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Abstract Objective To understand the impact of the coronavirus disease 2019 pandemic on in vitro fertilization (IVF) clinical pregnancy rates and analyze factors that may have influenced their outcome. Methods This was a retrospective observational study conducted at a tertiary-care Brazilian fertility center. All fresh IVF and embryo warming cycles performed from March 11 to December 31, 2018–2021 were analyzed, and their data were used to calculate fertilization, embryo cleavage, cycle cancellation, embryo transfer (ET), and clinical pregnancy rates. Statistical tests were used to evaluate the alterations found. Logistic regression models were used to explore the association of the categorical variables with the observed clinical pregnancy rates. Data from 2018 and 2019 (prepandemic) and 2020 and 2021 (pandemic) were grouped. Results A total of 756 cycles were analyzed (n = 360 prepandemic and n = 396 pandemic). The age group of the patients, fertilization rates, and cleavage rates did not have significant differences (p > 0.05). There was a reduction in the percentage of fresh IVF and an increase in embryo warming cycles (p = 0.005) during the pandemic. There was also an increase in fresh cycle cancellations (p < 0.001) and a reduction in ET rates (p < 0.001). The pandemic had a negative impact on clinical pregnancy rates (p < 0.001) especially due to the increase in fresh cycle cancellations (p < 0.001). Conclusion Embryo warming cycles with subsequent frozen-thawed ET were presented as a viable alternative to continue assisted reproductive treatments against pandemic restrictions on fresh cycles, ensuring clinical pregnancy, albeit at a lower rate than that of the prepandemic period.

Resumo Objetivo Compreender os impactos da pandemia de COVID-19 nas taxas de gravidez clínica em fertilização in vitro (FIV) e analisar fatores que possam ter influenciado seu resultado. Métodos Foi realizado um estudo observacional retrospectivo em um centro brasileiro de reprodução assistida. Todos os ciclos de FIV com embriões frescos e descongelados realizados entre 11 de março e 31 de dezembro, 2018-2021 foram analisados, e seus dados utilizados para cálculo das taxas de fertilização, clivagem embrionária, cancelamento de ciclos, transferência de embriões (TE) e gravidez clínica. Testes estatísticos avaliaram significância das alterações encontradas e modelos de regressão logística exploraram associação das variáveis categóricas estudadas com as taxas de gravidez clínica observadas. Os dados de 2018 e 2019 (pré-pandemia) e 2020 e 2021 (pandemia) foram agrupados. Resultados Foram analisados um total de 756 ciclos (n = 360 na pré-pandemia e n = 396 na pandemia). A faixa etária das pacientes e as taxas de fertilização e de clivagem não tiveram alterações significativas (p > 0,05). Na pandemia, houve redução da porcentagem de ciclos de FIV com embriões frescos e aumento dos com descongelamento (p = 0,005). Também foi notado aumento das taxas de cancelamentos de ciclos com embriões frescos (p < 0,001) e redução do número de TEs (p < 0,001). A pandemia exerceu impacto negativo na taxa de gravidez clínica (p < 0,001), especialmente devido ao aumento de cancelamentos dos ciclos a fresco (p < 0,001). Conclusão Frente às limitações pandêmicas impostas aos ciclos com embriões frescos, os ciclos de descongelamento de embriões se apresentaram como alternativa viável à continuidade dos ciclos de FIV, garantindo gravidez clínica ainda que em taxas inferiores às do período pré-pandêmico.

https://doi.org/10.1055/s-0043-1768459

Diretriz Brasileira de Dispositivos Cardíacos Eletrônicos Implantáveis – 2023
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Teixeira, Ricardo Alkmim

; Fagundes, Alexsandro Alves

; Baggio Junior, José Mário

; Oliveira, Júlio César de

; Medeiros, Paulo de Tarso Jorge

; Valdigem, Bruno Pereira

; Teno, Luiz Antônio Castilho

; Silva, Rodrigo Tavares

; Melo, Celso Salgado de

; Elias Neto, Jorge

; Moraes Júnior, Antonio Vitor

; Pedrosa, Anisio Alexandre Andrade

; Porto, Fernando Mello

; Brito Júnior, Hélio Lima de

; Souza, Thiago Gonçalves Schroder e

; Mateos, José Carlos Pachón

; Moraes, Luis Gustavo Belo de

; Forno, Alexander Romeno Janner Dal

; D’Avila, Andre Luiz Buchele

; Cavaco, Diogo Alberto de Magalhães

; Kuniyoshi, Ricardo Ryoshim

; Pimentel, Mauricio

; Camanho, Luiz Eduardo Montenegro

; Saad, Eduardo Benchimol

; Zimerman, Leandro Ioschpe

; Oliveira, Eduardo Bartholomay

; Scanavacca, Mauricio Ibrahim

; Martinelli Filho, Martino

; Lima, Carlos Eduardo Batista de

; Peixoto, Giselle de Lima

; Darrieux, Francisco Carlos da Costa

; Duarte, Jussara de Oliveira Pinheiro

; Galvão Filho, Silas dos Santos

; Costa, Eduardo Rodrigues Bento

; Mateo, Enrique Indalécio Pachón

; Melo, Sissy Lara De

; Rodrigues, Thiago da Rocha

; Rocha, Eduardo Arrais

; Hachul, Denise Tessariol

; Lorga Filho, Adalberto Menezes

; Nishioka, Silvana Angelina D’Orio

; Gadelha, Eduardo Barreto

; Costa, Roberto

; Andrade, Veridiana Silva de

; Torres, Gustavo Gomes

; Oliveira Neto, Nestor Rodrigues de

; Lucchese, Fernando Antonio

; Murad, Henrique

; Wanderley Neto, José

; Brofman, Paulo Roberto Slud

; Almeida, Rui M. S.

; Leal, João Carlos Ferreira

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 1 elocation e20220892

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

https://doi.org/10.36660/abc.20220892

Multiparametric flow cytometry directing the evaluation of CRLF2 rearrangements and JAK2 status in pediatric B cell precursor acute lymphoblastic leukemia
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Noronha, Elda Pereira

; Ferreira, Priscilla Moniz Sodré

; Andrade, Francianne Gomes

; Blunck, Caroline Barbieri

; Camargo, Ricardo

; Gimba, Etel Rodrigues Pereira

; Pombo-de-Oliveira, Maria S.

; Terra-Granado, Eugênia

Hematology, Transfusion and Cell Therapy

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2023, Volume 45 N. 2 Pages 245 - 252

Abstract: En | Text: En | PDF: En

Asbtract Introduction This study aimed to determine whether cytokine receptor-like factor 2 (CRLF2) antigen expression evaluated using multiparametric flow cytometry (MFC) could predict the genotype of CRLF2 and Janus kinase 2 (JAK2) status for application in the diagnosis of pediatric B-cell precursor acute lymphoblastic leukemia (BCP-ALL). Methods A total of 321 BCP-ALL bone marrow samples were collected, 291 at diagnosis and 13 at first relapse, while 17 samples were excluded due to low cellular viability. The CRLF2 antigen expression was evaluated using flow cytometry (percentage of positivity and median fluorescence intensity [MFI]). The CRLF2 transcript levels were assessed via quantitative reverse transcription polymerase chain reaction using SYBR Green. The CRLF2 rearrangements (CRLF2-r) were identified using the CRLF2 break-apart probe via fluorescence in situ hybridization. Sanger sequencing was performed to identify the JAK2 exon 16 mutations. Results We observed that 60 of the 291 cases (20.6%) presented CRLF2 antigen positivity, whereas the CRLF2 transcript overexpression was found in 19 of 113 cases (16.8%). The JAK2 mutation was found in four out of 116 cases (3.4%), all of which had CRLF2 ≥10% of positive cells and intermediate or high MFI (p < 0.0001). In addition, in the 13 cases with the CRLF2-r, a positive correlation was found with the CRLF2 antigen intermediate (61.5%) MFI (p= 0.017). Finally, the CRLF2-positive antigen was identified in the BCP-ALL subclones. Conclusion The identification of the CRLF2 antigen using the MFC, based on the percentage of positivity and MFI values, is a useful tool for predicting JAK2 mutations and CRLF2-r.

https://doi.org/10.1016/j.htct.2022.06.008

Morphofunctional analysis of fibroblast-like synoviocytes in human rheumatoid arthritis and mouse collagen-induced arthritis
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Machado, Camilla Ribeiro Lima

; Dias, Felipe Ferraz

; Resende, Gustavo Gomes

; Oliveira, Patrícia Gnieslaw de

; Xavier, Ricardo Machado

; Andrade, Marcus Vinicius Melo de

; Kakehasi, Adriana Maria

Advances in Rheumatology

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2023, Volume 63 elocation 1

Abstract: En | Text: En | PDF: En

Abstract Background Fibroblast-like synoviocytes (FLS) play a prominent role in rheumatoid synovitis and degradation of the extracellular matrix through the production of inflammatory cytokines and metalloproteinases (MMPs). Since animal models are frequently used for elucidating the disease mechanism and therapeutic development, it is relevant to study the ultrastructural characteristics and functional responses in human and mouse FLS. The objective of the study was to analyze ultrastructural characteristics, Interleukin-6 (IL-6) and Metalloproteinase-3 (MMP-3) production and the activation of intracellular pathways in Fibroblast like synoviocytes (FLS) cultures obtained from patients with rheumatoid arthritis (RA) and from mice with collagen-induced arthritis (CIA). Methods FLSs were obtained from RA patients (RA-FLSs) (n = 8) and mice with CIA (CIA-FLSs) (n = 4). Morphology was assessed by transmission and scanning electron microscopy. IL-6 and MMP-3 production was measured by ELISA, and activation of intracellular signaling pathways (NF-κB and MAPK: p-ERK1/2, p-P38 and p-JNK) was measured by Western blotting in cultures of RA-FLSs and CIA-FLSs stimulated with tumor necrosis factor-alpha (TNF-α) and IL-1β. Results RA-FLS and CIA-FLS cultures exhibited rich cytoplasm, rough endoplasmic reticula and prominent and well- developed Golgi complexes. Transmission electron microscopy demonstrated the presence of lamellar bodies, which are cytoplasmic structures related to surfactant production, in FLSs from both sources. Increased levels of pinocytosis and numbers of pinocytotic vesicles were observed in RA-FLSs (p < 0.05). Basal production of MMP-3 and IL-6 was present in RA-FLSs and CIA-FLSs. Regarding the production of MMP-3 and IL-6 and the activation of signaling pathways, the present study demonstrated a lower response to IL-1β by CIA-FLSs than by RA-FLSs. Conclusion This study provides a comprehensive understanding of the biology of RA-FLS and CIA-FLS. The differences and similarities in ultrastructural morphology and important inflammatory cytokines shown, contribute to future in vitro studies using RA-FLS and CIA-FLS, in addition, they indicate that the adoption of CIA-FLS for studies should take careful and be well designed, since they do not completely resemble human diseases.

https://doi.org/10.1186/s42358-022-00281-0

Correction to: Morphofunctional analysis of fibroblast-like synoviocytes in human rheumatoid arthritis and mouse collagen-induced arthritis to fibroblastlike fibroblast like collageninduced collagen induced
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Machado, Camilla Ribeiro Lima

; Dias, Felipe Ferraz

; Resende, Gustavo Gomes

; Oliveira, Patrícia Gnieslaw de

; Xavier, Ricardo Machado

; Andrade, Marcus Vinicius Melo de

; Kakehasi, Adriana Maria

Advances in Rheumatology

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2023, Volume 63 elocation 4

Abstract: En | Text: En | PDF: En

https://doi.org/10.1186/s42358-023-00287-2

Effects of the healing activity of rosemary-of-Chapada (Lippia gracilis Schauer) on cutaneous lesions in rats
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Bulhões, Apolônia Agnes Vilar de Carvalho

; Estevão, Lígia Reis de Moura

; Florencio-Silva, Rinaldo

; Simoes, Ricardo Santos

; Leite, Ana Greice Borba

; Cunha, Dayana Maria Serafim da Silva

; Ramos, Clécio Souza

; Soares, Érica Bruna de Andrade

; D’Emery, Marcela Barbosa

; Câmara, Cláudio Augusto Gomes da

; Evêncio-Neto, Joaquim

Acta Cirúrgica Brasileira

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2022, Volume 37 N. 1 elocation e370104

Abstract: En | Text: En | PDF: En

ABSTRACT Purpose: To evaluate the effects of rosemary leaf essential oil-based ointments on the healing of rat skin lesions. Methods: Sixty adult male rats, with dorsal excisional skin wounds made surgically under anesthesia, were divided into three groups (n = 20): Sham group (untreated wounds); control group (CG, wounds treated with vehicle); and essential oil (EO) treated group (wounds treated with essential oil-based ointments), administered topically once daily. Skin wounds were evaluated at 4, 7, 14, and 21 days after EO or vehicle treatments. Lesions were analyzed macroscopically for the contraction degree. Formalin-fixed paraffin-embedded sections of skin wounds were used for histopathological evaluation. Results: Macroscopic evaluation showed wounds edges with thin crust without firmness and yellowish color, along with an improvement in wound contraction in EO group when compared to the other groups. A reduced inflammatory reaction, along with newly formed small diameter capillaries and more organized and elongated collagen fibers, were more frequently observed in EO group than in the other groups. Moreover, blood vessel number and collagen fibers density were significantly higher in EO group. Conclusions: Skin lesion treatment with rosemary leaf essential oil-based ointments accelerates the initial stages of healing, reduces inflammation, and increases angiogenesis, collagen fibers density, and wound contraction in rats.

https://doi.org/10.1590/acb370104

Visceral leishmaniasis caused by Leishmania (Leishmania) amazonensis associated with Hodgkin’s lymphoma
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Porto, Victor Bertolo Gomes

; Carvalho, Laína Bubach

; Buzo, Bruno Fernando

; Litvoc, Marcelo Nobrega

; Santos, Ana Catharina S.

; Rocci, Rafael Avila

; Soares, Sandra Regina Castro

; Zampieri, Ricardo Andrade

; Duarte, Maria Irma Seixas

; Lindoso, José Angelo Lauletta

Revista do Instituto de Medicina Tropical de São Paulo

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2022, Volume 64 elocation e51

Abstract: En | Text: En | PDF: En

ABSTRACT Visceral leishmaniasis (VL) is mainly caused by Leishmania (Leishmania) donovani and Leishmania (L.) infantum; however, other Leishmania species have been associated with VL. We report a case of a patient simultaneously diagnosed with VL caused by Leishmania (L.) amazonensis and Hodgkin’s lymphoma. After treatment with liposomal amphotericin B and chemotherapy, the patient presented a clinical cure. This case report reinforces the hypothesis that other Leishmania species can cause visceral lesions mainly related to immunosuppression.

https://doi.org/10.1590/s1678-9946202264051

Preliminary observations of the urbanization and domiciliation of the American cutaneous leishmaniasis in Rio Branco, Acre, Western Amazon
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Brilhante, Andreia Fernandes

; Zampieri, Ricardo Andrade

; Souza, Eduardo Alcici de

; Carneiro, Ana Carolina Gomes

; Barroso, Edmilson Pereira

; Ávila, Marcia Moreira de

; Melchior, Leonardo Augusto Kohara

; Souza, Janis Lunier de

; Oliveira, Elizangela Soares de

; Pinto, Maria Carmelinda Gonçalves

; Floeter-Winter, Lucile Maria

; Galati, Eunice Aparecida Bianchi

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volume 55 elocation e0359-2022

Abstract: En | Text: En | PDF: En

ABSTRACT Background: The American cutaneous leishmaniasis (ACL) is expanding in peri-urban environments. Methods: An entomological survey was conducted in the area of the occurrence of an autochthonous urban case of ACL. Sandflies and a parasitological slide of the human case were submitted for molecular diagnosis. Results: Nyssomyia whitmani and Ny. antunesi were the most frequently collected species. Ny. whitmani and Bichromomyia flaviscutellata were positive for Leishmania guyanensis and L. lainsoni, respectively. The human case tested positive for L. lainsoni. Conclusions: Sandflies and Leishmania parasites present in urban forest may occur frequently in nearby domiciliary environments; thus, these areas must be monitored.

https://doi.org/10.1590/0037-8682-0359-2022

Implications for Clinical Practice from a Multicenter Survey of Heart Failure Management Centers
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Bocchi, Edimar Alcides

; Moreira, Henrique Turin

; Nakamuta, Juliana Sanajotti

; Simões, Marcus Vinicius

; Casas, Alberto de Almeida Las

; Costa, Altamiro Reis da

; Assis, Amberson Vieira de

; Durães, André Rodrigues

; Pereira-Barretto, Antonio Carlos

; Ravessa, Antonio Delduque de Araujo

; Macedo, Ariane Vieira Scarlatelli

; Biselli, Bruno

; Pinto, Carolina Maria Nogueira

; Filho, Conrado Roberto Hoffmann

; Costantini, Costantino Roberto

; Almeida, Dirceu Rodrigues

; Santos Jr, Edval Gomes dos

; Soliva Junior, Erwin

; Figueiredo, Estevão Lanna

; Albuquerque, Felipe Neves de

; Paulitsch, Felipe

; Neuenschwander, Fernando Carvalho

; Figueiredo Neto, José Albuquerque de

; Brito, Flavio de Souza

; Lopes, Heno Ferreira

; Villacorta, Humberto

; Souza Neto, João David de

; Sepulveda, João Mariano

; Ayoub, José Carlos Aidar

; Vilela-Martin, José F.

; Cardoso, Juliano Novaes

; Uemura, Laercio

; Moura, Lidia Zytynski

; Maia, Lilia Nigro

; Oliveira, Lucia Brandão de

; Maia, Lucimir

; Silva, Luís Beck da

; Gowdak, Luís Henrique Wolff

; Danzmann, Luiz Claudio

; Andrade, Marcus

; Braile-Sternieri, Maria Christiane Valeria Braga

; Moreira, Maria da Consolação Vieira

; França Neto, Olimpio R

; Filho, Otavio Rizzi Coelho

; Esteves, Paulo Frederico

; Raupp-da-Rosa, Priscila

; Silva, Ricardo Jorge de Queiroz e

; Mourilhe-Rocha, Ricardo

; Viégas, Ruy Felipe Melo

; Rassi, Salvador

; Mangili, Sandrigo

; Kaiser, Sergio Emanuel

; Martins, Silvia Marinho

; Kawabata, Vitor Sergio

Clinics

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2021, Volume 76 elocation e1991

Abstract: En | Text: En | PDF: En

OBJECTIVES: This observational, cross-sectional study based aimed to test whether heart failure (HF)-disease management program (DMP) components are influencing care and clinical decision-making in Brazil. METHODS: The survey respondents were cardiologists recommended by experts in the field and invited to participate in the survey via printed form or email. The survey consisted of 29 questions addressing site demographics, public versus private infrastructure, HF baseline data of patients, clinical management of HF, performance indicators, and perceptions about HF treatment. RESULTS: Data were obtained from 98 centers (58% public and 42% private practice) distributed across Brazil. Public HF-DMPs compared to private HF-DMP were associated with a higher percentage of HF-DMP-dedicated services (79% vs 24%; OR: 12, 95% CI: 94-34), multidisciplinary HF (MHF)-DMP [84% vs 65%; OR: 3; 95% CI: 1-8), HF educational programs (49% vs 18%; OR: 4; 95% CI: 1-2), written instructions before hospital discharge (83% vs 76%; OR: 1; 95% CI: 0-5), rehabilitation (69% vs 39%; OR: 3; 95% CI: 1-9), monitoring (44% vs 29%; OR: 2; 95% CI: 1-5), guideline-directed medical therapy-HF use (94% vs 85%; OR: 3; 95% CI: 0-15), and less B-type natriuretic peptide (BNP) dosage (73% vs 88%; OR: 3; 95% CI: 1-9), and key performance indicators (37% vs 60%; OR: 3; 95% CI: 1-7). In comparison to non- MHF-DMP, MHF-DMP was associated with more educational initiatives (42% vs 6%; OR: 12; 95% CI: 1-97), written instructions (83% vs 68%; OR: 2: 95% CI: 1-7), rehabilitation (69% vs 17%; OR: 11; 95% CI: 3-44), monitoring (47% vs 6%; OR: 14; 95% CI: 2-115), GDMT-HF (92% vs 83%; OR: 3; 95% CI: 0-15). In addition, there were less use of BNP as a biomarker (70% vs 84%; OR: 2; 95% CI: 1-8) and key performance indicators (35% vs 51%; OR: 2; 95% CI: 91,6) in the non-MHF group. Physicians considered changing or introducing new medications mostly when patients were hospitalized or when observing worsening disease and/or symptoms. Adherence to drug treatment and non-drug treatment factors were the greatest medical problems associated with HF treatment. CONCLUSION: HF-DMPs are highly heterogeneous. New strategies for HF care should consider the present study highlights and clinical decision-making processes to improve HF patient care.

https://doi.org/10.6061/clinics/2021/e1991 870 downloads

10.

Establishment of rapid and non-invasive protocols to identify B-carrying individuals of Psalidodon paranae
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Goes, Caio Augusto Gomes

; Silva, Duílio Mazzoni Zerbinato de Andrade

; Utsunomia, Ricardo

; Yasui, George Shigueki

; Artoni, Roberto Ferreira

; Foresti, Fausto

; Porto-Foresti, Fábio

Genetics and Molecular Biology

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2021, Volume 44 N. 2 elocation e20200003

Abstract: En | Text: En | PDF: En

Abstract Supernumerary, or B, chromosomes are present in several eukaryotes, including characid fish of the genus Psalidodon. Notably, Psalidodon paranae carries the most studied B chromosome variant, a macro-B chromosome. The origin of this element was determined to be an isochromosome; however, data regarding its inheritance remain unavailable due to methodological barriers such as the lack of an efficient, non-invasive, and rapid protocol for identifying B-carrying individuals that would enable the design of efficient crossing experiments. Thus, in this study, we primarily aimed was to develop two non-invasive and fast (approximately 2 h) methods to identify the presence of B chromosomes in live specimens of P. paranae based on satellite DNA (satDNA) sequences known to be present in this element. The methods include fluorescence in situ hybridization in interphase nuclei and relative gene quantification of satDNAs using quantitative polymerase chain reaction. Our results reveal the efficiency of quick-fluorescence in situ hybridization and quantitative polymerase chain reaction for identifying B-carrying individuals using the proposed satDNA sequences and open up new possibilities to study B chromosomes.

https://doi.org/10.1590/1678-4685-gmb-2020-0003 453 downloads

11.

Distrofia macular oculta
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Demachki, Nabila Terra

; Carvalho, Karolyna de Andrade

; Reis, Ricardo Gomes dos

Revista Brasileira de Oftalmologia

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mar 2020, Volume 79 N. 2 Pages 128 - 130

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Apresentamos um caso de distrofia macular oculta bilateral, em paciente de 70 anos com queixa de baixa acuidade visual progressiva, sem achados fundoscópicos ou angiográficos justificáveis. Foram realizados exames de imagem do sistema nervoso central que afastaram lesões expansivas e testes eletrofisiológicos que sugeriram diagnóstico.

Abstract We report a case of bilateral occult macular dystrophy in a 70-year-old woman with progressive low visual acuity, without justifiable fundoscopic or angiographic findings. Imaging tests were done to excluding expansive lesions and electrophysiological tests that suggested the diagnosis.

https://doi.org/10.5935/0034-7280.20200027 1257 downloads

12.

Epidemiologia e desfecho dos pacientes de alto risco cirúrgico admitidos em unidades de terapia intensiva no Brasil
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Silva Júnior, João Manoel

; Chaves, Renato Carneiro de Freitas

; Corrêa, Thiago Domingos

; Assunção, Murillo Santucci Cesar de

; Katayama, Henrique Tadashi

; Bosso, Fabio Eduardo

; Amendola, Cristina Prata

; Serpa Neto, Ary

; Malbouisson, Luiz Marcelo Sá

; Oliveira, Neymar Elias de

; Veiga, Viviane Cordeiro

; Rojas, Salomón Soriano Ordinola

; Postalli, Natalia Fioravante

; Alvarisa, Thais Kawagoe

; Lucena, Bruno Melo Nobrega de

; Oliveira, Raphael Augusto Gomes de

; Sanches, Luciana Coelho

; Silva, Ulysses Vasconcellos de Andrade e

; Nassar Junior, Antonio Paulo

; Réa-Neto, Álvaro

; Amaral, Alexandre

; Teles, José Mário

; Freitas, Flávio Geraldo Rezende de

; Bafi, Antônio Tonete

; Pacheco, Eduardo Souza

; Ramos, Fernando José

; Vieira Júnior, José Mauro

; Pereira, Maria Augusta Santos Rahe

; Schwerz, Fábio Sartori

; Menezes, Giovanna Padoa de

; Magalhães, Danielle Dourado

; Castro, Cristine Pilati Pileggi

; Henrich, Sabrina Frighetto

; Toledo, Diogo Oliveira

; Parra, Bruna Fernanda Camargo Silva

; Dias, Fernando Suparregui

; Zerman, Luiza

; Formolo, Fernanda

; Nobrega, Marciano de Sousa

; Piras, Claudio

; Piras, Stéphanie de Barros

; Conti, Rodrigo

; Bittencourt, Paulo Lisboa

; D’Oliveira, Ricardo Azevedo Cruz

; Estrela, André Ricardo de Oliveira

; Oliveira, Mirella Cristine de

; Reese, Fernanda Baeumle

; Motta Júnior, Jarbas da Silva

; Câmara, Bruna Martins Dzivielevski da

; David-João, Paula Geraldes

; Tannous, Luana Alves

; Chaiben, Viviane Bernardes de Oliveira

; Miranda, Lorena Macedo Araújo

; Brasil, José Arthur dos Santos

; Deucher, Rafael Alexandre de Oliveira

; Ferreira, Marcos Henrique Borges

; Vilela, Denner Luiz

; Almeida, Guilherme Cincinato de

; Nedel, Wagner Luis

; Passos, Matheus Golenia dos

; Marin, Luiz Gustavo

; Oliveira Filho, Wilson de

; Coutinho, Raoni Machado

; Oliveira, Michele Cristina Lima de

; Friedman, Gilberto

; Meregalli, André

; Höher, Jorge Amilton

; Soares, Afonso José Celente

; Lobo, Suzana Margareth Ajeje

Revista Brasileira de Terapia Intensiva

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mar 2020, Volume 32 N. 1 Pages 17 - 27

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Definir o perfil epidemiológico e os principais determinantes de morbimortalidade dos pacientes cirúrgicos não cardíacos de alto risco no Brasil. Métodos: Estudo prospectivo, observacional e multicêntrico. Todos os pacientes cirúrgicos não cardíacos admitidos nas unidades de terapia intensiva, ou seja, considerados de alto risco, no período de 1 mês, foram avaliados e acompanhados diariamente por, no máximo, 7 dias na unidade de terapia intensiva, para determinação de complicações. As taxas de mortalidade em 28 dias de pós-operatório, na unidade de terapia intensiva e hospitalar foram avaliadas. Resultados: Participaram 29 unidades de terapia intensiva onde foram realizadas cirurgias em 25.500 pacientes, dos quais 904 (3,5%) de alto risco (intervalo de confiança de 95% - IC95% 3,3% - 3,8%), tendo sido incluídos no estudo. Dos pacientes envolvidos, 48,3% eram de unidades de terapia intensiva privadas e 51,7% de públicas. O tempo de internação na unidade de terapia intensiva foi de 2,0 (1,0 - 4,0) dias e hospitalar de 9,5 (5,4 - 18,6) dias. As taxas de complicações foram 29,9% (IC95% 26,4 - 33,7) e mortalidade em 28 dias pós-cirurgia 9,6% (IC95% 7,4 - 12,1). Os fatores independentes de risco para complicações foram Simplified Acute Physiology Score 3 (SAPS 3; razão de chance − RC = 1,02; IC95% 1,01 - 1,03) e Sequential Organ Failure Assessment Score (SOFA) da admissão na unidade de terapia intensiva (RC =1,17; IC95% 1,09 - 1,25), tempo de cirurgia (RC = 1,001; IC95% 1,000 - 1,002) e cirurgias de emergências (RC = 1,93; IC95% 1,10 - 3,38). Em adição, foram associados com mortalidade em 28 dias idade (RC = 1,032; IC95% 1,011 - 1,052) SAPS 3 (RC = 1,041; IC95% 1,107 - 1,279), SOFA (RC = 1,175; IC95% 1,069 - 1,292) e cirurgias emergenciais (RC = 2,509; IC95% 1,040 - 6,051). Conclusão: Pacientes com escores prognósticos mais elevados, idosos, tempo cirúrgico e cirurgias emergenciais estiveram fortemente associados a maior mortalidade em 28 dias e mais complicações durante permanência em unidade de terapia intensiva.

ABSTRACT Objective: To define the epidemiological profile and the main determinants of morbidity and mortality in noncardiac high surgical risk patients in Brazil. Methods: This was a prospective, observational and multicenter study. All noncardiac surgical patients admitted to intensive care units, i.e., those considered high risk, within a 1-month period were evaluated and monitored daily for a maximum of 7 days in the intensive care unit to determine complications. The 28-day postoperative, intensive care unit and hospital mortality rates were evaluated. Results: Twenty-nine intensive care units participated in the study. Surgeries were performed in 25,500 patients, of whom 904 (3.5%) were high-risk (95% confidence interval - 95%CI 3.3% - 3.8%) and were included in the study. Of the participating patients, 48.3% were from private intensive care units, and 51.7% were from public intensive care units. The length of stay in the intensive care unit was 2.0 (1.0 - 4.0) days, and the length of hospital stay was 9.5 (5.4 - 18.6) days. The complication rate was 29.9% (95%CI 26.4 - 33.7), and the 28-day postoperative mortality rate was 9.6% (95%CI 7.4 - 12.1). The independent risk factors for complications were the Simplified Acute Physiology Score 3 (SAPS 3; odds ratio - OR = 1.02; 95%CI 1.01 - 1.03) and Sequential Organ Failure Assessment Score (SOFA) on admission to the intensive care unit (OR = 1.17; 95%CI 1.09 - 1.25), surgical time (OR = 1.001, 95%CI 1.000 - 1.002) and emergency surgeries (OR = 1.93, 95%CI, 1.10 - 3.38). In addition, there were associations with 28-day mortality (OR = 1.032; 95%CI 1.011 - 1.052), SAPS 3 (OR = 1.041; 95%CI 1.107 - 1.279), SOFA (OR = 1.175, 95%CI 1.069 - 1.292) and emergency surgeries (OR = 2.509; 95%CI 1.040 - 6.051). Conclusion: Higher prognostic scores, elderly patients, longer surgical times and emergency surgeries were strongly associated with higher 28-day mortality and more complications during the intensive care unit stay.

https://doi.org/10.5935/0103-507x.20200005 1048 downloads

13.

Characteristics and outcomes of patients with COVID-19 admitted to the ICU in a university hospital in São Paulo, Brazil - study protocol
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Ferreira, Juliana C.

; Ho, Yeh-Li

; Besen, Bruno A.M.P.

; Malbuisson, Luiz M.S.

; Taniguchi, Leandro U.

; Mendes, Pedro V.

; Costa, Eduardo L.V.

; Park, Marcelo

; Daltro-Oliveira, Renato

; Roepke, Roberta M.L.

; Silva Jr, João M.

; Carmona, Maria José C.

; Carvalho, Carlos Roberto Ribeiro

; Hirota, Adriana

; Kanasiro, Alberto Kendy

; Crescenzi, Alessandra

; Fernandes, Amanda Coelho

; Miethke-Morais, Anna

; Bellintani, Arthur Petrillo

; Canasiro, Artur Ribeiro

; Carneiro, Bárbara Vieira

; Zanbon, Beatriz Keiko

; Batista, Bernardo Pinheiro De Senna Nogueira

; Nicolao, Bianca Ruiz

; Besen, Bruno Adler Maccagnan Pinheiro

; Biselli, Bruno

; Macedo, Bruno Rocha De

; Toledo, Caio Machado Gomes De

; Pompilio, Carlos Eduardo

; Carvalho, Carlos Roberto Ribeiro De

; Mol, Caroline Gomes

; Stipanich, Cassio

; Bueno, Caue Gasparotto

; Garzillo, Cibele

; Tanaka, Clarice

; Forte, Daniel Neves

; Joelsons, Daniel

; Robira, Daniele

; Costa, Eduardo Leite Vieira

; Silva Júnior, Elson Mendes Da

; Regalio, Fabiane Aliotti

; Segura, Gabriela Cardoso

; Marcelino, Gustavo Brasil

; Louro, Giulia Sefrin

; Ho, Yeh-Li

; Ferreira, Isabela Argollo

; Gois, Jeison de Oliveira

; Silva Junior, Joao Manoel Da

; Reusing Junior, Jose Otto

; Ribeiro, Julia Fray

; Ferreira, Juliana Carvalho

; Galleti, Karine Vusberg

; Silva, Katia Regina

; Isensee, Larissa Padrao

; Oliveira, Larissa dos Santos

; Taniguchi, Leandro Utino

; Letaif, Leila Suemi

; Lima, Lígia Trombetta

; Park, Lucas Yongsoo

; Chaves Netto, Lucas

; Nobrega, Luciana Cassimiro

; Haddad, Luciana

; Hajjar, Ludhmila

; Malbouisson, Luiz Marcelo

; Pandolfi, Manuela Cristina Adsuara

; Park, Marcelo

; Carmona, Maria José Carvalho

; Andrade, Maria Castilho Prandini H De

; Santos, Mariana Moreira

; Bateloche, Matheus Pereira

; Suiama, Mayra Akimi

; Oliveira, Mayron Faria de

; Sousa, Mayson Laercio

; Louvaes, Michelle

; Huemer, Natassja

; Mendes, Pedro

; Lins, Paulo Ricardo Gessolo

; Santos, Pedro Gaspar Dos

; Moreira, Pedro Ferreira Paiva

; Guazzelli, Renata Mello

; Reis, Renato Batista Dos

; Oliveira, Renato Daltro De

; Roepke, Roberta Muriel Longo

; Pedro, Rodolpho Augusto De Moura

; Kondo, Rodrigo

; Rached, Samia Zahi

; Fonseca, Sergio Roberto Silveira Da

; Borges, Thais Sousa

; Ferreira, Thalissa

; Cobello Junior, Vilson

; Sales, Vivian Vieira Tenório

; Ferreira, Willaby Serafim Cassa

Clinics

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2020, Volume 75 elocation e2294

Abstract: En | Text: En | PDF: En

OBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital’s electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials.gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.

https://doi.org/10.6061/clinics/2020/e2294 1957 downloads

14.

Elevated prevalence of high-risk HPV in healthy oral mucosa of users and nonusers of drugs in Northeastern Brazil
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Ribeiro, Mariana Goveia Melo

; Marcolino, Larissa Doddi

; Ramos, Bruna Ribeiro de Andrade

; Trento, Cleverson Luciano

; Araujo, Karina Conceição Gomes Machado de

; Silva, José Rodrigo Santos

; Jain, Sona

; Gurgel, Ricardo Queiroz

; Silva, Márcia Guimarães

; Dolabella, Silvio Santana

Brazilian Oral Research

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2019, Volume 33 elocation e031

Abstract: En | Text: En | PDF: En

Abstract: Variable rates of HPV infection have been reported in healthy oral mucosa worldwide. The main objective of this study was to detect and genotype HPV infection in users and nonusers of drugs with clinically healthy mucosa from the Northeast Brazil. Samples from 105 patients were amplified using the primers MY09/MY11 and GP5+/GP6+, and genotyping was performed by multiplex-PCR for HPV-6/11, 16 and 18. A total of 81.9% samples were positive. Among drug users, 84.5% presented the virus and 20.4% showed multiple infections. Among non-drug users, 78.7% were positive and 13.5% had multiple infections. Limited information is available on oral HPV in Brazilian population, especially for drug users, and our results showed higher HPV infection rates in both users and nonusers of drugs. More studies and researches focused on drug users including factors like sexual behavior, nutrition and cultural habits are necessary to enhance the comprehension of this relationship, and develop preventive strategies.

https://doi.org/10.1590/1807-3107bor-2019.vol33.0031 1081 downloads

15.

NON-INVASIVE PREVENTIVE VENTILATION WITH TWO PRESSURE LEVELS IN THE POSTOPERATIVE PERIOD OF ROUX-EN-Y GASTRIC BYPASS: RANDOMIZED TRIAL
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CAVALCANTI, Mabelle Gomes de Oliveira

; ANDRADE, Lívia Barboza

; SANTOS, Patrícia Clara Pereira dos

; LUCENA, Leandro Ricardo Rodrigues

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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2018, Volume 31 N. 1 elocation e1361

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Racional: A obesidade é caracterizada pelo acúmulo excessivo de gordura corporal, que acarreta prejuízos à saúde dos indivíduos, tais como dificuldades respiratórias. Objetivo: Verificar a efetividade da ventilação não invasiva, sobre o declínio da função respiratória e complicações pós-operatórias em pacientes submetidos ao bypass gástrico em Y-de-Roux. Métodos: Ensaio randomizado aberto, segundo padrões do CONSORT, com obesos, entre 18-40 anos. Foram randomizados em grupo controle (n=25) que receberam orientações quanto à postura, deambulação precoce e estímulo à tosse, e em grupo VNI (n=25) que além do citado, realizou ventilação não invasiva com dois níveis pressóricos, uma vez ao dia durante 60 min, do 1° ao 3º dia do pós-operatório (DPO). Ambos os grupos foram avaliados no pré-operatório e no 1o e 3o DPO quanto à função respiratória avaliando-se a capacidade vital lenta (CVL), capacidade inspiratória (CI), volume minuto (VM), volume corrente (VC), pressão inspiratória máxima (Pimáx) e pico de fluxo expiratório (PFE). O tempo de estadia hospitalar e os episódios de complicações pós-operatórias foram registrados. Resultados: Dos 50 pacientes avaliados na análise intergrupo, observou-se melhora da CVL e VM apenas no 1º )DPO no grupo VNI, CI nos três momentos avaliados no grupo VNI e o PFE no 1º )e 3º DPO também nesse grupo (p<0,05). As complicações mais frequentes foram pneumonia, infecção da ferida operatória e atelectasias; houve diferença significativa entre os grupos mostrando maior ocorrência na pneumonia e atelectasia no controle. Dias de internamento hospitalar, enfermaria e na unidade de terapia intensiva foram semelhantes. Conclusão: Houve recuperação mais rápida até o 3º DPO nas variáveis CI e PFE no grupo submetido à VNI, além de menos complicações pós-operatórias nesse grupo.

ABSTRACT Background: Obesity is characterized by excessive accumulation of body fat, which causes damage to the health of individuals, such as breathing difficulties. Aim: To verify the results of non-invasive ventilation as a preventive strategy on the decline of respiratory function and postoperative complications in patients undergoing Roux-en-Y gastric bypass. Methods: This is a randomized trial, according to CONSORT standards, with obese adults aged 18-40 years. Randomized control group (n=25) only received guidelines regarding posture, early ambulation and cough stimuli, and in the NIV group (n=25), in addition to the aforementioned group, non-invasive ventilation was performed with two pressure levels, once day for 60 min, from the 1st to the 3rd postoperative day (POD). Both groups were evaluated in the preoperative period and in the 1st and 3rd POD for respiratory function, which were: slow vital capacity (VC), inspiratory capacity (IC), minute volume (MV), tidal volume maximal inspiratory muscle strength (Pimax) and peak expiratory flow (PEF). The length of hospital stay and the episodes of postoperative complications were recorded. Results: Of the 50 patients the majority were young adults with degrees of obesity between III and IV. In the intergroup analysis, there was an improvement in the CVL and MV only in the 1st POD in the NIV group, CI in the three moments evaluated in the NIV group and the PFE in the 1st and 3rd PDO also in this group. The most frequent complications were pneumonia, followed by operative wound infection and atelectasis. There was a significant difference between groups, showing a higher occurrence in pneumonia and atelectasis in the control group. The days of hospitalization and intensive care unit were similar. Conclusion: It was observed a faster recovery until the 3rd POD in the IC and PEF variables in the NIV group; in addition, there were fewer complications in this group.

https://doi.org/10.1590/0102-672020180001e1361 2171 downloads

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