Santa Casa Medical School

São Paulo, Brazil

Santa Casa Medical School

São Paulo, Brazil
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da Cunha Santos G.,University of Toronto | Saieg M.A.,Santa Casa Medical School
Cancer Cytopathology | Year: 2017

With increasing requests for the evaluation of prognostic and predictive molecular biomarkers, great attention must be paid to the preanalytical issues regarding sample quality and DNA/RNA yield from all different types of cytological preparations. The objectives of this review were: 1) to provide an update regarding the importance of specimen triage as well as specimen handling and collection; 2) to discuss the different cell preparations that can be used for molecular testing, their advantages and limitations; and 3) to highlight the strategies for biobanking cytology samples. Good-quality DNA/RNA can be harvested from fresh cells in cell suspensions, formalin-fixed paraffin-embedded cell blocks, archival stained smears, archival unstained cytospin preparations, liquid-based cytology slides, FTA cards, and cryopreserved cells. In contrast to formalin-fixed paraffin-embedded tissue specimens (small biopsies and surgical resections), the multitude of types of sample preparations as well as the diversity in sample collection and processing procedures make cytology an ideal specimen for most genomic platforms, with less DNA and RNA degradation and a purer sample, usually with a higher concentration of tumor cells. The broad incorporation of cytological specimens into clinical practice. A should increase the number of samples potentially available for molecular tests and avoid repeat invasive procedures for tissue procurement, thereby increasing patient safety. In this context, it is of utmost importance that cytopathologists become familiar with the variables that can affect test results and embrace the goal of excellence in sample quality. Cancer Cytopathol 2017;125(6 suppl):455-64. © 2017 American Cancer Society. © 2017 American Cancer Society

Cancado R.D.,Santa Casa Medical School | Munoz M.,University of Malaga
Transfusion Alternatives in Transfusion Medicine | Year: 2012

Lack of iron is one of the main causes of anemia in the general population and iron deficiency anemia (IDA) is associated with increased morbidity and mortality. Treatment of iron deficiency with oral iron supplements is a simple and inexpensive, but oral iron is a less-than-ideal treatment because of gastrointestinal side-effects and long treatment times needed to resolve anemia and replenish body iron stores. Nonadherence is common, and even in compliant patients poor intestinal absorption fails to compensate for the iron need in the presence of ongoing blood losses or inflammatory conditions. Modern intravenous (IV) iron formulations have emerged as safe and effective alternatives to oral iron for the treatment of IDA. Given their demonstrated effectiveness and favorable safety profile in a broad spectrum of diseases associated with IDA, the current paradigm that oral iron is first-line therapy should be reconsidered. In the past few years, three new IV iron compounds (ferric carboxymaltose, ferumoxytol and iron isomaltoside 1000) have been released for clinical use in patients with IDA. These new preparations with more favorable administration regimens have the potential to improve the convenience and cost-effectiveness of IV iron therapy. © 2012 Medical Education Global Solutions.

Ribeiro R.B.,King's College London | Ribeiro R.B.,University of Sao Paulo | Melzer-Ribeiro D.L.,University of Sao Paulo | Rigonatti S.P.,University of Sao Paulo | Cordeiro Q.,Santa Casa Medical School
Journal of ECT | Year: 2012

Objectives: The Brazilian public health system does not provide electroconvulsive therapy (ECT), which is limited to a few academic services. National mental health policies are against ECT. Our objectives were to analyze critically the public policies toward ECT and present the current situation using statistics from the Institute of Psychiatry of the University of São Paulo (IPq-HCFMUSP) and summary data from the other 13 ECT services identified in the country. Methods: Data regarding ECT treatment at the IPq-HCFMUSP were collected from January 2009 to June 2010 (demographical, number of sessions, and diagnoses). All the data were analyzed using SPSS 19, Epic Info 2000, and Excel. Results: During this period, 331 patients were treated at IPq-HCFMUSP: 221 (67%) were from São Paulo city, 50 (15.2%) from São Paulo's metropolitan area, 39 (11.8%) from São Paulo's countryside, and 20 (6.1%) from other states; 7352 ECT treatments were delivered-63.0% (4629) devoted entirely via the public health system (although not funded by the federal government); the main diagnoses were a mood disorder in 86.4% and schizophrenia in 7.3% of the cases. Conclusions: There is an important lack of public assistance for ECT, affecting mainly the poor and severely ill patients. The university services are overcrowded and cannot handle all the referrals. The authors press for changes in the mental health policies. Copyright © 2012 by Lippincott Williams & Wilkins.

Korkes F.,ABC Medical School | De Castro M.G.,Santa Casa Medical School | De Cassio Zequi S.,AC Camargo Hospital | Nardi L.,Genos Laboratory | And 2 more authors.
BJU International | Year: 2014

Objectives To evaluate hyaluronan-mediated motility receptor (RHAMM) expression in normal, hyperplasic and neoplastic prostate tissue after various types and durations of androgen-deprivation therapy (ADT). Clinical and oncological data from men with localised prostate adenocarcinoma were also assessed and compared with RHAMM expression data. Patients and Methods Data from 367 men who underwent histological evaluation of the prostate were retrospectively evaluated under six conditions: (i) benign prostatic hyperplasia (BPH), (ii) BPH treated with finasteride, (iii) prostate cancer without ADT, (iv) prostate cancer treated with neoadjuvant ADT before prostatectomy (cyproterone 200 mg/day), (v) castration-resistant prostate cancer (CRPC), and (vi) normal peritumoral prostate tissue. Tissue microarrays were constructed and 1354 cores were evaluated for immunohistochemical RHAMM expression. Results There was no RHAMM expression in any tissue from normal patients or those with BPH or prostate cancer without ADT. There was RHAMM expression in 39.4% of prostate cancer tissues treated with ADT and in 46.2% of CRPC samples (P = 0.001). There was a significant increase in RHAMM expression with increased ADT duration in group 4, with a marked increase in RHAMM expression after 6-12 months of ADT (P = 0.04). No prognostic or clinical factors related to prostate cancer were associated with RHAMM expression. Conclusions RHAMM expression in prostate cancer is directly associated with ADT. Significant RHAMM expression occurs as early as after 1 month of ADT and progressively increases with ADT duration. When prostate cancer becomes CRPC, RHAMM expression is higher. RHAMM expression was not associated with prostate cancer prognostic factors. RHAMM overexpression may contribute to the development of hormonal resistance in prostate cancer. © 2013 The Authors. BJU International © 2013 BJU International.

Melo K.C.,University of Sao Paulo | Melo M.R.,Santa Casa Medical School | Ricci B.V.,University of Sao Paulo | Segurado A.C.,University of Sao Paulo
Menopause | Year: 2012

Objective: The aims of this study were to compare the intensity of human immunodeficiency virus (HIV)-RNA genital shedding among postmenopausal (PM) and fertile-aged (F) women and to investigate the association between viral shedding and gynecological features, HIV plasma viral loads, and other markers of HIV disease progression. Methods: We interviewed 146 HIV-infected women (73 PM/73 F) in search of gynecological complaints and signs and symptoms of HIV disease and obtained additional information concerning HIV infection by medical chart review. Cervicovaginal lavages (CVLs) were collected for assessment of HIV shedding. Laboratory analyses included CD4 cell counts, HIV-RNA quantitation in plasma and CVL, and screening for concurrent genital infections. Results: HIV-RNA genital shedding was detected in 16.4% of PM and 21.9% of F women (P = 0.400), and the intensity of HIV shedding did not differ between both groups (means-PM: 1.4log/mL; F: 1.4log/mL; P = 0.587). Three women (2 PM/1 F) exhibited viral shedding in the absence of detectable viremia. HIV plasma viral loads correlated with HIV shedding in both groups. In multivariable analysis, HIV plasma viral loads were independently associated with HIV shedding in both groups. Moreover, the intensity of shedding was independently associated with vaginal pH, tumor necrosis factor α concentrations in CVL, and HIV plasma viral loads. Conclusions: Despite significant changes that occur in the vaginal mucosa of PM women, HIV cervicovaginal shedding was not significantly influenced by this state in our cohort. In contrast, increased vaginal pH and genital inflammation, evidenced by increased tumor necrosis factor α concentrations in CVL and HIV plasma viral loads, were independently associated with the intensity of HIV shedding in PM and F women. © 2012 The North American Menopause Society.

Cohen R.V.,Oswaldo Cruz Hospital | Pinheiro J.C.,Oswaldo Cruz Hospital | Schiavon C.A.,Oswaldo Cruz Hospital | Salles J.E.,Santa Casa Medical School | And 2 more authors.
Diabetes Care | Year: 2012

OBJECTIVE - Roux-en-Y gastric bypass (RYGB) ameliorates type 2 diabetes in severely obese patients through mechanisms beyond just weight loss, and it may benefit less obese diabetic patients. We determined the long-term impact of RYGB on patients with diabetes and only class I obesity. RESEARCH DESIGN AND METHODS - Sixty-six consecutively selected diabetic patients with BMI 30-35 kg/m 2 underwent RYGB in a tertiary-care hospital and were prospectively studied for up to 6 years (median 5 years [range 1-6]), with 100% follow-up. Main outcome measures were safety and the percentage of patients experiencing diabetes remission (HbA 1c <6.5% without diabetes medication). RESULTS - Participants had severe, longstanding diabetes, with disease duration 12.5 ± 7.4 years and HbA 1c 9.7 ± 1.5%, despite insulin and/or oral diabetes medication usage in everyone. For up to 6 years following RYGB, durable diabetes remission occurred in 88% of cases, with glycemic improvement in 11%. Mean HbA 1c fell from 9.7 ± 1.5 to 5.9 ± 0.1% (P < 0.001), despite diabetes medication cessation in the majority. Weight loss failed to correlate with several measures of improved glucose homeostasis, consistent with weight-independent antidiabetes mechanisms of RYGB. C-peptide responses to glucose increased substantially, suggesting improved β-cell function. There was no mortality, major surgical morbidity, or excessive weight loss. Hypertension and dyslipidemia also improved, yielding 50-84% reductions in predicted 10-year cardiovascular disease risks of fatal and nonfatal coronary heart disease and stroke. CONCLUSIONS - This is the largest, longest-term study examining RYGB for diabetic patients without severe obesity. RYGB safely and effectively ameliorated diabetes and associated comorbidities, reducing cardiovascular risk, in patients with a BMI of only 30-35 kg/m 2. © 2012 by the American Diabetes Association.

De Souza F.C.,Doctor of Health Science | Olival-Costa H.,Santa Casa Medical School | Da Silva L.,Doctor of Health Science | Pontes P.A.,University of Sao Paulo | Lancellotti C.L.P.,Doctor of Health Science
Journal of Voice | Year: 2011

Hypothesis: The use of a material made of bacterial cellulose with the aim of obtaining vocal fold medialization has not hitherto been fully investigated. Although the material has been tested in other animal models, the evaluation did not include the larynx; hence, situations, such as tissue reaction, material absorption, and extrusion, need to be addressed to evaluate its usefulness as a material for laryngeal reconstruction. Objective: To evaluate the medialization, tissue response, and healing of rabbit vocal folds, after the implantation of a membrane of bacterial cellulose. Study Design: Experimental study. Methods: A total of 32 rabbits were used, two of which were used to check out the adequacy of the implant location. The animals were followed for 4 months and grouped according to follow-up times of 2, 4, and 16 weeks. All test animals received an implant of bacterial cellulose in one vocal fold and the injection of distilled water in the other, both performed by videoendoscopic cervicotomy. At the end of the follow-up, the presence of inflammatory and medial displacement was evaluated. Results: No statistically significant difference in the inflammatory parameters between the study and control vocal folds or among follow-up times was found. All animals receiving cellulose presented medial displacement of vocal folds, and all retained this material at the implant site up to study endpoint. Conclusion: Bacterial cellulose is a useful material for laryngeal medialization, showing no signs of rejection or absorption. © 2011 The Voice Foundation.

Da Cunha Santos G.,University of Toronto | Saieg M.A.,Santa Casa Medical School
Cancer Cytopathology | Year: 2015

The results from molecular assays can be affected significantly by the preanalytic condition of cytologic samples. The authors review current knowledge on the use of cytologic samples for epidermal growth factor receptor (EGFR) mutation testing in non-small cell lung cancer with a focus on preanalytic parameters. A systematic electronic search of the MEDLINE database was performed to identify original articles that reported the use of cytologic samples for EGFR molecular analysis and included a minimum of 100 samples. The information collected included author(s), journal, and year of publication; number of patients and samples; sampling method; type of preparation; type of fixative; staining techniques; mutation analysis techniques; tumor cellularity; the percentage of tumor cells; data on DNA quantity, quality, and concentration; failed assays; and the mutation rate. EGFR mutation analysis was conducted on 4999 cytologic samples from 22 studies that fulfilled the inclusion criteria. Fine-needle aspirates and pleural effusions were the most common types of specimens used. DNA was mainly extracted from cell blocks and smears, and the most commonly reported fixatives included formalin, ethanol, and CytoLyt. Cellularity assessments and DNA yields were available from 5 studies each. The average success rate for the assays that used cytologic specimens was 95.87% (range, 85.2%-100%). The mutation rate ranged from 6% to 50.46%, and a higher mutation detection rate and lower numbers of insufficient cases were reported for pleural effusions and lymph node samples from endobronchial ultrasound-guided transbronchial needle aspiration compared with histologic specimens. Low cellularity and a low percentage of tumor cells were associated with higher test failure rates. Future guidelines should consider the current data for specific recommendations regarding cytologic samples. © 2015 The Authors. Cancer Cytopathology published by Wiley Periodicals, Inc.

Belini Jr. E.,São Paulo State University | Cancado R.D.,Santa Casa Medical School | Domingos C.R.B.,São Paulo State University
Archives of Medical Science | Year: 2010

We report a 20-year-old female with sickle cell anaemia and with an HbF concentration of 15.8%. The patient was not using hydroxyurea and was not receiving regular blood transfusions. The patient never had chronic manifestations of sickle cell anaemia, only pain crises of a mild intensity. After laboratory tests, we found that she was homozygous for HbS with the Bantu/atypical haplotype, and was heterozygous for the XmnI site. The influence of the XmnI site on the expression of HbF can explain the amelioration in clinical features in this haplotype association in a case of sickle cell anaemia. Copyright © 2010 Termedia & Banach.

Belini Jr. E.,São Paulo State University | Da Silva D.G.H.,São Paulo State University | De Souza Torres L.,São Paulo State University | De Almeida E.A.,São Paulo State University | And 3 more authors.
Annals of Hematology | Year: 2012

To evaluate, in a longitudinal study, the profile of lipid peroxidation and antioxidant capacity markers in sickle cell anaemia patients receiving different treatments and medication over different time periods. The three groups were: patients undergoing transfusion therapy and receiving iron chelator deferasirox (DFX group, n=20); patients receiving deferasirox and hydroxyurea (DFX + HU group, n=10), and patients receiving only folic acid (FA group, n=15). Thiobarbituric acid-reactive substance (TBARS) assays and trolox-equivalent antioxidant capacity (TEAC) assays were evaluated during two different periods of analysis, T0 and T1 (after ~388 days). Higher FA group TBARS values were observed compared with the DFX + HU group (p=0.016) at T0; and at T1, higher FA group TBARS values were also observed compared with both the DFX group (p=0.003) and the DFX + HU group (p=0.0002). No variation in TEAC values was seen between groups, at either T0 or T1. The mean values of TBARS and TEAC for both the DFX and DFX + HU groups decreased at T1. The antioxidant effects of HU and DFX were observed by through an increase in TEAC levels in DFX and DFX + HU groups when compared with those of normal subjects. Increased TEAC values were not recorded in the FA group, and lipid peroxidation was seen to decrease after DFX and HU use. © Springer-Verlag 2011.

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