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Wallace Mendes-Silva - Top 30 Publications

Zika Virus Infection Associated With Congenital Birth Defects in a HIV-infected Pregnant Woman.

We describe a case of Zika virus infection acquired during the first trimester in a HIV-infected pregnant woman that led to multiple fetal malformations and fetal demise in Rio de Janeiro, Brazil.

The Hospital Information System of the Brazilian Unified National Health System: a performance evaluation for auditing maternal near miss.

This study aimed to investigate the performance of the Hospital Information System of the Brazilian Unified National Health System (SIH-SUS) in identifying cases of maternal near miss in a hospital in Rio de Janeiro, Brazil, in 2008. Cases were identified by reviewing medical records of pregnant and postpartum women admitted to the hospital. The search for potential near miss events in the SIH-SUS database relied on a list of procedures and codes from the International Classification of Diseases, 10th revision (ICD-10) that were consistent with this diagnosis. The patient chart review identified 27 cases, while 70 potential occurrences of near miss were detected in the SIH-SUS database. However, only 5 of 70 were "true cases" of near miss according to the chart review, which corresponds to a sensitivity of 18.5% (95%CI: 6.3-38.1), specificity of 94.3% (95%CI: 92.8-95.6), area under the ROC of 0.56 (95%CI: 0.48-0.63), and positive predictive value of 10.1% (IC95%: 4.7-20.3). These findings suggest that SIH-SUS does not appear appropriate for monitoring maternal near miss.

Comparing different diagnostic approaches to severe maternal morbidity and near-miss: a pilot study in a Brazilian tertiary hospital.

Despite recent guidelines proposed by the World Health Organization (WHO), the operational definition of maternal near-miss (MNM) is still heterogeneous. This study aimed at evaluating the pros and cons of three instruments in characterizing MNM cases. The performance of two of the three instruments was also investigated vis-à-vis the WHO criteria.

Management of obstetric antiphospholipid syndrome.

Recurrent early miscarriages (excluding chromosomal anomalies), late fetal loss, and maternal thrombosis are characteristic of obstetric antiphospholipid syndrome (APS). Obstetric complications such as preeclampsia, fetal growth restriction, premature delivery, and fetal death also occur in higher frequency in APS patients than in the general population. A high-risk obstetric center is needed for proper evaluation of and intervention with pregnant women with APS. Association with lupus carries additional risk of thrombosis when antiphospholipid antibodies (aPLs) are present. Gestational results with live births are improved to about 80% when antithrombotic therapy is used, but failure in 20% to 30% of the cases despite correct treatment with low-dose aspirin with or without heparin reveals new pathways for pregnancy loss in APS and unmet needs. At the moment, there is no recommendation to investigate patients with infertility for the presence of aPLs.

Antithrombotic effect of Glycyrrhizin, a plant-derived thrombin inhibitor.

Glycyrrhizin (GL), an anti-inflammatory compound isolated from licorice (Glycyrrhiza glabra), has been previously identified as a thrombin inhibitor (Francischetti et al., Biochem Biophys Res Commun 1997;235:259-63). Here we report the in vivo effects of GL upon two experimental models of induced thrombosis in rats. Intravenous administration of GL caused a dose-dependent reduction in thrombus size on a venous thrombosis model that combines stasis and hypercoagulability. It was observed that GL doses of 180 mg/kg body weight produced 93% decrease on thrombus weight. This effect showed a time-dependent pattern being significantly reduced when the thrombogenic stimulus was applied 60 min after drug administration. GL was also able to prevent thrombosis using an arteriovenous shunt model. GL doses of 180 and 360 mg/kg decreased the thrombus weight by 35 and 90%, respectively. Accordingly, the APTT ex vivo was enhanced by 1.5- and 4.3-fold at GL doses of 180 and 360 mg/kg, respectively. In addition, GL doses above 90 mg/kg caused significant hemorrhagic effect. In contrast with heparin, GL did not potentiate the inhibitory activity of antithrombin III or heparin cofactor II towards thrombin. Altogether, data indicate that GL is an effective thrombin inhibitor in vivo, which may account for its other known pharmacological properties.