750 Washington Street, Nemc #299 New England Medical Center
Boston MA 02111
Medical School: Other - 2001
Accepts Medicare: Yes
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: 228004
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Awards & Recognitions
Dr. Carlos Cunha is associated with these group practices
|HCPCS Code||Description||Average Price||Average Price
Allowed By Medicare
|HCPCS Code:70553||Description:Mri brain w/o & w/dye||Average Price:$382.00||Average Price Allowed
|HCPCS Code:70551||Description:Mri brain w/o dye||Average Price:$239.00||Average Price Allowed
|HCPCS Code:71250||Description:Ct thorax w/o dye||Average Price:$188.00||Average Price Allowed
|HCPCS Code:70450||Description:Ct head/brain w/o dye||Average Price:$136.00||Average Price Allowed
|HCPCS Code:76700||Description:Us exam abdom complete||Average Price:$131.00||Average Price Allowed
|HCPCS Code:71020||Description:Chest x-ray||Average Price:$36.00||Average Price Allowed
|HCPCS Code:71010||Description:Chest x-ray||Average Price:$30.00||Average Price Allowed
|HCPCS Code:74000||Description:X-ray exam of abdomen||Average Price:$30.00||Average Price Allowed
HCPCS Code Definitions
- Computed tomography, head or brain; without contrast material
- Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences
- Radiologic examination, chest; single view, frontal
- Radiologic examination, chest, 2 views, frontal and lateral
- Computed tomography, thorax; without contrast material
- Radiologic examination, abdomen; single anteroposterior view
- Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material
- Ultrasound, abdominal, real time with image documentation; complete
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Cardiovascular Disease (Cardiology)
Cardiovascular Disease (Cardiology)
*These referrals represent the top 10 that Dr. Cunha has made to other doctors
Detection of post-exercise stunning by early gated SPECT myocardial perfusion imaging: results from the IAEA multi-center study. - Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology
Transient post-ischemic LV dysfunction due to myocardial stunning in patients with coronary artery disease can be missed by conventional gated SPECT (GSPECT) acquisitions. The aim of this IAEA-sponsored multi-center study was to determine whether early post-exercise imaging is more likely to detect stunning than conventional without adversely affecting image quality or perfusion information.Patients undergoing exercise/rest GSPECT were enrolled in this international multicenter study. Post-exercise studies were acquired at 15 Â± 5 minutes after radiotracer injection (Stress-1) and repeated at 60 Â± 15 minutes (Stress-2). Rest studies (R) were acquired at 60 minutes post injection. A core laboratory quantitatively assessed perfusion pattern and LV blinded to the acquisition time. Ischemia was defined as summed stress score (SDS) â‰¥4, and stunning was defined as the difference between rest and post-stress LVEF (Î”-LVEF). In the 229 patients enrolled into the study, both image quality and perfusion information were similar between Stress-1 and Stress-2. Post-stress LVEF was associated with both ischemia and time of acquisition, with a significant correlation between SDS and Î”-LVEF, which was stronger at Stress-1 than Stress-2 in the ischemic compared to the non-ischemic population (r = 0.23 vs 0.08, P = 0.10).Early post-exercise imaging is feasible, and can potentially improve the detection of post-ischemic stunning without compromising image quality and perfusion data.
GTP hydrolysis by EF-G synchronizes tRNA movement on small and large ribosomal subunits. - The EMBO journal
Elongation factor G (EF-G) promotes the movement of two tRNAs and the mRNA through the ribosome in each cycle of peptide elongation. During translocation, the tRNAs transiently occupy intermediate positions on both small (30S) and large (50S) ribosomal subunits. How EF-G and GTP hydrolysis control these movements is still unclear. We used fluorescence labels that specifically monitor movements on either 30S or 50S subunits in combination with EF-G mutants and translocation-specific antibiotics to investigate timing and energetics of translocation. We show that EF-G-GTP facilitates synchronous movements of peptidyl-tRNA on the two subunits into an early post-translocation state, which resembles a chimeric state identified by structural studies. EF-G binding without GTP hydrolysis promotes only partial tRNA movement on the 50S subunit. However, rapid 30S translocation and the concomitant completion of 50S translocation require GTP hydrolysis and a functional domain 4 of EF-G. Our results reveal two distinct modes for utilizing the energy of EF-G binding and GTP hydrolysis and suggest that coupling of GTP hydrolysis to translocation is mediated through rearrangements of the 30S subunit.
[Nutritional status of adolescents in the state of MaranhÃ£o, Brazil, assessed by national and international criteria]. - CiÃªncia & saÃºde coletiva
This study sought to compare national and international criteria for assessing the nutritional status of adolescents. A cross-sectional analytical study was conducted in the period from July 2007 to January 2008 with a representative sample comprised of 1256 adolescents from the state of MaranhÃ£o. Body mass index (BMI) for age and gender was used to diagnose underweight, normal weight and overweight, using the criteria proposed by Conde and Monteiro and the World Health Organization (WHO). Chi-square, McNemar concordance and Spearman correlation tests were applied. According to the criteria of Conde and Monteiro and the WHO, there were significant differences among the boys with respect to low weight and obesity. It was observed that there was no significant divergence between the two criteria, and a significant positive correlation (0.011) between the two criteria was detected. With this analysis it can be seen that there are many divergences between the criteria used, therefore the best option and the advantage of using one or the other cannot be singled out. However, it should be stressed that the national criterion can also be used more, since there are no significant differences with the criteria advocated by the Ministry of Health of the WHO.
Vaccination of cattle with a recombinant bivalent toxoid against botulism serotypes C and D. - Vaccine
Cattle botulism is a fatal intoxication caused by botulinum neurotoxins (BoNTs) produced by Clostridium botulinum serotypes C and D resulting in economic losses. Vaccination is the most effective way to control botulism. However, the commercially available vaccines are difficult and hazardous to produce. Neutralizing antibodies against the C-terminal fragment of the BoNT heavy chain (HC) are known to protect against lethal doses of BoNTs. We report the vaccination of cattle with a previously tested recombinant chimera consisting of Escherichia coli heat-labile enterotoxin B subunit and the HC of BoNTs C and D. Vaccinated animals produced neutralizing antibodies against serotypes C and D averaging 5Â±0 and 6.14Â±1.06IU/mL, respectively. For BoNT D, the titers were greater than those measured for the commercial vaccine, which induced titers of 5Â±0 and 2.85Â±1.35 against the respective serotypes, suggesting that this chimera is effective against cattle botulism.Copyright Â© 2013 Elsevier Ltd. All rights reserved.
Production and evaluation of a recombinant chimeric vaccine against clostridium botulinum neurotoxin types C and D. - PloS one
Bovine botulism is a fatal disease that is caused by botulinum neurotoxins (BoNTs) produced by Clostridium botulinum serotypes C and D and that causes great economic losses, with nearly 100% lethality during outbreaks. It has also been considered a potential source of human food-borne illness in many countries. Vaccination has been reported to be the most effective way to control bovine botulism. However, the commercially available toxoid-based vaccines are difficult and hazardous to produce. Neutralizing antibodies targeted against the C-terminal fragment of the BoNT heavy chain (HC) are known to confer efficient protection against lethal doses of BoNTs. In this study, a novel recombinant chimera, consisting of Escherichia coli heat-labile enterotoxin B subunit (LTB), a strong adjuvant of the humoral immune response, fused to the HC of BoNT serotypes C and D, was produced in E. coli. Mice vaccinated with the chimera containing LTB and an equivalent molar ratio of the chimera without LTB plus aluminum hydroxide (Al(OH)3) developed 2 IU/mL of antitoxins for both serotypes. Guinea pigs immunized with the recombinant chimera with LTB plus Al(OH)3 developed a protective immune response against both BoNT/C (5 IU/mL) and BoNT/D (10 IU/mL), as determined by a mouse neutralization bioassay with pooled sera. The results achieved with guinea pig sera fulfilled the requirements of commercial vaccines for prevention of botulism, as determined by the Brazilian Ministry of Agriculture, Livestock and Food, Supply. The presence of LTB was essential for the development of a strong humoral immune response, as it acted in synergism with Al(OH)3. Thus, the vaccine described in this study is a strong candidate for the control of botulism in cattle.
Vaccination with recombinant Clostridium perfringens toxoids Î± and Î² promotes elevated antepartum and passive humoral immunity in swine. - Vaccine
Due to the increasingly restricted use of antimicrobials in animal production systems, the prevention and control of Clostridium perfringens type A- and C-induced diarrhea in piglets should be based on passive immunization via the prepartum vaccination of sows. Given the current obstacles in the production of conventional clostridial vaccines, the use of recombinant proteins has been considered to represent a promising alternative. In the present study, the neutralizing antibody response of immunized sows and their litters to a bivalent vaccine containing the C. perfringens recombinant toxoids alpha (rTA) and beta (rTB) produced in Escherichia coli was assessed. Rabbits (n=8) and pregnant sows (n=7) were immunized with 200Î¼g of each recombinant antigen using Al(OH)3 as adjuvant. The alpha and beta antitoxin titer detected in the rabbits' serum pool was 9.6 and 20.4IU/mL, respectively. The mean alpha and beta antitoxin titers in the sows' sera were 6.0Â±0.9IU/mL and 14.5Â±2.2IU/mL, and the corresponding individual coefficients of variation (CV) were 16.04% and 14.91%, respectively. The mean alpha and beta antitoxin titers in the litters' serum pools were 4.2Â±0.4IU/mL and 10.9Â±1.7IU/mL, and the CV between litters was 9.23% and 9.85%, respectively. The results showed that the rTA and rTB proteins produced and tested in the present study induced an immune response and can be regarded as candidates for the development of a commercial vaccine against C. perfringens type A- and C-induced diarrhea in pigs.Copyright Â© 2013 Elsevier Ltd. All rights reserved.
[Opportunistic screening for breast cancer among young women in MaranhÃ£o State, Brazil]. - Cadernos de saÃºde pÃºblica
Although breast cancer is infrequent in women under 40 years of age, it deserves attention, since diagnosis requires a high rate of clinical suspicion. Thus, preventive practices should be emphasized in childbearing-age women, with opportunistic screening as a relevant strategy. This study focused on breast cancer prevention practices adopted by young women in MaranhÃ£o State, Brazil. This was a population-based descriptive study conducted from June 2007 to January 2008. The majority of the women had low income (42.1%) and fewer than eight years of schooling (62.6%). Some 30% reported breast self-examination. Among women older than 35, 71.6% had never had a mammogram. The most common preventive measure was clinical examination (35.2%), which had increased by 11.5% in the previous ten years. Such information on opportunistic breast cancer screening in MaranhÃ£o should help produce specific public health policies for the State.
[The profile of victims attended by the Pernambuco prehospital air service]. - Revista da Escola de Enfermagem da U S P
This descriptive, exploratory study was performed using a quantitative approach to address the profile of victims attended by the Pernambuco prehospital air service. The events were evaluated from August 2007 to July 2008, corresponding to the first year of the hangar working in Recife. In the studied period, 283 event forms were studied, with an average 23 events per month. Regarding the flights, 66% were rescue flights with an answer-time of 11 minutes. As for the causes, 79% were external, mainly traffic accidents. Most victims were male, with a median age range of 34 years. The rescue of severe cases should be fast and effective, thus this study analyzed the association between the severity of a victim and the answer-time.
[Coverage characterization of pre-natal in MaranhÃ£o State, Brazil]. - Revista brasileira de enfermagem
The purpose of the study was to characterize the coverage of prenatal care in the State of MaranhÃ£o. A population-based study, descriptive in 30 municipalities of the State of MaranhÃ£o, with 2075 women of childbearing age, with previous pregnancy, from July 2008 to Januray 2009. The results demonstrated that the units of family health accounted for 45.9% of the care of pregnant women and that 46.8% reported carrying out consultations six or more prenatal care during last pregnancy and 64.6% started prenatal in the first three months of pregnancy. The coverage of prenatal care, without regard to adequacy, was 85.6%, however, when considering the coverage of adequate prenatal as established by Brazilian Health Ministry was 43.4%. Although coverage of prenatal above 80%, less than half is considered adequate, showing a gap in primary care quality.
Kinetic characterization of the Escherichia coli oligopeptidase A (OpdA) and the role of the Tyr(607) residue. - Archives of biochemistry and biophysics
Oligopeptidase A (OpdA) belongs to the M3A subfamily of bacterial peptidases with catalytic and structural properties similar to mammalian thimet-oligopeptidase (TOP) and neurolysin (NEL). The three enzymes have four conserved Tyr residues on a flexible loop in close proximity to the catalytic site. In OpdA, the flexible loop is formed by residues 600-614 ((600)SHIFAGGYAAGYYSY(614)). Modeling studies indicated that in OpdA the Tyr(607) residue might be involved in the recognition of the substrate with a key role in catalysis. Two mutants were constructed replacing Tyr(607) by Phe (Y607F) or Ala (Y607A) and the influence of the site-directed mutagenesis in the catalytic process was examined. The hydrolysis of Abz-GXSPFRQ-EDDnp derivatives (Abz=ortho-aminobenzoic acid; EDDnp N-[2,4-dinitrophenyl]-ethylenediamine; X=different amino acids) was studied to compare the activities of wild-type OpdA (OpdA WT) and those of Y607F and Y607A mutants The results indicated that OpdA WT cleaved all the peptides only on the X-S bond whereas the Y607F and Y607A mutants were able to hydrolyze both the X-S and the P-F bonds. The kinetic parameters showed the importance of Tyr(607) in OpdA catalytic activity as its substitution promoted a decrease in the k(cat)/K(m) value of about 100-fold with Y607F mutant and 1000-fold with Y607A. Both mutations, however, did not affect protein folding as indicated by CD and intrinsic fluorescence analysis. Our results indicate that the OpdA Tyr(607) residue plays an important role in the enzyme-substrate interaction and in the hydrolytic activity.2010 Elsevier Inc. All rights reserved.
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