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1.
What is a manual of procedures and why do we need one? one
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2.
Randomized controlled trials: advantages and pitfalls when studying causality trials
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3.
How to become a productive academic writer? writer
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4.
Aging-related predictive factors for oxygenation improvement and mortality in COVID-19 and acute respiratory distress syndrome (ARDS) patients exposed to prone position: A multicenter cohort study Agingrelated Aging related COVID19 COVID 19 COVID-1 ARDS (ARDS position COVID1 1 COVID-
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Cunha, Marieta C.A.
; Schardong, Jociane
; Righi, Natiele C.
; Lunardi, Adriana C.
; Sant’Anna, Guadalupe N.
; Isensee, Larissa P.
; Xavier, Rafaela F.
; Pompeu, Jose E.
; Weigert, Renata M.
; Matte, Darlan L.
; Cardoso, Rozana A.
; Abras, Ana C.V.
; Silva, Antonio M.V.
; Dorneles, Camila C.
; Werle, Roberta W.
; Starke, Ana C.
; Ferreira, Juliana C.
; Plentz, Rodrigo D.M.
; Carvalho, Celso R.F.
.
Abstract Background: Elderly patients are more susceptible to Coronavirus Disease-2019 (COVID-19) and are more likely to develop it in severe forms, (e.g., Acute Respiratory Distress Syndrome [ARDS]). Prone positioning is a treatment strategy for severe ARDS; however, its response in the elderly population remains poorly understood. The main objective was to evaluate the predictive response and mortality of elderly patients exposed to prone positioning due to ARDS-COVID-19. Methods: This retrospective multicenter cohort study involved 223 patients aged ≥ 65 years, who received prone position sessions for severe ARDS due to COVID-19, using invasive mechanical ventilation. The PaO2/FiO2 ratio was used to assess the oxygenation response. The 20-point improvement in PaO2/FiO2 after the first prone session was considered for good response. Data were collected from electronic medical records, including demographic data, laboratory/image exams, complications, comorbidities, SAPS III and SOFA scores, use of anticoagulants and vasopressors, ventilator settings, and respiratory system mechanics. Mortality was defined as deaths that occurred until hospital discharge. Results: Most patients were male, with arterial hypertension and diabetes mellitus as the most prevalent comorbidities. The non-responders group had higher SAPS III and SOFA scores, and a higher incidence of complications. There was no difference in mortality rate. A lower SAPS III score was a predictor of oxygenation response, and the male sex was a risk predictor of mortality. Conclusion: The present study suggests the oxygenation response to prone positioning in elderly patients with severe COVID-19-ARDS correlates with the SAPS III score. Furthermore, the male sex is a risk predictor of mortality. Background Disease2019 Disease 2019 Disease-201 COVID19 COVID 19 (COVID-19 forms e.g., eg e g (e.g. ARDS. . [ARDS]) however understood ARDSCOVID19. ARDSCOVID19 ARDSCOVID 19. ARDS-COVID-19 Methods 22 6 years COVID19, 19, COVID-19 ventilation PaO2FiO2 PaOFiO PaO2 FiO2 PaO FiO PaO2/FiO 20point point 20 records data laboratoryimage laboratory image exams complications comorbidities scores vasopressors settings mechanics discharge Results nonresponders non responders rate Conclusion COVID19ARDS COVIDARDS Furthermore Disease201 201 Disease-20 COVID1 1 (COVID-1 e.g. (e.g [ARDS] ARDSCOVID1 ARDS-COVID-1 2 COVID-1 PaO2FiO Disease20 Disease-2 (COVID- e.g [ARDS ARDS-COVID- COVID- Disease2 Disease- (COVID ARDS-COVID
5.
Prediction of intensive care admission and hospital mortality in COVID-19 patients using demographics and baseline laboratory data COVID19 COVID 19 COVID-1 COVID1 1 COVID-
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Avelino-Silva, Vivian I.
; Avelino-Silva, Thiago J.
; Aliberti, Marlon J.R.
; Ferreira, Juliana C.
; Cobello Junior, Vilson
; Silva, Katia R.
; Pompeu, Jose E.
; Antonangelo, Leila
; Magri, Marcello M.
; Barros Filho, Tarcisio E.P.
; Souza, Heraldo P.
; Kallás, Esper G.
.
Abstract Introduction: Optimized allocation of medical resources to patients with COVID-19 has been a critical concern since the onset of the pandemic. Methods: In this retrospective cohort study, the authors used data from a Brazilian tertiary university hospital to explore predictors of Intensive Care Unit (ICU) admission and hospital mortality in patients admitted for COVID-19. Our primary aim was to create and validate prediction scores for use in hospitals and emergency departments to aid clinical decisions and resource allocation. Results: The study cohort included 3,022 participants, of whom 2,485 were admitted to the ICU; 1968 survived, and 1054 died in the hospital. From the complete cohort, 1,496 patients were randomly assigned to the derivation sample and 1,526 to the validation sample. The final scores included age, comorbidities, and baseline laboratory data. The areas under the receiver operating characteristic curves were very similar for the derivation and validation samples. Scores for ICU admission had a 75% accuracy in the validation sample, whereas scores for death had a 77% accuracy in the validation sample. The authors found that including baseline flu-like symptoms in the scores added no significant benefit to their accuracy. Furthermore, our scores were more accurate than the previously published NEWS-2 and 4C Mortality Scores. Discussion and conclusions: The authors developed and validated prognostic scores that use readily available clinical and laboratory information to predict ICU admission and mortality in COVID-19. These scores can become valuable tools to support clinical decisions and improve the allocation of limited health resources. Introduction COVID19 COVID 19 COVID-1 pandemic Methods (ICU COVID19. 19. Results 3022 3 022 3,02 participants 2485 2 485 2,48 196 survived 105 1496 1 496 1,49 1526 526 1,52 age comorbidities samples 75 77 flulike flu like Furthermore NEWS2 NEWS NEWS- C conclusions COVID1 COVID- 302 02 3,0 248 48 2,4 10 149 49 1,4 152 52 1,5 7 30 0 3, 24 4 2, 14 1, 15 5
6.
COVID-19 knowledge, attitudes, and practices among health care workers in Latin America
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Sousa, Mayson Laércio de Araújo
; Shimizu, Iara S
; Patino, Cecilia M
; Torres-Duque, Carlos A.
; Zabert, Ignacio
; Zabert, Gustavo E
; Perez-Padilla, Rogelio
; Varón-Vega, Fabio
; Cohen, Mark
; Ferreira, Juliana C
.
RESUMO Objetivo: Avaliar o conhecimento, atitudes e práticas em relação à COVID-19 entre profissionais de saúde atuantes em países da América Latina durante o primeiro surto da pandemia. Métodos: Estudo multinacional transversal com uso de questionário on-line autoaplicável. A versão final do questionário foi composta por 40 perguntas, organizadas em cinco seções: características demográficas e profissionais; conhecimento sobre COVID-19; atitudes em relação à COVID-19; práticas relacionadas à COVID-19; e recursos institucionais. Resultados: O estudo envolveu 251 profissionais de saúde de 19 países da América Latina que aceitaram participar. Em nossa amostra, 77% dos profissionais de saúde participaram de algum tipo de treinamento institucional sobre COVID-19 e 43% tiveram baixa pontuação de conhecimento sobre COVID-19. O conhecimento sobre COVID-19 apresentou associação com o tipo de instituição de saúde (pública/privada), disponibilidade de treinamento institucional e fontes de informação. Receio de não prestar atendimento adequado foi relatado por 60% dos participantes. As estratégias ventilatórias mais utilizadas foram ventilação mecânica protetora, manobras de recrutamento alveolar e posição prona, e o uso de medicamentos para tratar a COVID-19 foi baseado principalmente em protocolos institucionais. Conclusões: Neste estudo multinacional na América Latina, quase metade da amostra teve baixa pontuação de conhecimento sobre COVID-19 e o nível de conhecimento apresentou associação com o tipo de instituição, participação em treinamento institucional e fontes de informação. Os profissionais de saúde consideravam a COVID-19 muito relevante, e mais da metade tinha receio de não prestar atendimento adequado aos pacientes.
ABSTRACT Objective: To evaluate COVID-19 knowledge, attitudes, and practices among health care workers (HCWs) practicing in Latin American countries during the first surge of the COVID-19 pandemic. Methods: This was a multinational cross-sectional survey study, using an online self-administered questionnaire. The final version of the questionnaire comprised 40 questions, organized in five sections: demographic and professional characteristics; COVID-19 knowledge; attitudes toward COVID-19; COVID-19 practices; and institutional resources. Results: The study involved 251 HCWs from 19 Latin American countries who agreed to participate. In our sample, 77% of HCWs participated in some sort of institutional training on COVID-19, and 43% had a low COVID-19 knowledge score. COVID-19 knowledge was associated with the type of health center (public/private), availability of institutional training, and sources of information about COVID-19. Concerns about not providing adequate care were reported by 60% of the participants. The most commonly used ventilatory strategies were protective mechanical ventilation, alveolar recruitment maneuvers, and prone positioning, and the use of drugs to treat COVID-19 was mainly based on institutional protocols. Conclusions: In this multinational study in Latin America, almost half of HCWs had a low COVID-19 knowledge score, and the level of knowledge was associated with the type of institution, participation in institutional training, and information sources. HCWs considered that COVID-19 was very relevant, and more than half were concerned about not providing adequate care to patients.
7.
Poor Sleep quality and health-related quality of life impact in adolescents with and without chronic immunosuppressive conditions during COVID-19 quarantine
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Helito, Alberto C.
; Lindoso, Livia
; Sieczkowska, Sofia M.
; Astley, Camilla
; Queiroz, Ligia B.
; Rose, Natalia
; Santos, Claudia Renata P.
; Bolzan, Thalis
; Peralta, Rita María I.A.
; Franco, Ruth R.
; Cominato, Louise
; Pereira, Rosa Maria R.
; Tannuri, Uenis
; Campos, Lucia Maria A.
; Lourenço, Benito
; Toma, Ricardo K.
; Medeiros, Karina
; Watanabe, Andréia
; Grangeiro, Patricia Moreno
; Farhat, Sylvia C.
; Casella, Caio B.
; Polanczyk, Guilherme V.
; Gualano, Bruno
; Silva, Clovis A.
; Sallum, Adriana M. E.
; Iraha, Amanda Y.
; Ihara, Bianca P.
; Mazzolani, Bruna C.
; Martinez, Claudia A.
; Strabelli, Claudia A. A.
; Fonseca, Claudia B.
; Lima, Dandara C. C.
; Setoue, Debora N. D.
; Roz, Deborah F. P.
; Smaira, Fabiana I.
; Roschel, Hamilton
; Miyatani, Helena T.
; Marques, Isabela G.
; Oba, Jane
; Ferreira, Juliana C. O.
; Simon, Juliana R.
; Kozu, Katia
; Saccani, Ligia P.
; Martiniano, Lorena V. M.
; Miranda, Luana C. A.
; Silva, Luiz E. V.
; Laurentino, Moisés F.
; Aikawa, Nadia E.
; Sakita, Neusa K.
; Tanigava, Nicolas Y.
; Pereira, Paulo R. A.
; Palmeira, Patrícia
; Angelo, Simone S.
; Lavorato, Sofia S. M.
; Bernardes, Tamires M.
; Franco, Tathiane C.
; Viana, Vivianne S. L.
; Barros, Vera P. M. F. R.
; Zheng, Yingying
.
OBJECTIVE: To assess the possible factors that influence sleep quality in adolescents with and without chronic immunosuppressive conditions quarantined during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This cross-sectional study included 305 adolescents with chronic immunocompromised conditions and 82 healthy adolescents. Online surveys were completed, which included questions on socio-demographic data and self-rated healthcare routine during COVID-19 quarantine and the following validated questionnaires: the Pittsburgh Sleep Quality Index (PSQI), Pediatric Quality of Life Inventory 4.0 (PedsQL4.0), and Pediatric Outcome Data Collection Instrument (PODCI). RESULTS: The median current age [14 (10-18) vs. 15 (10-18) years, p=0.847] and frequency of female sex (62% vs. 58%, p=0.571) were similar in adolescents with chronic conditions compared with healthy adolescents. The frequency of poor sleep quality was similar in both groups (38% vs. 48%, p=0.118). Logistic regression analysis, including both healthy adolescents and adolescents with chronic conditions (n=387), demonstrated that self-reported increase in screen time (odds ratio [OR] 3.0; 95% confidence interval [CI] 1.3-6.8; p=0.008) and intrafamilial violence report (OR 2.1; 95% CI 1.2-3.5; p=0.008) were independently associated with poor sleep quality in these adolescents. However, the PODCI global function score was associated with a lower OR for poor sleep quality (OR 0.97; 95% CI 0.94-0.99; p=0.001). Further logistic regression, including only adolescents with chronic conditions (n=305), demonstrated that self-reported increase in screen time (OR 3.1; 95% CI 1.4-6.8; p=0.006) and intrafamilial violence report (OR 2.0; 95% CI 1.2-3.4; p=0.011) remained independently associated with poor quality of sleep, whereas a lower PODCI global function score was associated with a lower OR for sleep quality (OR 0.96; 95% CI 0.94-0.98; p<0.001). CONCLUSION: Self-reported increases in screen time and intrafamilial violence report impacted sleep quality in both healthy adolescents and those with chronic conditions. Decreased health-related quality of life was observed in adolescents with poor sleep quality.
8.
Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital
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Fink, Thais T.
; Marques, Heloisa H.S.
; Gualano, Bruno
; Lindoso, Livia
; Bain, Vera
; Astley, Camilla
; Martins, Fernanda
; Matheus, Denise
; Matsuo, Olivia M.
; Suguita, Priscila
; Trindade, Vitor
; Paula, Camila S.Y.
; Farhat, Sylvia C.L.
; Palmeira, Patricia
; Leal, Gabriela N.
; Suzuki, Lisa
; Odone Filho, Vicente
; Carneiro-Sampaio, Magda
; Duarte, Alberto José S.
; Antonangelo, Leila
; Batisttella, Linamara R.
; Polanczyk, Guilherme V.
; Pereira, Rosa Maria R.
; Carvalho, Carlos Roberto R.
; Buchpiguel, Carlos A.
; Latronico, Ana Claudia
; Seelaender, Marilia
; Silva, Clovis Artur
; Pereira, Maria Fernanda B.
; Sallum, Adriana M. E.
; Brentani, Alexandra V. M.
; Neto, Álvaro José S.
; Ihara, Amanda
; Santos, Andrea R.
; Canton, Ana Pinheiro M.
; Watanabe, Andreia
; Santos, Angélica C. dos
; Pastorino, Antonio C.
; Franco, Bernadette D. G. M.
; Caruzo, Bruna
; Ceneviva, Carina
; Martins, Carolina C. M. F.
; Prado, Danilo
; Abellan, Deipara M.
; Benatti, Fabiana B.
; Smaria, Fabiana
; Gonçalves, Fernanda T.
; Penteado, Fernando D.
; Castro, Gabriela S. F. de
; Gonçalves, Guilherme S.
; Roschel, Hamilton
; Disi, Ilana R.
; Marques, Isabela G.
; Castro, Inar A.
; Buscatti, Izabel M.
; Faiad, Jaline Z.
; Fiamoncini, Jarlei
; Rodrigues, Joaquim C.
; Carneiro, Jorge D. A.
; Paz, Jose A.
; Ferreira, Juliana C.
; Ferreira, Juliana C. O.
; Silva, Katia R.
; Bastos, Karina L. M.
; Kozu, Katia
; Cristofani, Lilian M.
; Souza, Lucas V. B.
; Campos, Lucia M. A.
; Silva Filho, Luiz Vicente R. F.
; Sapienza, Marcelo T.
; Lima, Marcos S.
; Garanito, Marlene P.
; Santos, Márcia F. A.
; Dorna, Mayra B.
; Aikawa, Nadia E.
; Litvinov, Nadia
; Sakita, Neusa K.
; Gaiolla, Paula V. V.
; Pasqualucci, Paula
; Toma, Ricardo K.
; Correa-Silva, Simone
; Sieczkowska, Sofia M.
; Imamura, Marta
; Forsait, Silvana
; Santos, Vera A.
; Zheng, Yingying
.
OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.
9.
Use and misuse of biomarkers and the role of D-dimer and C-reactive protein in the management of COVID-19: A post-hoc analysis of a prospective cohort study
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Gonçalves, Fabio Augusto Rodrigues
; Besen, Bruno Adler Maccagnan Pinheiro
; Lima, Clarice Antunes de
; Corá, Aline Pivetta
; Pereira, Antônio José Rodrigues
; Perazzio, Sandro Félix
; Gouvea, Christiane Pereira
; Fonseca, Luiz Augusto Marcondes
; Trindade, Evelinda Marramon
; Sumita, Nairo Massakazu
; Duarte, Alberto José da Silva
; Lichtenstein, Arnaldo
; Bonfa, Eloisa
; Utiyama, Edivaldo M.
; Segurado, Aluisio C.
; Perondi, Beatriz
; Miethke-Morais, Anna
; Montal, Amanda C.
; Harima, Leila
; Fusco, Solange R. G.
; Silva, Marjorie F.
; Rocha, Marcelo C.
; Marcilio, Izabel
; Rios, Izabel Cristina
; Kawano, Fabiane Yumi Ogihara
; Jesus, Maria Amélia de
; Kallas, Ésper George
; Carmo, Carolina
; Tanaka, Clarice
; Souza, Heraldo Possolo de
; Marchini, Julio F. M.
; Carvalho, Carlos
; Ferreira, Juliana C.
; Levin, Anna Sara Shafferman
; Oliveira, Maura Salaroli
; Guimarães, Thaís
; Lázari, Carolina dos Santos
; Sabino, Ester
; Magri, Marcello M. C.
; Barros-Filho, Tarcisio E. P.
; Francisco, Maria Cristina Peres Braido
; Costa, Silvia F.
.
OBJECTIVE: Coronavirus disease 2019 (COVID-19) is associated with high mortality among hospitalized patients and incurs high costs. Severe acute respiratory syndrome coronavirus 2 infection can trigger both inflammatory and thrombotic processes, and these complications can lead to a poorer prognosis. This study aimed to evaluate the association and temporal trends of D-dimer and C-reactive protein (CRP) levels with the incidence of venous thromboembolism (VTE), hospital mortality, and costs among inpatients with COVID-19. METHODS: Data were extracted from electronic patient records and laboratory databases. Crude and adjusted associations for age, sex, number of comorbidities, Sequential Organ Failure Assessment score at admission, and D-dimer or CRP logistic regression models were used to evaluate associations. RESULTS: Between March and June 2020, COVID-19 was documented in 3,254 inpatients. The D-dimer level ≥4,000 ng/mL fibrinogen equivalent unit (FEU) mortality odds ratio (OR) was 4.48 (adjusted OR: 1.97). The CRP level ≥220 mg/dL OR for death was 7.73 (adjusted OR: 3.93). The D-dimer level ≥4,000 ng/mL FEU VTE OR was 3.96 (adjusted OR: 3.26). The CRP level ≥220 mg/dL OR for VTE was 2.71 (adjusted OR: 1.92). All these analyses were statistically significant (p<0.001). Stratified hospital costs demonstrated a dose-response pattern. Adjusted D-dimer and CRP levels were associated with higher mortality and doubled hospital costs. In the first week, elevated D-dimer levels predicted VTE occurrence and systemic inflammatory harm, while CRP was a hospital mortality predictor. CONCLUSION: D-dimer and CRP levels were associated with higher hospital mortality and a higher incidence of VTE. D-dimer was more strongly associated with VTE, although its discriminative ability was poor, while CRP was a stronger predictor of hospital mortality. Their use outside the usual indications should not be modified and should be discouraged.
10.
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
.
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
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11.
Panniculitis in childhood-onset systemic lupus erythematosus: a multicentric cohort study
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Verdier, Mônica
; Anuardo, Pedro
; Gormezano, Natali Weniger Spelling
; Romiti, Ricardo
; Campos, Lucia Maria Arruda
; Aikawa, Nadia Emi
; Pereira, Rosa Maria Rodrigues
; Terreri, Maria Teresa
; Magalhães, Claudia Saad
; Ferreira, Juliana C. O. A.
; Silva, Marco Felipe Castro
; Ferriani, Mariana
; Sakamoto, Ana Paula
; Ferriani, Virginia Paes Leme
; Centeville, Maraísa
; Sato, Juliana
; Santos, Maria Carolina
; Bonfá, Eloisa
; Silva, Clovis Artur
.
Abstract Objective: To evaluate prevalence, clinical manifestations, laboratory abnormalities, treatment and outcome in a multicenter cohort of childhood-onset systemic lupus erythematosus (cSLE) patients with and without panniculitis. Methods: Panniculitis was diagnosed due to painful subcutaneous nodules and/or plaques in deep dermis/subcutaneous tissues and lobular/mixed panniculitis with lymphocytic lobular inflammatory infiltrate in skin biopsy. Statistical analysis was performed using Bonferroni correction(p < 0.004). Results: Panniculitis was observed in 6/847(0.7%) cSLE. Painful subcutaneous erythematosus and indurated nodules were observed in 6/6 panniculitis patients and painful subcutaneous plaques in 4/6. Generalized distribution was evidenced in 3/6 and localized in upper limbs in 2/6 and face in 1/6. Cutaneous hyperpigmentation and/or cutaneous atrophy occurred in 5/6. Histopathology features showed lobular panniculitis without vasculitis in 5/6(one of them had concomitant obliterative vasculopathy due to antiphospholipid syndrome) and panniculitis with vasculitis in 1/6. Comparison between cSLE with panniculitis and 60 cSLE without panniculitis with same disease duration [2.75(0-11.4) vs. 2.83(0-11.8) years,p = 0.297], showed higher frequencies of constitutional involvement (67% vs. 10%,p = 0.003) and leukopenia (67% vs. 7%,p = 0.002). Cutaneous atrophy and hyperpigmentation occurred in 83% of patients. Conclusions: Panniculitis is a rare skin manifestation of cSLE occurring in the first three years of disease with considerable sequelae. The majority of patients have concomitant mild lupus manifestations.
https://doi.org/10.1186/s42358-019-0049-9
635 downloads
12.
Autoimmune hepatitis in 847 childhoodonset systemic lupus erythematosus population: a multicentric cohort study
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Balbi, Verena A.
; Montenegro, Bárbara
; Pitta, Ana C.
; Schmidt, Ana R.
; Farhat, Sylvia C.
; Coelho, Laila P.
; Ferreira, Juliana C. O.
; Pereira, Rosa M. R.
; Terreri, Maria T.
; Saad-Magalhães, Claudia
; Aikawa, Nadia E.
; Sakamoto, Ana P.
; Kozu, Kátia
; Campos, Lucia M.
; Sallum, Adriana M.
; Ferriani, Virginia P.
; Piotto, Daniela P.
; Bonfá, Eloisa
; Silva, Clovis A.
.
Abstract Objective: To evaluate autoimmune hepatitis (AIH) in a multicenter cohort of childhood-onset systemic lupus erythematosus (cSLE) patients. Methods: This retrospective multicenter study included 847 patients with cSLE, performed in 10 Pediatric Rheumatology services of São Paulo state, Brazil. AIH was defined according to the International Autoimmune Hepatitis Group criteria (IAHGC). The statistical analysis was performed using the Bonferroni's correction (p < 0.0033). Results: AIH in cSLE patients confirmed by biopsy was observed in 7/847 (0.8%) and all were diagnosed during adolescence. The majority occurred before or at cSLE diagnosis [5/7 (71%)]. Antinuclear antibodies were a universal finding, 43% had concomitantly anti-smooth muscle antibodies and all were seronegative for anti-liver kidney microsomal antibodies. All patients with follow-up ≥18 months (4/7) had complete response to therapy according to IAHGC. None had severe hepatic manifestations such as hepatic failure, portal hypertension and cirrhosis at presentation or follow-up. Further comparison of 7 cSLE patients with AIH and 28 without this complication with same disease duration [0 (0–8.5) vs. 0.12 (0–8.5) years, p = 0.06] revealed that the frequency of hepatomegaly was significantly higher in cSLE patients in the former group (71% vs. 11%, p = 0.003) with a similar median SLEDAI-2 K score [6 (0–26) vs. 7 (0–41), p = 0.755]. No differences were evidenced regarding constitutional involvement, splenomegaly, serositis, musculoskeletal, neuropsychiatric and renal involvements, and treatments in cSLE patients with and without AIH (p > 0.0033). Conclusions: Overlap of AIH and cSLE was rarely observed in this large multicenter study and hepatomegaly was the distinctive clinical feature of these patients. AIH occurred during adolescence, mainly at the first years of lupus and it was associated with mild liver manifestations.
https://doi.org/10.1186/s42358-018-0043-7
473 downloads
13.
Diffuse alveolar hemorrhage in childhoodonset systemic lupus erythematosus: a severe disease flare with serious outcome
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Blay, Gabriela
; Rodrigues, Joaquim C.
; Ferreira, Juliana C. O.
; Leal, Gabriela N.
; Gormezano, Natali W.
; Novak, Glaucia V.
; Pereira, Rosa M. R.
; Terreri, Maria T.
; Magalhães, Claudia S.
; Molinari, Beatriz C.
; Sakamoto, Ana P.
; Aikawa, Nadia E.
; Campos, Lucia M. A.
; Fernandes, Taciana A. P.
; Clemente, Gleice
; Peracchi, Octavio A. B.
; Bugni, Vanessa
; Marini, Roberto
; Sacchetti, Silvana B.
; Carvalho, Luciana M.
; Fraga, Melissa M.
; Castro, Tânia C. M.
; Ramos, Valéria C.
; Bonfá, Eloisa
; Silva, Clovis A.
.
Abstract Objective: To evaluate prevalence, clinical manifestations, laboratory abnormalities and treatment in a multicenter cohort study including 847 childhood-onset systemic lupus erythematosus (cSLE) patients with and without diffuse alveolar hemorrhage (DAH), as well as concomitant parameters of severity. Methods: DAH was defined as the presence of at least three respiratory symptoms/signs associated with diffuse interstitial/alveolar infiltrates on chest x-ray or high-resolution computer tomography and sudden drop in hemoglobin levels. Statistical analysis was performed using Bonferroni correction (p < 0.0022). Results: DAH was observed in 19/847 (2.2%) cSLE patients. Cough/dyspnea/tachycardia/hypoxemia occurred in all cSLE patients with DAH. Concomitant parameters of severity observed were: mechanical ventilation in 14/19 (74%), hemoptysis 12/19 (63%), macrophage activation syndrome 2/19 (10%) and death 9/19 (47%). Further analysis of cSLE patients at DAH diagnosis compared to 76 cSLE control patients without DAH with same disease duration [3 (1–151) vs. 4 (1–151) months, p = 0.335], showed higher frequencies of constitutional involvement (74% vs. 10%, p < 0.0001), serositis (63% vs. 6%, p < 0.0001) and sepsis (53% vs. 9%, p < 0.0001) in the DAH group. The median of disease activity score(SLEDAI-2 K) was significantly higher in cSLE patients with DAH [18 (5–40) vs. 6 (0–44), p < 0.0001]. The frequencies of thrombocytopenia (53% vs. 12%, p < 0.0001), intravenous methylprednisolone (95% vs. 16%, p < 0.0001) and intravenous cyclophosphamide (47% vs. 8%, p < 0.0001) were also significantly higher in DAH patients. Conclusions: This was the first study to demonstrate that DAH, although not a disease activity score descriptor, occurred in the context of significant moderate/severe cSLE flare. Importantly, we identified that this condition was associated with serious disease flare complicated by sepsis with high mortality rate.
https://doi.org/10.1186/s42358-018-0038-4
467 downloads
14.
A sigmoidal fit for pressure-volume curves of idiopathic pulmonary fibrosis patients on mechanical ventilation: clinical implications
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Ferreira, Juliana C.
; Benseñor, Fabio E. M.
; Rocha, Marcelo J. J.
; Salge, Joao M.
; Harris, R. Scott
; Malhotra, Atul
; Kairalla, Ronaldo A.
; Kacmarek, Robert M.
; Carvalho, Carlos R. R.
.
OBJECTIVE: Respiratory pressure-volume curves fitted to exponential equations have been used to assess disease severity and prognosis in spontaneously breathing patients with idiopathic pulmonary fibrosis. Sigmoidal equations have been used to fit pressure-volume curves for mechanically ventilated patients but not for idiopathic pulmonary fibrosis patients. We compared a sigmoidal model and an exponential model to fit pressure-volume curves from mechanically ventilated patients with idiopathic pulmonary fibrosis. METHODS: Six idiopathic pulmonary fibrosis patients and five controls underwent inflation pressure-volume curves using the constant-flow technique during general anesthesia prior to open lung biopsy or thymectomy. We identified the lower and upper inflection points and fit the curves with an exponential equation, V = A-B.e-k.P, and a sigmoid equation, V = a+b/(1+e-(P-c)/d). RESULTS: The mean lower inflection point for idiopathic pulmonary fibrosis patients was significantly higher (10.5 ± 5.7 cm H2O) than that of controls (3.6 ± 2.4 cm H2O). The sigmoidal equation fit the pressure-volume curves of the fibrotic and control patients well, but the exponential equation fit the data well only when points below 50% of the inspiratory capacity were excluded. CONCLUSION: The elevated lower inflection point and the sigmoidal shape of the pressure-volume curves suggest that respiratory system compliance is decreased close to end-expiratory lung volume in idiopathic pulmonary fibrosis patients under general anesthesia and mechanical ventilation. The sigmoidal fit was superior to the exponential fit for inflation pressure-volume curves of anesthetized patients with idiopathic pulmonary fibrosis and could be useful for guiding mechanical ventilation during general anesthesia in this condition.
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