triglycerides were reduced by diet (from 135 ± 67 mg/dl to 101 ± 42 mg/dl) and increased in the control group (from 134 ± 70 mg/dl to 160 ± 76 mg/dl). After 1-year follow-up, 21% of patients who received diet had lipid profile compatible with dyslipidemia compared with 68% (p < 0.001) of controls. Conclusions: Among HIV-1positive individuals naive of previous treatment, diet prevents dyslipidemia associated with HAART. (Effect of Nutritional Intervention on the Lipid Profile of HIV-Positive Patients Who Start HAART: a Randomized Trial; NCT00429845) © 2012 American College of Cardiology Foundation.

Bohmer A.E.,Federal University of Rio Grande do Sul | Oses J.P.,Catholic University of Pelotas | Schmidt A.P.,Federal University of Rio Grande do Sul | Peron C.S.,Hospital Cristo Redentor | And 6 more authors.
Neurosurgery | Year: 2011

Background: The availability of markers able to provide an early insight related to prognostic and functional outcome of patients with traumatic brain injury (TBI) are limited. Objective: The relationship of clinical outcome with CSF neuron-specific enolase (NSE), S100B and glial fibrillary acidic protein (GFAP) levels in patients with severe TBI was investigated. Methods: Twenty patients with severe TBI (7 days at unit care) and controls were studied. Patients were grouped according to the outcome: (1) nonsurvival (n = 5): patients who died; (2) survival A (n = 15): CSF sampled between 1st and 3rd day from patients who survived after hospital admission; and (3) survival B (n = 7): CSF sampled between 4th and 7th day from patients who survived after hospital admission and were maintained with intraventricular catheter up to 7 days. Results: Up to 3 days, S100B and NSE levels (ng/mL) were significantly elevated in the nonsurvival compared with survival A group (S100: 12.45 ± 5.46 vs 5.64 ± 3.36; NSE: 313.20 ± 45.51 vs 107.80 ± 112.10). GFAP levels did not differ between groups. In the survival B group S100B, GFAP, and NSE levels were still elevated compared with control (4.59 ± 2.19, 2.48 ± 2.55, and 89.80 ± 131.10, respectively). To compare S100B and NSE for the prediction of nonsurvival and survival patients we performed receiver operating characteristic curves. At admission, CSF NSE level predicts brain death more accurately than S100B. Conclusion: Early elevations (up to 3 days) of S100B and NSE secondary to severe TBI predict deterioration to brain death. However, this feature was more prominently associated with NSE than S100B. Copyright © 2011 by the Congress of Neurological Surgeons.

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