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Registros recuperados: 26
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Immune reconstitution syndrome in patients treated for HIV and tuberculosis in Rio de Janeiro 55
Serra,Fabiana C.; Hadad,David; Orofino,Renata L.; Marinho,Flavia; Lourenço,Cristina; Morgado,Mariza; Rolla,Valeria.
We made a retrospective longitudinal study from January 2000 to January 2003 to examine cases of immune reconstitution syndrome (IRS) and its incidence rate in tuberculosis (TB)-human immunodeficiency virus (HIV) co-infected patients. The incidence rate (IR) was calculated using a Poisson regression. The confidence interval (CI) that was stipulated was 95%. IRS occurred in 10/84 HIV and TB-positive patients; nine of them were on highly active anti-retroviral therapy (HAART) during a mean of 61.7 (±59) days following the introduction of antiretrovirals. Lymph-node enlargement was the sole clinical manifestation. CD4 counts were <100 cells/mm³in 50% of the patients, at the time of TB diagnosis. All but two patients were treated with prednisone, and...
Tipo: Info:eu-repo/semantics/article Palavras-chave: AIDS; Immune reconstitution syndrome; Tuberculosis; HAART; Lymph node enlargement; Paradoxical reaction.
Ano: 2007 URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702007000500004
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Classical and alternative macrophages have impaired function during acute and chronic HIV-1 infection 55
Galvão-Lima,Leonardo J.; Espíndola,Milena S.; Soares,Luana S.; Zambuzi,Fabiana A.; Cacemiro,Maira; Fontanari,Caroline; Bollela,Valdes R.; Frantz,Fabiani G..
Abstract Objectives: Three decades after HIV recognition and its association with AIDS development, many advances have emerged – especially related to prevention and treatment. Undoubtedly, the development of Highly Active Antiretroviral Therapy (HAART) dramatically changed the future of the syndrome that we know today. In the present study, we evaluate the impact of Highly Active Antiretroviral Therapy on macrophage function and its relevance to HIV pathogenesis. Methods: PBMCs were isolated from blood samples and monocytes (CD14+ cells) were purified. Monocyte-Derived Macrophages (MDMs) were activated on classical (MGM-CSF+IFN-γ) or alternative (MIL-4+IL13) patterns using human recombinant cytokines for six days. After this period, Monocyte-Derived...
Tipo: Info:eu-repo/semantics/article Palavras-chave: HIV-1; Innate immune response; HAART; Macrophages.
Ano: 2017 URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702017000100042
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Identifying risk factors of immune reconstitution inflammatory syndrome in AIDS patients receiving highly active anti-retroviral therapy 55
He,Bo; Zheng,Yuhuang; Liu,Meng; Zhou,Guoqiang; Chen,Xia; Mamadou,Diallo; He,Yan; Zhou,Huaying; Chen,Zi.
Immune reconstitution inflammation syndrome typically occurs within days after patients undergo highly active anti-retroviral therapy and is a big hurdle for effective treatment of AIDS patients. In this study, we monitored immune reconstitution inflammation syndrome occurrence in 238 AIDS patients treated with highly active anti-retroviral therapy. Among them, immune reconstitution inflammation syndrome occurred in 47 cases (19.7%). Immune reconstitution inflammation syndrome patients had significantly higher rate of opportunistic infection (p < 0.001) and persistently lower CD4+ cell count (p < 0.001) compared to the non-immune reconstitution inflammation syndrome patients. In contrast, no significant differences in HIV RNA loads were observed...
Tipo: Info:eu-repo/semantics/article Palavras-chave: IRIS; AIDS; HIV; HAART.
Ano: 2013 URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702013000200009
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Metabolic profile and cardiovascular risk factors among Latin American HIV-infected patients receiving HAART 55
Cahn,P; Leite,O; Rosales,A; Cabello,R; Alvarez,CA; Seas,C; Carcamo,C; Cure-Bolt,N; L'Italien,Gp; Mantilla,P; Deibis,L; Zala,C; Suffert,T.
OBJECTIVE: Determine the prevalence of metabolic abnormalities (MA) and estimate the 10-year risk for cardiovascular disease (CVD) among Latin American HIV-infected patients receiving highly active anti-retroviral therapy (HAART). METHODS: A cohort study to evaluate MA and treatment practices to reduce CVD has been conducted in seven Latin American countries. Adult HIV-infected patients with at least one month of HAART were enrolled. Baseline data are presented in this analysis. RESULTS: A total of 4,010 patients were enrolled. Mean age (SD) was 41.9 (10) years; median duration of HAART was 35 (IQR: 10-51) months, 44% received protease inhibitors. The prevalence of dyslipidemia and metabolic syndrome was 80.2% and 20.2%, respectively. The overall 10-year...
Tipo: Info:eu-repo/semantics/article Palavras-chave: HAART; HIV; Metabolic parameters; Cardiovascular risk factors; Metabolic syndrome; Dyslipidemia.
Ano: 2010 URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000200008
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Metabolic effects associated to the highly active antiretroviral therapy (HAART) in AIDS patients 55
Domingos,Hamilton; Cunha,Rivaldo Venâncio da; Paniago,Anamaria Mello Miranda; Martins,Diego Mira; Elkhoury,Eduardo Brandão; Souza,Albert Schiaveto de.
The aim of this study was to evaluate the metabolic abnormalities (dyslipidaemia and insulin resistance) associated with highly active antiretroviral therapy (HAART) in AIDS patients, treated in Campo Grande, Mato Grosso do Sul, Brazil. The patients were distributed in five different groups: Group 1, HIV-infected without antiretroviral therapy; Group 2, with Zidovudine, Lamivudine and Efavirenz or Nevirapine; Group 3, with Zidovudine, Lamivudine and Protease Inhibitor; Group 4, with Stavudine, Lamivudine and Efavirenz or Nevirapine; and Group 5, with Stavudine, Lamivudine and Protease Inhibitor. The lipid and glucose profile were determined and statistics comparison was made. The findings of this study showed significant statistics elevations of total...
Tipo: Info:eu-repo/semantics/article Palavras-chave: AIDS; HAART; Metabolic effects; Dyslipidaemia; Insulin resistance.
Ano: 2009 URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702009000200012
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Changing patterns of AIDS: impact on the indications and diagnostic yield of bone marrow biopsies 55
Morais,José Carlos; Machado,Marcel; Biasoli,Irene; Barroso,Paulo Feijó; Milito,Cristiane; Spector,Nelson.
After the advent of HAART, the clinical course of HIV infection has dramatically improved. Therefore, it seems appropriate to reevaluate the performance of bone marrow biopsy (BMB) as a diagnostic tool. The aim of the present study was to compare the reasons for performing a BMB and its diagnostic yield in HIV-patients before and after HAART. A total of 165 BMB specimens obtained from HIV-infected patients receiving care at the Hospital of Universidade Federal do Rio de Janeiro in two different periods (1986-1994 and 1999-2004) were analysed. The main reason for BMB examination in the first period was fever (88%), which decreased in the second period (57%, p < 0.0001), when cytopenia (51%) was the leading reason for BMB, whereas in the first period it...
Tipo: Info:eu-repo/semantics/other Palavras-chave: Bone marrow biopsy; HIV; HAART.
Ano: 2010 URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000400019
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Factors associated with clinical, immunological and virological responses in protease-inhibitor-experienced brazilian children receiving highly active antiretroviral therapy containing Lopinavir-Ritonavir 55
Machado,Daisy Maria; Gouvêa,Aída de Fátima Barbosa; Cardoso,Maria Regina; Beltrão,Suênia Vasconcelos; Cunegundes,Kelly Simone; Bononi,Fabiana; Almeida,Fernanda; Cavalheiro,Kaline; Angelis,Daniela Souza Araújo de; Succi,Regina Célia de Menezes.
This study evaluates clinical, virological and immunological responses to antiretroviral (ARV) therapy based on Lopinavir/ritonovir (LPV/r) in previously protease -inhibitor-experienced children. The study included 29 Brazilian children (median age = 5.91 years) who had failed previous ARV therapy and had begun a regimen based on LPV/r. At 12 months follow-up, a good virological response to LPV/r therapy was defined as achieving an undetectable viral load or as a decrease in plasma HIV RNA levels to > 1 log. A good immunological response was defined as an increase in CD4+ cell count from baseline sufficient to attain a better CDC immune stage classification. The number of infectious episodes 12 months before and 12 months after beginning LPV/r was...
Tipo: Info:eu-repo/semantics/article Palavras-chave: HIV; Children; HAART; Lopinavir/ritonavir.
Ano: 2007 URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702007000100006
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Dyslipidemia in AIDS patients on highly active antiretroviral therapy 55
Nery,Max Weyler; Martelli,Celina Maria Turchi; Turchi,Marília Dalva.
Highly active antiretroviral therapy (HAART) reduces AIDS-related morbidity and mortality, however it has been associated with metabolic abnormalities. This study estimated the prevalence of lipid abnormalities and related factors among patients on HAART. A cross-sectional study was conducted on adult patients, in central Brazil. Patients were interviewed, and blood obtained for lipids measurement. Dyslipidemia was defined as total cholesterol (TC) &gt; 240 mg/dL, low-density lipoprotein (LDL) &gt; 160 mg/dL, triglycerides (TG) &gt; 200 and/or high-density lipoprotein (HDL) < 40 mg/dL. Multiple logistic regression analyses were performed (SPSS 13.0). One hundred and thirteen patients were recruited. Mean age was 39.3 years; 68.1% were males;...
Tipo: Info:eu-repo/semantics/article Palavras-chave: Prevalence; Dyslipidemia; HIV; AIDS; HAART.
Ano: 2011 URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702011000200010
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Comparative performances of serologic and molecular assays for detecting human T lymphotropic virus type 1 and type 2 (HTLV-1 and HTLV-2) in patients infected with human immunodeficiency virus type 1 (HIV-1) 55
Campos,Karoline Rodrigues; Gonçalves,Maria Gisele; Costa,Nadia Aparecida; Caterino-de-Araujo,Adele.
ABSTRACT The present study evaluated several techniques currently available (commercial kits and in-house assays) for diagnosing human T lymphotropic viruses types 1 and 2 in two groups of patients enrolled at HIV/AIDS specialized care services in São Paulo: Group 1 (G1), n = 1608, 1237 male/371 female, median age 44.3 years old, majority using highly active antiretroviral therapy (HAART); G2, n = 1383, 930 male/453 female, median age of 35.6 years old, majority HAART naïve. Enzyme immunoassays [(EIA) Murex and Gold ELISA] were employed for human T lymphotropic viruses types 1 and 2 screening; Western blotting (WB), INNO-LIA (LIA), real-time PCR pol (qPCR), and nested-PCR-RFLP (tax) were used to confirm infection. Samples were considered human T...
Tipo: Info:eu-repo/semantics/article Palavras-chave: HTLV-1/2; HIV-1; Coinfection; Diagnosis; Immunoblotting; PCR; HAART.
Ano: 2017 URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702017000300297
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Aging with HIV: a practical review 55
Cardoso,Sandra Wagner; Torres,Thiago Silva; Santini-Oliveira,Marilia; Marins,Luana Monteiro Spindola; Veloso,Valdiléa Gonçalves; Grinsztejn,Beatriz.
The worldwide elderly population is expected to grow by an additional 694 million people by 2025. By that time, there will be approximately two billion elderly people in the world, most of whom (80%) will be living in developing countries. Based on recent estimates, this population will number over 40 million in 2030 in Brazil and a consequent increase in governmental spending for this population can be expected. Since highly active antiretroviral therapy became available in the mid-1990s, the life expectancy of people living with HIV has increased significantly. Approximately 12 million life years were added to the world between 1996 and 2008 as a consequence of wider access to highly active antiretroviral therapy. In Brazil, the incidence of AIDS among...
Tipo: Info:eu-repo/semantics/article Palavras-chave: HIV; AIDS; Aging; Elderly; Brazil; Comorbidity; HAART.
Ano: 2013 URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702013000400013
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Clinical forms and outcome of tuberculosis in HIV-infected patients in a tertiary hospital in São Paulo - Brazil 55
Klautau,Giselle Burlamaqui; Kuschnaroff,Tuba M..
Tuberculosis (TB)/HIV co-infection significantly changes the natural history of both diseases. Proper comprehension and clinical management of co-infected TB/HIV patients is still a challenge, particularly in places like Brazil, where both types of infection are prevalent. OBJECTIVES: Evaluate the frequency of the clinical forms of TB in HIV-infected patients; correlate the clinical forms of TB with the level of immunodeficiency; evaluate the response to therapy with different regimens for the treatment of TB; identify potential prognostic factors in TB/HIV patients. MATERIAL AND METHODS: The following data were collected at the beginning of the study: medical history, epidemiological background, physical examination, and laboratory evaluation (complete...
Tipo: Info:eu-repo/semantics/article Palavras-chave: Tuberculosis (TB); Prognostic factors; Co-infection TB/HIV; HAART.
Ano: 2005 URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702005000600004
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Prevalence of resistance-associated mutations in Human Immunodeficiency Virus type 1-positive individuals failing HAART in Rio de Janeiro, Brazil 55
Varella,Rafael Brandão; Ferreira,Selma Baía; Castro,Márcia Braga de; Tavares,Marisa Dias; Zalis,Mariano Gustavo.
We investigated the occurrence of HIV-1 antiretroviral resistance in individuals failing to respond to highly active antiretroviral therapy (HAART) attended by RENAGENO from 2001-2004. One hundred and seventeen patients were selected for this study; their plasma viral RNA was extracted and the PR and RT genes sequenced to examine subtype, genetic polymorphisms and mutations associated with resistance to antiretroviral drugs. HIV-1 sequence analysis showed that 86/100 (86%) were infected with subtype B, 7/100 (7%) with subtype F and 7/100 (7%) with RT/PR hybrid forms (2 D/B, 2 F/B, 2 B/F and 1 D/F). In 14 (12%) of the samples, the subtype was not determined. The prevalence of resistance mutations was high (93.1%), mainly in the RT gene. The most prevalent...
Tipo: Info:eu-repo/semantics/article Palavras-chave: HIV-1; HAART; Reverse transcriptase; Protease; Resistance.
Ano: 2008 URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702008000500007
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Aging with HIV: an overview of an urban cohort in Rio de Janeiro (Brazil) across decades of life 55
Torres,Thiago Silva; Cardoso,Sandra Wagner; Velasque,Luciane de Souza; Marins,Luana Monteiro Spindola; Oliveira,Marília Santini de; Veloso,Valdilea Gonçalves; Grinsztejn,Beatriz.
The introduction of highly active antiretroviral therapy during the 1990s was crucial to the decline in the rates of morbidity and death related to the acquired immunodeficiency syndrome (AIDS) and turned human immunodeficiency virus (HIV) infection into a chronic condition. Consequently, the HIV/AIDS population is becoming older. The aim of this study was to describe the immunological, clinical and comorbidity profile of an urban cohort of patients with HIV/AIDS followed up at Instituto de Pesquisa Clinica Evandro Chagas, Oswaldo Cruz Foundation in Rio de Janeiro, Brazil. Retrospective data from 2307 patients during January 1st, 2008 and December 31st, 2008 were collected. For continuous variables, Cuzick's non-parametric test was used. For categorical...
Tipo: Info:eu-repo/semantics/article Palavras-chave: HIV; AIDS; Aging; Elderly; Brazil; Comorbidity; HAART.
Ano: 2013 URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702013000300004
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Immune restoration in human immunodeficiency virus and hepatitis C virus coinfected patients after highly active antiretroviral therapy 55
Antonello,Vicente Sperb; Appel-da-Silva,Marcelo Campos; Kliemann,Dimas Alexandre; Santos,Breno Riegel; Tovo,Cristiane Valle.
OBJECTIVE: To evaluate the influence of hepatitis C virus on immunological and virological responses after highly active antiretroviral therapy initiation in human immunodeficiency virus/hepatitis C virus coinfected patients compared to monoinfected human immunodeficiency virus-infected patients. METHODS: The study enrolled 65 human immunodeficiency virus-1-infected subjects who initiated highly active antiretroviral therapy and attended follow-up visits over 48 weeks from 2008 to 2010. They were grouped based on hepatitis C virus-RNA results. Virological and immunological responses were monitored at baseline and at the end of weeks 12, 24, 36, and 48. RESULTS: There were 35 human immunodeficiency virus monoinfected and 30 human immunodeficiency...
Tipo: Info:eu-repo/semantics/article Palavras-chave: HIV; Hepatitis C; Coinfection; HAART; CD4; Immunological response.
Ano: 2013 URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702013000500007
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Prediction of brain atrophy using three drug scores in neuroasymptomatic HIV-infected patients with controlled viremia 55
Novakovic,Marko; Turkulov,Vesna; Maric,Daniela; Kozic,Dusko; Rajkovic,Uros; Bjelan,Mladen; Lucic,Milos; Brkic,Snezana.
ABSTRACTBACKGROUND: Despite potent antiretroviral therapy, HIV still causes brain damage. Better penetration into the CNS and efficient elimination of monocyte/macrophages reservoirs are two main characteristics of an antiretroviral drug that could prevent brain damage. The aim of our study was to assess efficacy of three antiretroviral drug scores to predict brain atrophy in HIV-infected patients.METHODS:A cross sectional study consisting of 56 HIV-infected patients with controlled viremia, who had no clinically evident neurocognitive impairment. All patients had MRI of the head. A typical T2 transversal slice was analyzed and ventricles-brain ratio (VBr) as an overall brain atrophy index was calculated. Three antiretroviral drug scores were used and...
Tipo: Info:eu-repo/semantics/article Palavras-chave: CPE; Monocyte efficacy score; Brain atrophy; HAART; HIV.
Ano: 2015 URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702015000500503
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Durability of the first combined antiretroviral regimen in patients with AIDS at a reference center in Belo Horizonte, Brazil, from 1996 to 2005 55
Ribeiro,Flávia Andrade; Tupinambás,Unaí; Fonseca,Marise Oliveira; Greco,Dirceu Bartolomeu.
Finding a better first antiretroviral regimen is one of the strategies used to improve span and quality of life of HIV/AIDS patients. 891 patients were followed during 24 months or until interruption/abandonment of treatment, changing regimen or death. At the end of 6 months, 69% of the patients were still being treated with the first regimen, 54% at 12 months, 48% at 18 months and 39% at 24 months. AZT-3TC-EFV was the most prescribed regimen and with the lesser discontinuation. NNRTI regimens showed high effectiveness and durability compared to PI regimens. Irregular medication dispensation was the only risk factor for failure/interruption of treatment in multivariate analyses. Intolerance/adverse effects were mainly responsible for first regimen...
Tipo: Info:eu-repo/semantics/article Palavras-chave: HIV; AIDS; HAART; Durability; Efficacy.
Ano: 2012 URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702012000100005
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Effectiveness of highly active antiretroviral therapy (HAART) used concomitantly with rifampicin in patients with tuberculosis and AIDS 55
Sant'Anna,Flávia Marinho; Velasque,Luciane; Costa,Marli Jane; Schmaltz,Carolina Arana; Morgado,Mariza Gonçalves; Lourenço,Maria Cristina; Grinsztejn,Beatriz; Rolla,Valéria Cavalcanti.
This study evaluated the effectiveness of two HAART regimens concomitant to rifampicin based tuberculosis (TB) treatment. Patients with TB/HIV diagnosis followed at the TB program between June 2000 and March 2005 were prospectively evaluated. The different HAART regimens in antiretrovirals (ARV) treatment naïve and ARV experienced patients were compared. The effectiveness of HAART was defined as a VL <80 copies/mL from month 4 to month 10 after TB treatment. One hundred and forty-two patients were included. Among these, 68 (47%) were treatment naïve and 76 (53%) previously exposed. Odds ratio (OR) in naïve patients treated with efavirenz (EFV) based regimen (n=42) compared to ritonavir/saquinavir (RTV/SQV) based regimen (n=26) was 8.0 (CI=1.67-38.35,...
Tipo: Info:eu-repo/semantics/article Palavras-chave: Tuberculosis; AIDS; HAART; Rifampicin; Effectiveness.
Ano: 2009 URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702009000500010
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Bezafibrate for the treatment of hypertriglyceridemia in HIV1-infected patients on highly active antiretroviral therapy 55
Geraix,Juliana; Souza,Micheli Evangelista de; Delatim,Francieli Cristina; Pereira,Paulo Câmara Marques.
The use of highly active antiretroviral therapy (HAART) in HIV-infected patients has been associated with the development of risk factors for cardiovascular diseases (CD) including dyslipidemia and insulin resistance, hypertriglyceridemia being the most frequent metabolic disturbance in these patients. Fibrates are indicated when hypertriglyceridemia is accentuated and persists for over six months. We evaluated the efficacy and safety of bezafibrate for the treatment of hypertriglyceridemia in HIV-infected individuals on HAART. All patients received 400mg/day of bezafibrate and were evaluated three times: Mo (pre-treatment), M1 (one month after treatment), and M2 (six months after treatment). Fifteen adult individuals, eight males and seven females with...
Tipo: Info:eu-repo/semantics/article Palavras-chave: HIV; HAART; Hypertriglyceridemia; Bezafibrate.
Ano: 2006 URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702006000300001
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Long-term use of first-line highly active antiretroviral therapy is not associated with carotid artery stiffness in human immunodeficiency virus-positive patients 55
Zhu,Haohui; Yuan,Jianjun; Wang,Yisa; Gao,Fan; Wang,Xiao; Wei,Changhua; Chen,Jiyun; Fan,Xiaohui; Zhang,Mei.
Objective:To evaluate whether or not highly active antiretroviral therapy is associated with carotid artery stiffness in human immunodeficiency virus-positive patients in Henan Province, China.Method:Fifty human immunodeficiency virus-positive patients with at least a 5-year history of highly active antiretroviral therapy use and 50 human immunodeficiency virus-positive patients without a history of highly active antiretroviral therapy use were enrolled in this study. Carotid artery intima-media thickness and stiffness were determined by quantitative inter-media thickness and quantitative artery stiffness, respectively.Results:No statistically significant difference in carotid artery intima-media thickness and stiffness was observed between groups. A...
Tipo: Info:eu-repo/semantics/article Palavras-chave: Artery stiffness; AIDS; Ultrasound; HAART.
Ano: 2014 URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702014000500496
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Ocular problems in brazilian patients with AIDS before and in highly active antiretroviral therapy (HAART) era 55
Rodrigues,Marcia Lopes; Rodrigues,Maria de Lourdes Veronese; Figueiredo,José Fernando de Castro; Freitas,João Alberto Holanda de.
This study determined the total frequency of patients with AIDS and ophthalmologic problems before and after the introduction of combined highly active antiretroviral therapy (HAART), regardless of the use of this treatment; it also determined the frequency of external ocular diseases, intraocular infections and inflammations, and problems of the anterior portion of the optic nerve in these two groups of patients; and it determined the differences in the frequency of ophthalmologic problems in patients receiving HAART or not. This was a retrospective study of 207 patients examined using the same protocol, from June 1995 to February 1998 (n=58, pre-HAART era) and from March 1998 to May 2005 (n=149, HAART era). The frequency of ophthalmologic problems was...
Tipo: Info:eu-repo/semantics/article Palavras-chave: Ocular problems; AIDS; HAART.
Ano: 2007 URL: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702007000200005
Registros recuperados: 26
Primeira ... 12 ... Última
 

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