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De Almeida S.M.,Federal University of Parana | De Almeida S.M.,Institute Pesquisa Pele Pequeno Principe
Arquivos de Neuro-Psiquiatria | Year: 2015

The nervous system plays an important role in HIV infection. The purpose of this review is to discuss the indications for cerebrospinal fluid (CSF) analysis in HIV infection in clinical practice. CSF analysis in HIV infection is indicated for the diagnosis of opportunistic infections and co-infections, diagnosis of meningitis caused by HIV, quantification of HIV viral load, and analysis of CNS HIV compartmentalization. Although several CSF biomarkers have been investigated, none are clinically applicable. The capacity of HIV to generate genetic diversity, in association with the constitutional characteristics of the CNS, facilitates the generation of HIV quasispecies in the CNS that are distinct from HIV in the systemic circulation. CSF analysis has a well-defined and valuable role in the diagnosis of CNS infections in HIV/AIDS patients. Further research is necessary to establish a clinically applicable biomarker for the diagnosis of HIV-associated neurocognitive disorders. © 2015 Associacao Arquivos de Neuro-Psiquiatria. All rights reserved. Source

Doghman M.,French National Center for Scientific Research | Doghman M.,University of Nice Sophia Antipolis | Figueiredo B.C.,French National Center for Scientific Research | Figueiredo B.C.,Federal University of Parana | And 5 more authors.
Nucleic Acids Research | Year: 2013

Steroidogenic Factor-1 (SF-1) is a nuclear receptor that has a pivotal role in the development of adrenal glands and gonads and in the control of steroid hormone production, being also implicated in the pathogenesis of adrenocortical tumors. We have analyzed the mechanisms how SF-1 controls gene expression in adrenocortical cells and showed that it regulates different categories of genes according to its dosage. Significant correlations exist between the localization of SF-1-binding sites in chromatin under different dosage conditions and dosage-dependent regulation of gene expression. Our study revealed unexpected functional interactions between SF-1 and Neuron-Restrictive Silencer Factor/RE1-Silencing Transcription Factor (NRSF/REST), which was first characterized as a repressor of neuronal gene expression in non-neuronal tissues, in the regulation of gene expression in steroidogenic cells. When overexpressed, SF-1 reshapes the repertoire of NRSF/REST - regulated genes, relieving repression of key steroidogenic genes. These data show that NRSF/REST has a novel function in regulating gene expression in steroidogenic cells and suggest that it may have a broad role in regulating tissue-specific gene expression programs. © 2013 The Author(s) 2013. Source

De Almeida S.M.,University of California at San Diego | De Almeida S.M.,Federal University of Parana | De Almeida S.M.,Institute Pesquisa Pele Pequeno Principe | Shumaker S.D.,University of California at San Diego | And 6 more authors.
Headache | Year: 2011

Objective.- To determine the frequency and risk factors of post-dural puncture headache (PDPH) in research volunteers. Background.- Despite increasing interest in measuring cerebrospinal fluid (CSF) biomarkers to investigate disease pathogenesis and diagnosis, previous case series have evaluated lumbar puncture (LP) safety only in clinical care. PDPH is a common complication after LP. Methods.- We determined the frequency of PDPH in neurologically unselected HIV seropositive and seronegative adults volunteering for research, as well as the variables associated with the development of PDPH. Variables studied were body mass index (BMI), HIV serostatus, volume of CSF removed, number of previous LPs, use of pre-medication, LP position, lumbar space, number of needle passes, whether or not aspiration was used, CSF white blood cell counts, CSF red blood cell counts, CD4 count, CD4 nadir, CSF HIV viral load, plasma HIV viral load, and race. Results.- Of 675 LPs performed over 1 year, headache developed in 38 (5.6%; 95% CI 4.2, 7.1). Most PDPH (92%) resolved spontaneously or with conservative medical management; 3 required epidural blood patch. Greater headache risk was associated with lower BMI (BMI 25vs>25) (OR 3.3; CI 95% 1.5, 7.0; P =.001) and less prior LP experience (previous LPs 2 vs >2) (OR 2.1; CI 95% 1.1, 4.1; P =.03). PDPH was not significantly (P >.05) related to HIV serostatus, CSF volume, or gender. Conclusion.- In this study, where tolerance to risk was low because LPs were done for research rather than clinical purposes and healthy controls were included, adverse effects were mild and self-limited. © 2011 American Headache Society. Source

Lalli E.,French National Center for Scientific Research | Lalli E.,University of Nice Sophia Antipolis | Figueiredo B.C.,French National Center for Scientific Research | Figueiredo B.C.,Federal University of Parana | Figueiredo B.C.,Institute Pesquisa Pele Pequeno Principe
Frontiers in Endocrinology | Year: 2015

Adrenocortical tumors (ACT) in children are very rare and are most frequently diagnosed in the context of the Li-Fraumeni syndrome, a multiple cancer syndrome linked to germline mutations of the tumor suppressor gene TP53 with loss of heterozygosity in the tumors. A peak of children ACT incidence is present in the states of southern Brazil, where they are linked to the high prevalence in the population of a specific TP53 mutation (R337H). Children ACT have specific features distinguishing them from adult tumors in their pathogenetic mechanisms, genomic profiles, and prognosis. Epidemiological and molecular evidence suggests that in most cases they are derived from the fetal adrenal. © 2015 Lalli and Figueiredo. Source

Stachon A.,Institute Pesquisa Pele Pequeno Principe | Da Silva I.M.,Federal University of Santa Catarina
Journal of Cognitive Psychotherapy | Year: 2014

Pediatric obsessive-compulsive disorder (OCD) is a prevalent condition that responds well to specialized treatment including cognitive behavioral therapy (CBT) or serotonin reuptake inhibitors or their combination. In Brazil, the dissemination of evidence-based treatment for pediatric OCD is hindered because of the peculiarities of the health system. The presence of a multitiered health system (public, insured, and private) with insufficient investment in public mental health and relative inaccessibility of insured/private care for most of the Brazilian population make the implementation of specialized OCD treatment centers largely unavailable in Brazil. Furthermore, lack of appropriate training in child mental health, CBT, and evidencebased approaches to OCD in current psychiatry and psychology training programs further impede improvement in diagnosis and treatment. The challenges faced in the current system in Brazil will be discussed and also strategies and programs that are currently being implemented in the south of Brazil to help address the gaps in treatment for pediatric patients with OCD. © 2014 Springer Publishing Company. Source

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