Adauto Castelo

Universidade Federal de São Paulo, San Paulo, São Paulo, Brazil

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Publications (78)166.97 Total impact

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    ABSTRACT: Abstract HIV mother-to-child transmission (MTCT) is significantly reduced if antepartum viral load (apVL) is<50 copies/mL. Pharmacokinetic studies suggest increasing the dosage of lopinavir/ritonavir (LPV/r) in pregnancy. It is important to assess tolerance, safety, and rate of patients presenting a apVL<50 copies/mL when treating with increased dose of LPV/r during pregnancy. Confirmed HIV-infected pregnant women with a fetus at a gestational age of 14-33 weeks were randomly assigned to receive LPV/r 400/100 or 600/150 mg b.i.d. plus two nucleoside analogues (NRTIs). Treatment was discontinued in the case of alanine transaminase (ALT) of grade III elevation or higher, glucose, or triglycerides. Thirty-two women were randomized to the LPV/r 400/100 mg dose, and 31 women were randomized to the 600/150 mg dose. Overall, 9.4% of the women receiving the conventional dose, and 17.2% receiving the increased dose, discontinued treatment because of adverse events (p=0.29). The rates of gastrointestinal (GI) symptoms, laboratory abnormalities, preterm delivery, and low birth weight were similar in both groups. There were no cases of HIV MTCT. Among the women with a baseline VL>50 copies/mL assigned to the conventional dose group, 45% (95% confidence interval [CI] 62.5-27.5%) had a apVL>50 copies/mL compared with 10.5% (95% CI 21.6-0.6%) of those assigned to the increased dose group (p=0.01). There was no significant difference found for the patients with a baseline VL<50 copies/mL. In pregnant women with a baseline VL>50 copies/mL, it may be warranted to initiate LPV/r dosing at 600/150 mg, whereas the conventional dose is sufficient for pregnant women with a baseline VL<50 copies/mL.
    AIDS patient care and STDs 10/2013; 27(11). DOI:10.1089/apc.2013.0159 · 3.50 Impact Factor
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    ABSTRACT: Background & aims Maternal adequate micronutrient storage contributes to reducing morbidity and mortality of their children during the first two years of life. This study aimed at identifying hypovitaminosises among Brazilian HIV infected pregnant women and investigating their association with nutritional status, CD4+ cell counts, viral load and HAART use. Methods Cross-sectional study with 49 HIV infected pregnant women. Inclusion criteria followed: (1) HIV infection laboratory confirmation (HIV and HIV RNA); (2) Confirmed pregnancy, (3) Age above 14 years old; (4) Written consent. Exclusion criteria consisted of at least one of the following: (1) Use of any nutritional/multivitamin supplement (except iron or folinic acid); (2) Presence of nutritional counseling during the current pregnancy; (3) Presence of acute phase opportunistic diseases associated with HIV infection. Patients were evaluated according to anthropometric (gestational BMI, based on the curve of weight gain corrected for gestational age) and laboratory parameters (analysis of vitamin A, E, C, D, B6 and B12, CD4+ cell count, viral load, lipid profile, homocysteine and C-reactive protein). Blood samples were collected in 5 mL dry tubes with separating gel, after 12 h fasting. Vitamin profile was measured by HPLC. Results were classified according to abnormal ranges proposed for pregnant women. Results Low gestational weight was higher in women with CD4+ <200 cells/mm3 [OR = 12.5; 95% CI 2,00,77,89; p = 0.007]. Prevalence of abnormal serum concentrations was 38.8% for vitamin D, 14.3% for vitamin A, 22.4% for vitamin E, 12.2% for vitamin C, 53.2% for vitamin B6 and 32.6% for vitamin B12. C-reactive protein was associated with vitamin E [OR = 0.23, 95% CI 0.053, 1.01, p = 0.03] and A [OR = 0.15, 95% CI 0.028, 0.84, p = 0.03]. Homocysteine was not associated with lower vitamin concentrations. Women with optimal B12 levels were 4.3 times more likely to have CD4+ >200 cells/mm³ [OR = 0.23, 0.58 to 0.905, 95% CI, p = 0.03]. HIV viral load has not been significantly associated with vitamin concentrations. Conclusions There was high prevalence of abnormal concentrations of vitamin A, D, B6 and B12. Nutritional status was associated with CD4+ cell count and vitamins were associated with immune function and inflammatory markers. There is need for more studies on this matter in Brazil. Vitamin serum levels should be monitored in these patients during prenatal care, and results underscore the importance of early nutritional intervention to ensure favorable pregnancy and birth outcomes, specially regarding the vitamin profile described here.
    e-SPEN Journal 06/2013; 8(3):e108–e112. DOI:10.1016/j.clnme.2013.03.002
  • Jorge Senise · Simone Bonafé · Adauto Castelo
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    ABSTRACT: The purpose of this article is to update the current practice in the management of HIV-infected pregnant women and present evidence-based recommendations for the reduction of mother-to-child transmission. Early and sustained control of HIV viral replication is associated with decreasing residual risk of transmission and favors initiating antiretroviral drugs sufficiently early in naive women to suppress viral replication by the third trimester; however, this potential benefit must be balanced against the unknown long-term outcome of first-trimester drug exposure. Efavirenz should whenever possible be avoided in the first trimester of gestation, but its use seems well tolerated for 39 days after last menstrual period when the neural tube closes. Raltegravir may be considered in special circumstances in pregnancy. The HIV viral load and the risk factors for prematurity must be considered when deciding when to start antiretroviral treatment in each individual pregnant woman. A ritonavir-boosted protease inhibitor combined with two nucleoside reverse transcriptase inhibitors is currently the most widely used regimen. Among protease inhibitors, lopinavir combined with ritonavir is the most frequently used; however, atazanavir combined with ritonavir is a good alternative. Elective cesarean section is the best delivery mode for pregnant women with viral loads more than 50 copies/ml.
    Current opinion in obstetrics & gynecology 12/2012; 24(6):395-401. DOI:10.1097/GCO.0b013e328359f11e · 2.07 Impact Factor
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    Jorge F Senise · Adauto Castelo · Marisol Martínez
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    ABSTRACT: The global prevalence of HIV infection in the female population presents a significant healthcare burden in terms of mother-to-child transmission (MTCT) of the disease. This review aims to discuss current trends and treatment guidelines for the use of antiretroviral therapy during pregnancy and associated complications in this population. Historically, antiretroviral monotherapy with zidovudine was commonly used for preventing MTCT, and monotherapy with single-dose nevirapine is still used for prevention in resource-limited settings. Evidence suggests that combination therapy with HAART is a more effective treatment option than monotherapy when managing HIV in pregnant women. Current treatment guidelines recommend the use of HAART with a protease inhibitor (PI) or a nonnucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside reverse transcriptase inhibitors (NRTI) as first-line therapy for the management of HIV infection in pregnant women and for preventing MTCT. Complications associated with the use of antiretroviral therapy during pregnancy should be taken into consideration when selecting a new antiretroviral regimen, or when continuing certain antiretroviral regimens in HIV-infected women who become pregnant while on therapy. NNRTI have been associated with severe and sometimes fatal hepatoxicity in some pregnant women and potentially teratogenic side effects in the fetus, and their use raises concerns regarding the development of drug- and class-resistant mutations. PI-based HAART has been associated with an increased risk of adverse effects such as premature delivery, low birth weight, dyslipidemia, glucose intolerance, and lipodystrophy. Despite this, initiating antiretroviral therapy with a PI plus two NRTI may become the preferred treatment option in pregnant women. Many of the side effects associated with PI were more prevalent when older PI and PI-based regimens that included those in combination with thymidine analog NRTI were used. An individual's history and baseline clinical and laboratory parameters should also be taken into consideration when choosing the most appropriate antiretroviral regimen during pregnancy.
    AIDS reviews 10/2011; 13(4):198-213. · 3.79 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate the occurrence of the well-known predisposing factors and signs and symptoms usually associated with either overreaching or overtraining syndrome in physical fitness centers in São Paulo City, Brazil. A questionnaire consisting of 13 question groups pertaining to either predisposing factors (1-7) or signs and symptoms (8-13) was given to 413 subjects. The general training schedule of the volunteers was characterized by workout sessions of 2.18 ± 0.04 h for a total of 11.0 ± 0.3 h/week for 33 ± 2 months independent of the type of exercise performed (walking, running, spinning, bodybuilding and stretching). A mean score was calculated ranging from 1 (completely absent) to 5 (severe) for each question group. A low occurrence was considered to be a question group score lower than 4, which was observed in all 13 question groups. The psychological evaluation by POMS Mood State Questionnaire indicated a normal non-inverted iceberg. The hematological parameters, creatine kinase activity, cortisol, total testosterone and free testosterone concentrations were within the normal ranges for the majority of the volunteers selected for this analysis (n = 60). According to the questionnaire score analysis, no predisposing factors or signs and symptoms usually associated with either overreaching or overtraining were detected among the members of physical fitness centers in São Paulo City, Brazil. This observation was corroborated by the absence of any significant hematological or stress hormone level alterations in blood analyses of the majority of the selected volunteers (n = 60).
    Clinics (São Paulo, Brazil) 11/2010; 65(11):1161-6. DOI:10.1590/S1807-59322010001100019 · 1.19 Impact Factor
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    ABSTRACT: : A case of primary nasal chromoblastomycosis in a female patient from São Paulo (Brazil) is presented. The diagnosis was established by the observation of characteristic sclerotic cells in parasitism. The agent was identified by culturing as Fonsecaea pedrosoi.The present report seems to be the third documented case of primary nasal chromoblastomycosis in Brazil.Zusammenfassung: Bericht über einen Fall einer primären nasalen Chromomykose bei einer Patientin aus Sao Paulo (Brasilien). Die Diagnose wurde durch den Nachweis der charakteristischen sklerotischen Zellen im Gewebe gestellt. Kulturell konnte als Erreger Fonsecaea pedrosoi isoliert werden. Bei diesem Bericht handelt es sich urn den dritten Fall einer dokumentierten primären nasalen Chromomykose in Brasilien.
    Mycoses 10/2009; 30(10):468-471. DOI:10.1111/j.1439-0507.1987.tb03831.x · 2.24 Impact Factor
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    ABSTRACT: To investigate the possible role of chromatin texture parameters, nuclear morphology, DNA ploidy and clinical functional status in discriminating benign from malignant adrenocortical tumors (ACT). Forty-eight cases of clinically benign (n=40) and clinically malignant (n=8) ACT with a minimum of 5-years' follow-up were evaluated for chromatin texture parameters (run length, standard deviation, configurable run length, valley, slope, peak and other 21 Markovian features that describe the distribution of the chromatin in the nucleus), nuclear morphology (nuclear area, nuclear perimeter, nuclear maximum and minimum diameter, nuclear shape), and DNA ploidy. Nuclear parameters were evaluated in Feulgen-stained 5 mum paraffin-sections analyzed using a CAS 200 image analyzer. Since ACTs present different biological features in children and adults, patients were divided into two groups: children (< or = 15 years) and adults (>15 years). In the group of children DNA ploidy presented a marginal significance (p=0.05) in discriminating ACTs. None of the parameters discriminated between malignant and benign ACT in the adult group. ACTs are uncommon and definitive predictive criteria for malignancy remain uncertain, particularly in children. Our data point to DNA content evaluated by image analysis as a new candidate tool for this challenging task. Texture image analysis did not help to differentiate malignant from benign adrenal cortical tumors in children and adults.
    Anticancer research 08/2009; 29(8):3365-8. · 1.83 Impact Factor
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    ABSTRACT: Objetivo. Este estudio transversal tuvo como objetivo valorar la asociacion entre el analisis inmunohistoquimico de p16INK4A y de la triada de histidina fragil (FHIT) y la presencia de lesiones cervicales precancerosas. Material y metodos. Se estudio a mujeres visitadas en el Perola Byington Hospital, Sao Paulo, Brasil, que presentaban una cervicitis confirmada histologicamente (n = 31), neoplasia cervical intraepitelial (CIN) 1 (n = 30), CIN 2,3 (n = 30) o cancer cervical (n = 7), en las que se obtuvieron muestras de material cervical para citologia liquida (CL), prueba del virus del papiloma humano Hybrid Capture 2 (HC2), y reacciones inmunohistoquimicas de p16 y de FHIT. Resultados. Las reacciones de p16 y de FHIT se valoraron de la siguiente forma: <1%, 1% a 5%, > 5% a 25%, y > 25%. Se utilizo un analisis de curva de receptor-operador para elegir los valores de corte de p16 y FHIT para los ulteriores analisis de variables discretas. La totalidad de los 37 casos de CIN 2-3/cancer, excepto uno, presentaron una puntuacion de p16 de la clase superior a 1% a 5%. De los 61 casos de cervicitis/CIN 1, 46 (75%) tenian una puntuacion de p16 de la clase inferior a 1% a 5%. En cambio, no se observo asociacion alguna de la expresion de FHIT con la gravedad de las lesiones cervicales en este conjunto de datos. Los analisis de la curva de operador-receptor sugirieron la puntuacion de 1% a 5% para p16 como valor de corte que mejor discrimina entre CIN 2-3/cancer y cervicitis/CIN 1. No pudo sugerirse ningun valor de corte para las puntuaciones de FHIT con esta serie de datos. Conclusion. La expresion de p16, pero no en cambio la de FHIT, tiene un potencial de uso como herramienta diagnostica complementaria para el estudio de las lesiones cervicales inducidas por el virus del papiloma humano, si estos resultados son confirmados por estudios mas amplios. [black small square] (C)2009The American Society for Colposcopy and Cervical Pathology
    Journal of Lower Genital Tract Disease 05/2009; 2(2). DOI:10.1097/00128360-200906001-00008 · 1.99 Impact Factor
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    R Palacios · Jf Senise · Mjr Vaz · Rs Diaz · A Castelo
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    ABSTRACT: Short-term antiretroviral therapy (START) to prevent mother-to-child transmission (MTCT) is currently recommended for all HIV-1-infected pregnant women. The objective of this study was to assess the effect on CD4 cell counts and viral load dynamics the withdrawal of START after birth could generate. This was a 5-year cohort study involving HIV-1-infected pregnant women who presented with CD4 counts >300 cells/microL and had received START to prevent MTCT. Seventy-five pregnancies were assessed. In 24 cases, there was a history of antiretroviral therapy prior to prophylaxis. The median baseline CD4 count was 573 cells/microL. In 75% of cases, prophylaxis was started after 26.6 weeks of gestation. The median CD4 cell count increase over baseline during prophylaxis was 24.5%. In only five cases did HIV-1 viral load remain detectable during prophylaxis. After START, CD4 cell counts did not drop significantly, and the HIV-1 viral load plateau was near the baseline level. The estimated mean time for CD4 count to fall below 300 cells/microL was 3.5 years and was directly associated with high baseline CD4 cell count, as well as with CD4 increase after prophylaxis, whereas it was negatively correlated with previous use of antiretroviral (ARV) drugs and persistence of detectable HIV-1 viral load during prophylaxis. A potent, well-tolerated prophylactic ARV regimen can improve CD4 cell counts during and after START. In women receiving such prophylaxis, there is a remarkable time interval for CD4 cell counts to drop to levels that indicate treatment.
    HIV Medicine 03/2009; 10(3):157-62. DOI:10.1111/j.1468-1293.2008.00665.x · 3.99 Impact Factor
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    ABSTRACT: To translate the HIV/AIDS-Targeted Quality of Life Instrument (HAT-QoL) into Brazilian Portuguese, culturally adapt it, and evaluate its psychometric properties (validity and reliability) as a Brazilian version. This cross-sectional study was carried out at the laboratory of infectious diseases at Escola Paulista de Medicina (Universidade Federal de São Paulo). Data were collected on clinical and sociodemographic characteristics of 106 HIV-infected individuals who answered the HAT-QoL and the SF-36. Pearson's correlation coefficient was used to measure construct validity. Reliability was assessed using Cronbach's alpha and intraclass correlation coefficients. The sample was 70.8% male. The mean age was 39.9 years, with 40.5% of the participants being homosexual or bisexual. Eleven (10.4%) patients had a CD4 cell count <or= 200 cells/mm(3). A substantial ceiling effect was observed in 7 of 9 HAT-QoL domains (overall function, life satisfaction, health worries, medication worries, HIV acceptance, provider trust, and sexual function). Sexual function was the domain with the highest ceiling effect (63.2%). A substantial floor effect (30.2%) was observed for financial worries. Statistically significant associations were observed between the HAT-QoL domains and clinical and sociodemographic characteristics, as well as with SF-36 domains. Internal consistency was satisfactory (Cronbach's alpha = 0.73-0.90). Inter- and intra-observer reproducibility was very high (0.87-0.98 and 0.82-0.97, respectively). The Brazilian Portuguese version of the HAT-QoL is valid, reliable, and may contribute to evaluating the impact of HIV infection on the quality of life of patients in Brazil.
    Revista Panamericana de Salud Pública 01/2009; 25(1):69-76. · 0.85 Impact Factor
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    Revista Panamericana de Salud Pública 01/2009; 25(1). DOI:10.1590/S1020-49892009000100011 · 0.85 Impact Factor
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    ABSTRACT: Gynecological cytology has some inaccurate morphological categorization and poor interobserver reproducibility especially for glandular lesions. Liquid-based cytology (LBC) preparations are presumed to reduce artifacts that interfere in diagnosis performance, but its value to correctly identify glandular alterations has not been sufficiently reported. The objective of this study was to compare the diagnostic performance and interobserver agreement of LBC and conventional Pap smear to identify histologically confirmed glandular lesions according to five cytologists. Sensitivity ranged from 55.8 to 73.1% and 32.7 to 48.1% for Pap smear and LBC, respectively. Specificity ranged from 66.1 to 87.1% and 69.4 to 94.4%, respectively. In general, agreement between pairs of cytologists was poor with kappa-values around 0.45. In conclusion, relying entirely on cervical cytology to rule out glandular lesions may be risky. The use of HPV DNA test alone or combined to screening glandular lesions may contribute to minimize the limitations of both conventional and LBC preparations to diagnose glandular abnormalities.
    Diagnostic Cytopathology 05/2008; 36(4):270-4. DOI:10.1002/dc.20799 · 1.12 Impact Factor
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    ABSTRACT: The toxic potential of nevirapine in pregnant women with CD4 count over 250 cells mm −3 and the unsatisfactory efficacy of nelfinavir in patients with baseline Viral Load (VL) over 100,000 copies mL−1 has prompted the use of Lopinavir/ritonavir (LPV/r) in selected situations. This study aims to assess safety of LPV/r in pregnancy. Medical records from pregnant women receiving LPV/r were retrospectively reviewed. Charts corresponding to twin pregnancy, hypertension and having a lack of data supporting a reliable estimate of Gestational Age (GA) at delivery were excluded. Low Birth Weight (LBW) was defined as less than 2500 g. Pre-Term Delivery (PD), defined as GA at delivery less than 259 days, was estimated using date of Last Menstruation Period (LMP) and obstetrical ultrasound. A total of 64 women were analyzed. LPV/r was used in 46.9% due to virologic failure with other Protease Inhibitors (PIs). LPV/r was used for a mean of 108.8 days. Baseline median CD4+ cell count and HIV-1 RNA were 287 mm−3 and 31,100 copies mL−1, respectively and 345 mm−3 and less than 400 copies mL−1 at delivery. HIV-1 was not transmitted to any newborn. LBW was observed in 13 (20.3%) and PD in 16 (25%) newborns. Time on LPV/r during pregnancy, maternal age, baseline CD4+ cell count and HIV-1 RNA, GA at initiation of LPV/r, reason for prescribing LPV/r and type of delivery were not associated with PD. Frequencies of LBW and PD were, respectively, 20.3 and 25%. Neither the magnitude nor the timing in pregnancy of LPV/r use was associated with PD.
    American journal of infectious diseases 04/2008; 4(4):209-214. DOI:10.3844/ajidsp.2008.209.214
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    ABSTRACT: The G protein-coupled receptor kinase 3 gene (GRK3) is a candidate gene for cocaine addiction because it is involved in the regulation of several neurotransmitter receptors, including the response to dopaminergic agonists such as methamphetamine and cocaine. We hypothesized that genetic variants in the GRK3 gene might be associated with an increased risk of cocaine addiction. To test this, we genotyped three variants located in 5' untranslated and promoter regions of the gene in a sample of 711 cocaine users and 862 healthy control individuals from Sao Paulo, Brazil. Genotypic, allelic and haplotypic analyses provided no evidence for an association between alleles at these polymorphisms and cocaine abuse in this sample. Population stratification was tested for and its effect corrected for, but this did not affect the association test results. In conclusion, our results do not support a major role for GRK3 gene promoter variants in cocaine addiction.
    Psychiatric Genetics 09/2007; 17(4):239-42. DOI:10.1097/YPG.0b013e3280ae6c3d · 1.94 Impact Factor
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    ABSTRACT: This cross-sectional study was intended to assess the association between immunohistochemical analysis of p16 and fragile histidine triad (FHIT) and the presence of precancerous cervical lesions. Women seen at Pérola Byington Hospital, São Paulo, Brazil, with histologically confirmed cervicitis (n = 31), cervical intraepithelial neoplasia (CIN) 1 (n = 30), CIN 2,3 (n = 30), and cervical cancer (n = 7) had also cervical material collected for liquid-based cytology, human papillomavirus Hybrid Capture 2 (HC2) test, and p16 and FHIT immunohistochemical reactions. p16 and FHIT reactions were scored as the following: <1%, 1% to 5%, >5% to 25%, and >25%. Receiver operating curve analysis was used to select p16 and FHIT score cutoffs for further categorical analyses. All but one of the 37 CIN 2,3/cancer cases had a p16 score of greater than 1% to 5%. Among the 61 cervicitis/CIN 1 cases, 46 (75%) had a p16 score lower than 1% to 5%. In contrast, no association of FHIT expression and severity of cervical lesions could be demonstrated in this data set. Receiver operating curve analyses suggested the score of 1% to 5% for p16 as the cutoff that best discriminates CIN 2,3/cancer from cervicitis/CIN 1. No cutoff for FHIT scores could be suggested with data set. p16, but not FHIT expression, has the potential to be used as complementary diagnostic tool to investigate human papillomavirus-induced cervical lesions, if these results are confirmed in larger studies.
    Journal of Lower Genital Tract Disease 07/2007; 11(3):151-7. DOI:10.1097/LGT.0b013e31802efb9e · 1.99 Impact Factor
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    ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in most Brazilian Hospitals, and there are few studies which show the efficacy of control measures in such situations. This study evaluated intensive care unit (ICU) patients, in two years divided in control, intervention and post-intervention group. Intervention measures: hands-on educational programs for healthcare workers; early identification of MRSA infected or colonized patients, labeled with a bed-identification tag for contact isolation; nasal carriers, patients, and healthcare professionals treated with topical mupirocin for five days. The hospital infection rates in the control period were compared to the ones in the post-intervention period. Hospital infection rates were found by means of the NNISS methodology The incidence coefficients of MRSA hospital infection (monthly average of 1,000 pts/day) in the control, intervention and post-intervention groups were respectively: 10.2, 5.1 and 2.5/1,000 pts/day (p<0.001) and MRSA-originated bloodstream infections were 3.6, 0.9 and 1.8/1,000 central venous catheter/day (p=0.281). Nasal colonization in both intervention and post-intervention periods was of 30.9% and 22.1% among the hospitalized patients, respectively 54.4% and 46.1% of whom were already MRSA-positive when admitted to the unit. In the intervention period, most of those MRSA infected patients (76.2%) were nasal carrier. Mortality rates were, respectively 26.6%; 27.3% and 21.0% (p<0.001). Nasal carriers, both patients (93.7%) and healthcare professionals (88.2%), were successfully treated with topical mupirocin. Intervention measures for the prevention and control of MRSA infections in ICUs, have been efficient in the reduction of the bloodstream and MRSA-originated hospital infections incidence, and reduced the overall mortality rate significantly.
    Brazilian Journal of Infectious Diseases 03/2007; 11(1):57-62. DOI:10.1590/S1413-86702007000100015 · 1.30 Impact Factor
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    ABSTRACT: This study characterized HIV-1 among antiretroviral-naïve populations presenting recent infection (RI) or long-standing infection (LSI). Sera collected from January 1999 to December 2001 at an anonymous HIV testing site in Santos, Brazil, were submitted to serologic testing algorithm for recent HIV seroconversion (STARHS). The STARHS methodology uses a combination of a sensitive and a less sensitive version of an anti-HIV enzyme immunoassay (EIA), and specimens found to be positive on the sensitive EIA and negative on the less sensitive EIA are considered to represent RI. HIV-1 V3 and pol regions of those with RI and LSI were compared. Antiretroviral resistance was defined solely by genotypic analysis. Ninety samples were evaluated representing those taken from an original cohort of 345 individuals, for whom adequate samples were available. Of 90 HIV-positive individuals, 25 presented RI. Cumulatively, 36.8% of those with RI and 25% of those with LSI presented resistance to at least one antiretroviral class. In the pol and V3 regions, 47% and 53% of those with RI presented clade B viruses and B/F recombinant viruses, respectively, whereas 56.2%, 41.7%, and 2.1% of those with LSI harbored clades B, B/F, and clade C viruses, respectively. Primary resistance and the prevalence of B/F recombinants was high in this population. Monitoring HIV-1 genetic diversity is important for developing vaccines and treatment strategies.
    AIDS PATIENT CARE and STDs 03/2007; 21(2):116-28. DOI:10.1089/apc.2006.0079 · 3.50 Impact Factor
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    ABSTRACT: The objective of the study was to evaluate the influence of pregnancy on the level of adherence with antiretroviral (ARV) drugs, in a prospective cohort of 72 pregnant women and 79 non-pregnant women. Adherence was measured by pill counting and self-reporting. Women were deemed adherent if 95% or more of all ARV had been taken as prescribed, in two occasions. According to pill counting, 43.1 and 17.7% of pregnant and non-pregnant women, respectively, met the criteria of adherence (P = 0.001); in the postpartum, adherence declined to 20.6% (P = 0.002). In both groups, adherence rates by self-reporting were significantly higher as compared with pill counting (P = 0.001). In multivariate regression analysis, age >29 years (odds ratio [OR] 3.58, confidence interval [CI] 95% 0.10-0.75, P = 0.011), mean number of pills/day <6 (OR 2.53, CI 95% 1.07-6.01, P = 0.035), and being pregnant (OR 3.33, CI 95% 1.36-8.13, P = 0.008) were independently associated to greater adherence.
    International Journal of STD & AIDS 01/2007; 18(1):28-32. DOI:10.1258/095646207779949808 · 1.05 Impact Factor
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    ABSTRACT: To evaluate the use of community health agents (CHAs) to instruct women living in poor rural areas in obtaining self-collected cervical samples and compare the high-risk HPV (hrHPV) hybrid capture (HC) results obtained to those for gynecologist-collected samples. After a one-day training, CHAs visited sexually active women, instructing each in the use of collection brush and the Universal Collection Medium tube. One week thereafter, a gynecologist collected cervical samples from, and performed colposcopies on, the same women. A single reference lab performed all HCs. 878 women (Age: 15-69 years) participated. Among self-collected samples, hrHPV prevalence was 33.9% (95% CI: 30.8%-37%), compared with 28.6% (95% CI: 27%-30%) among gynecologist-collected samples. However, 9.3% of the patients were HPV HC II-positive in the self-collected sample and HPV HC II-negative in the gynecologist-collected samples (95% CI: 7.38%-11.22%), whereas 4% tested positive in gynecologist-collected samples and negative in self-collected samples (95% CI: 2.7%-5.3%) (P<0.01; kappa=0.7). Of 9 cases of histologically-confirmed, high-grade squamous intraepithelial lesion, self-collected and provider-collected samples missed one each. Self-collected vaginal sampling could be made an additional CHA function under existing program conditions, improving access to cervical cancer screening in poor rural settings.
    International Journal of Gynecology & Obstetrics 12/2006; 95(2):179-84. DOI:10.1016/j.ijgo.2006.07.012 · 1.54 Impact Factor
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    ABSTRACT: Influenza vaccination of elderly people is efficacious and cost effective for the prevention of influenza and its complications. Some studies have pointed out low immunogenicity in this group. Health status has been poorly investigated as a risk factor that may influence the immune response to influenza vaccine. We established an immunization response study of a highly-matched elderly population in a nursing home. One-hundred-twenty subjects of Ashkenazian origin had their vaccine-induced antibody response assessed. Good response was obtained in 30.8% (37/120), and 31.7% (38/120) did not react. A lack of good response was found to be associated with dementia (P=0.016) in a multivariate analysis. In addition to dementia, malnutrition was frequently observed among poor responders, suggesting that these factors should be considered in vaccination studies. Chemoprophylaxis in addition to vaccination for elderly presenting dementia should be considered, particularly for those people living nursing homes.
    Brazilian Journal of Infectious Diseases 09/2006; 10(4):269-73. DOI:10.1590/S1413-86702006000400011 · 1.30 Impact Factor

Publication Stats

1k Citations
166.97 Total Impact Points


  • 1996–2013
    • Universidade Federal de São Paulo
      • • Departamento de Medicina
      • • School of Medicine
      San Paulo, São Paulo, Brazil
  • 2007
    • Hospital Samaritano São Paulo
      San Paulo, São Paulo, Brazil
  • 2005
    • King's College London
      • MRC Social, Genetic and Developmental Psychiatry Centre
      London, ENG, United Kingdom
  • 2004
    • Universidade Federal do Ceará
      Ceará, Ceará, Brazil
  • 2002
    • Universidade Federal de Goiás
      • Instituto de Patologia Tropical e Saúde Pública (IPTSP)
      Goiânia, Estado de Goias, Brazil
    • Universidade Federal de Alagoas
      Maçayó, Alagoas, Brazil