Artigos e Materiais de Revistas Científicas - LIM/09
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A coleção de Artigos e Materiais de Revistas Científicas engloba artigos originais, artigos de revisão, artigos de atualização, artigos técnicos, relatos de experiências, resenhas, ensaios, editoriais, cartas ao editor, debates, notas científicas e técnicas, depoimentos, entrevistas e pontos de vista. Consideram-se como artigos científicos originais os trabalhos redigidos para divulgação de informações e resultados sobre determinada pesquisa científica, publicados em periódico científico após avaliação por outros pesquisadores.
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- Prognostic factors associated with mortality in acute exacerbations of idiopathic pulmonary fibrosis: A systematic review and meta-analysis(2024) PITRE, Tyler; LUPAS, Daniel; EBEIDO, Ibrahim; COLAK, Alexander; MODI, Mihir; KACHKOVSKI, George V.; MONTESI, Sydney B.; KHOR, Yet H.; KAWANO-DOURADO, Leticia; JENKINS, Gisli; FISHER, Jolene H.; SHAPERA, Shane; ROCHWERG, Bram; COUBAN, Rachel; ZERAATKAR, DenaBackground: Acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF) increases mortality risk, but which factors increase mortality is unknown. We aimed to perform a prognostic review of factors associated with mortality in patients with IPF. Study design: and methods: We searched MEDLINE, EMBASE, and CINAHL for studies that reported on the association between any prognostic factor and AE-IPF. We assessed risk of bias using the QUIPS tool. We conduced pairwise meta -analyses using REML heterogeneity estimator, and GRADE approach to assess the certainty of the evidence. Results: We included 35 studies in our analysis. We found that long-term supplemental oxygen at baseline (aHR 2.52 [95 % CI 1.68 to 3.80]; moderate certainty) and a diagnosis of IPF compared to non-IPF ILD (aHR 2.19 [95 % CI 1.22 to 3.92]; moderate certainty) is associated with a higher risk of death in patients with AE-IPF. A diffuse pattern on high resolution computed tomography (HRCT) compared to a non -diffuse pattern (aHR 2.61 [95 % CI 1.32 to 2.90]; moderate certainty) is associated with a higher risk of death in patients with AE-IPF. We found that using corticosteroids prior to hospital admission (aHR 2.19 [95 % CI 1.26 to 3.82]; moderate certainty) and those with increased neutrophils (by % increase) in bronchoalveolar lavage (BAL) during the exacerbation is associated with a higher risk of death (aHR 1.02 [1.01 to 1.04]; moderate certainty). Interpretation: Our results have implications for healthcare providers in making treatment decisions and prognosticating the clinical trajectory of patients, for researchers to design future interventions to improve patient trajectory, and for guideline developers in making decisions about resource allocation.
- Implementing the severe community-acquired pneumonia guidelines in low- and middle-income countries(2023) SALLUH, Jorge; KAWANO-DOURADO, Leticia
- Data-driven, cross-disciplinary collaboration: lessons learned at the largest academic health center in Latin America during the COVID-19 pandemic(2024) RITTO, Ana Paula; ARAUJO, Adriana Ladeira de; CARVALHO, Carlos Roberto Ribeiro de; SOUZA, Heraldo Possolo De; FAVARETTO, Patricia Manga e Silva; SABOYA, Vivian Renata Boldrim; GARCIA, Michelle Louvaes; KULIKOWSKI, Leslie Domenici; KALLAS, Esper Georges; PEREIRA, Antonio Jose Rodrigues; COBELLO JUNIOR, Vilson; SILVA, Katia Regina; ABDALLA, Eidi Raquel Franco; SEGURADO, Aluisio Augusto Cotrim; SABINO, Ester Cerdeira; RIBEIRO JUNIOR, Ulysses; FRANCISCO, Rossana Pulcineli Vieira; MIETHKE-MORAIS, Anna; LEVIN, Anna Sara Shafferman; SAWAMURA, Marcio Valente Yamada; FERREIRA, Juliana Carvalho; SILVA, Clovis Artur; MAUAD, Thais; GOUVEIA, Nelson da Cruz; LETAIF, Leila Suemi Harima; BEGO, Marco Antonio; BATTISTELLA, Linamara Rizzo; DUARTE, Alberto Jose da Silva; SEELAENDER, Marilia Cerqueira Leite; MARCHINI, Julio; FORLENZA, Orestes Vicente; ROCHA, Vanderson Geraldo; MENDES-CORREA, Maria Cassia; COSTA, Silvia Figueiredo; CERRI, Giovanni Guido; BONFA, Eloisa Silva Dutra de Oliveira; CHAMMAS, Roger; BARROS FILHO, Tarcisio Eloy Pessoa de; BUSATTO FILHO, GeraldoIntroduction The COVID-19 pandemic has prompted global research efforts to reduce infection impact, highlighting the potential of cross-disciplinary collaboration to enhance research quality and efficiency.Methods At the FMUSP-HC academic health system, we implemented innovative flow management routines for collecting, organizing and analyzing demographic data, COVID-related data and biological materials from over 4,500 patients with confirmed SARS-CoV-2 infection hospitalized from 2020 to 2022. This strategy was mainly planned in three areas: organizing a database with data from the hospitalizations; setting-up a multidisciplinary taskforce to conduct follow-up assessments after discharge; and organizing a biobank. Additionally, a COVID-19 curated collection was created within the institutional digital library of academic papers to map the research output.Results Over the course of the experience, the possible benefits and challenges of this type of research support approach were identified and discussed, leading to a set of recommended strategies to enhance collaboration within the research institution. Demographic and clinical data from COVID-19 hospitalizations were compiled in a database including adults and a minority of children and adolescents with laboratory confirmed COVID-19, covering 2020-2022, with approximately 350 fields per patient. To date, this database has been used in 16 published studies. Additionally, we assessed 700 adults 6 to 11 months after hospitalization through comprehensive, multidisciplinary in-person evaluations; this database, comprising around 2000 fields per subject, was used in 15 publications. Furthermore, thousands of blood samples collected during the acute phase and follow-up assessments remain stored for future investigations. To date, more than 3,700 aliquots have been used in ongoing research investigating various aspects of COVID-19. Lastly, the mapping of the overall research output revealed that between 2020 and 2022 our academic system produced 1,394 scientific articles on COVID-19.Discussion Research is a crucial component of an effective epidemic response, and the preparation process should include a well-defined plan for organizing and sharing resources. The initiatives described in the present paper were successful in our aim to foster large-scale research in our institution. Although a single model may not be appropriate for all contexts, cross-disciplinary collaboration and open data sharing should make health research systems more efficient to generate the best evidence.
- Bronchoscopic, laboratory and anatomopathological criteria for airway disease in patients diagnosed with granulomatosis with polyangiitis(2023) DíAZ, C. Moreno; JACOMELLI, M.; DEMARZO, S. E.; PALOMINO, A. M.; OLIVEIRA, E. P. de; ASSUNCAO, G. L. M. de; TOLEDO, A. P. de; BARBAS, C. S. V.Introduction: patients with granulomatosis with polyangiitis (GPA) may present upper airway (UA) and lower airway (LA) involvement. Objectives: we describe the endoscopic manifestations of the airways, histological findings from biopsied tissue and antineutrophilic cytoplasm antibody (ANCA) in a group of patients with GPA. Methods: retrospective study of medical records of patients with GPA undergoing bronchoscopy between 2012 and 2019. Airway findings, results of biopsies performed and ANCA results were analyzed. Results: 40 patients were included, with a mean age of 46.92±17.61 years and predominantly female (67.5%). Airway involvement was observed in 90% (n=36). The C-ANCA was reactive in 63.9%, P-ANCA in 25%, doubly reactive ANCA in 8.33% and non-reactive in 20%. The findings in upper airway (UA) were: chronic sinusitis (41.7%), destruction of the nasal septum (16.7%); and in lower airway (LA) were: tracheobronchial stenosis (38.9%) and tracheobronchitis (25%). The pathological findings most common of bronchoscopic biopsies were: polymorphonuclear inflammatory process (61.9%) and geographic necrosis (47.6%). Conclusion: the airway is involved in up to 90% of patients with GPA. Non-reactive ANCA does not rule out this possibility. Chronic sinusitis and tracheobronchial fibrostenotic processes were the most common endoscopic findings. Vasculitis in biopsies was found in a minority of cases.
- Risk Factors for the Impairment of Ambulation in Older People Hospitalized with COVID-19: A Retrospective Cohort Study(2023) SILVA, E. C. G. E.; SCHMITT, A. C. B.; GODOY, C. G. de; OLIVEIRA, D. B. de; TANAKA, C.; TOUFEN, C. Jr.; CARVALHO, C. R. R. de; CARVALHO, C. R. F.; FU, C.; HILL, K. D.; POMPEU, J. E.(1) Background: Some older people hospitalized with COVID-19 have experienced reduced ambulation capacity. However, the prevalence of the impairment of ambulation capacity still needs to be established. Objective: To estimate the prevalence of, and identify the risk factors associated with, the impairment of ambulation capacity at the point of hospital discharge for older people with COVID-19. (2) Methods: A retrospective cohort study. Included are those with an age > 60 years, of either sex, hospitalized due to COVID-19. Clinical data was collected from patients’ medical records. Ambulation capacity prior to COVID-19 infection was assessed through the patients’ reports from their relatives. Multiple logistic regressions were performed to identify the risk factors associated with the impairment of ambulation at hospital discharge. (3) Results: Data for 429 older people hospitalized with COVID-19 were randomly collected from the medical records. Among the 56.4% who were discharged, 57.9% had reduced ambulation capacity. Factors associated with reduced ambulation capacity at discharge were a hospital stay longer than 20 days (Odds Ratio (OR): 3.5) and dependent ambulation capacity prior to COVID-19 (Odds Ratio (OR): 11.3). (4) Conclusion: More than half of the older people who survived following hospitalization due to COVID-19 had reduced ambulation capacity at hospital discharge. Impaired ambulation prior to the infection and a longer hospital stay were risks factors for reduced ambulation capacity.
- Pronation Reveals a Heterogeneous Response of Global and Regional Respiratory Mechanics in Patients With Acute Hypoxemic Respiratory Failure(2023) MORAIS, C. C. A.; ALCALA, G.; SANTIAGO, R. R. De Santis; VALSECCHI, C.; DIAZ, E.; WANDERLEY, H.; FAKHR, B. S.; FENZA, R. Di; GIANNI, S.; FOOTE, S.; CHANG, M. G.; BITTNER, E. A.; CARROLL, R. W.; COSTA, E. L. V.; AMATO, M. B. P.; BERRA, L.OBJECTIVES: Experimental models suggest that prone position and positive end-expiratory pressure (PEEP) homogenize ventral-dorsal ventilation distribution and regional respiratory compliance. However, this response still needs confirmation on humans. Therefore, this study aimed to assess the changes in global and regional respiratory mechanics in supine and prone positions over a range of PEEP levels in acute respiratory distress syndrome (ARDS) patients. DESIGN: A prospective cohort study. PATIENTS: Twenty-two intubated patients with ARDS caused by COVID-19 pneumonia. INTERVENTIONS: Electrical impedance tomography and esophageal manometry were applied during PEEP titrations from 20 cm H2O to 6 cm H2O in supine and prone positions. MEASUREMENTS: Global respiratory system compliance (Crs), chest wall compliance, regional lung compliance, ventilation distribution in supine and prone positions. MAIN RESULTS: Compared with supine position, the maximum level of Crs changed after prone position in 59% of ARDS patients (n = 13), of which the Crs decreased in 32% (n = 7) and increased in 27% (n = 6). To reach maximum Crs after pronation, PEEP was changed in 45% of the patients by at least 4 cm H2O. After pronation, the ventilation and compliance of the dorsal region did not consistently change in the entire sample of patients, increasing specifically in a subgroup of patients who showed a positive change in Crs when transitioning from supine to prone position. These combined changes in ventilation and compliance suggest dorsal recruitment postpronation. In addition, the subgroup with increased Crs postpronation demonstrated the most pronounced difference between dorsal and ventral ventilation distribution from supine to prone position (p = 0.01), indicating heterogeneous ventilation distribution in prone position. CONCLUSIONS: Prone position modifies global respiratory compliance in most patients with ARDS. Only a subgroup of patients with a positive change in Crs postpronation presented a consistent improvement in dorsal ventilation and compliance. These data suggest that the response to pronation on global and regional mechanics can vary among ARDS patients, with some patients presenting more dorsal lung recruitment than others.
- Editorial: Reviews in pulmonary medicine 2022(2023) WANG, Shuibang; BALDI, Bruno Guedes
- Long-term outcomes of the global tuberculosis and COVID-19 co-infection cohort(2023) CASCO, Nicolas; JORGE, Alberto Levi; PALMERO, Domingo Juan; ALFFENAAR, Jan-Willem; FOX, Greg J.; EZZ, Wafaa; CHO, Jin-Gun; DENHOLM, Justin; SKRAHINA, Alena; SOLODOVNIKOVA, Varvara; ARBEX, Marcos Abdo; ALVES, Tatiana; RABAHI, Marcelo Fouad; PEREIRA, Giovana Rodrigues; SALES, Roberta; SILVA, Denise Rossato; SAFFIE, Muntasir M.; SALINAS, Nadia Escobar; MIRANDA, Ruth Caamano; CISTERNA, Catalina; CONCHA, Clorinda; FERNANDEZ, Israel; VILLALON, Claudia; VERA, Carolina Guajardo; TAPIA, Patricia Gallegos; CANCINO, Viviana; CARBONELL, Monica; CRUZ, Arturo; MUNOZ, Eduardo; MUNOZ, Camila; NAVARRO, Indira; PIZARRO, Rolando; SANCHEZ, Gloria Pereira Cristina; RIQUELME, Maria Soledad Vergara; VILCA, Evelyn; SOTO, Aline; FLORES, Ximena; GARAVAGNO, Ana; BAHAMONDES, Martina Hartwig; MERINO, Luis Moyano; PRADENAS, Ana Maria; REVILLOT, Macarena Espinoza; RODRIGUEZ, Patricia; SALINAS, Angeles Serrano; TAIBA, Carolina; VALDES, Joaquin Farias; SUBIABRE, Jorge Navarro; ORTEGA, Carlos; PALMA, Sofia; CASTILLO, Patricia Perez; PINTO, Monica; BIDEGAIN, Francisco Rivas; VENEGAS, Margarita; YUCRA, Edith; LI, Yang; CRUZ, Andres; GUELVEZ, Beatriz; PLAZA, Regina Victoria; HOYOS, Kelly Yoana Tello; CARDOSO-LANDIVAR, Jose; BOOM, Martin Van Den; ANDREJAK, Claire; BLANC, Francois-Xavier; DOURMANE, Samir; FROISSART, Antoine; IZADIFAR, Armine; RIVIERE, Frederic; SCHLEMMER, Frederic; MANIKA, Katerina; DIALLO, Boubacar Djelo; HASSANE-HAROUNA, Souleymane; ARTILES, Norma; MEJIA, Licenciada Andrea; GUPTA, Nitesh; ISH, Pranav; MISHRA, Gyanshankar; PATEL, Jigneshkumar M.; SINGLA, Rupak; UDWADIA, Zarir F.; ALLADIO, Francesca; ANGELI, Fabio; CALCAGNO, Andrea; CENTIS, Rosella; CODECASA, Luigi Ruffo; LAURETIS, Angelo De; ESPOSITO, Susanna M. R.; FORMENTI, Beatrice; GAVIRAGHI, Alberto; GIACOMET, Vania; GOLETTI, Delia; GUALANO, Gina; MATTEELLI, Alberto; MIGLIORI, Giovanni Battista; MOTTA, Ilaria; PALMIERI, Fabrizio; PONTALI, Emanuele; PRESTILEO, Tullio; RICCARDI, Niccolo; SADERI, Laura; SAPORITI, Matteo; SOTGIU, Giovanni; SPANEVELLO, Antonio; STOCHINO, Claudia; TADOLINI, Marina; TORRE, Alessandro; VILLA, Simone; VISCA, Dina; KURHASANI, Xhevat; FURJANI, Mohammed; RASHEED, Najia; DANILA, Edvardas; DIKTANAS, Saulius; RIDAURA, Ruy Lopez; LOPEZ, Fatima Leticia Luna; TORRICO, Marcela Munoz; RENDON, Adrian; AKKERMAN, Onno W.; CHIZARAM, Onyeaghala; AL-ABRI, Seif; ALYAQUOBI, Fatma; ALTHOHLI, Khalsa; AGUIRRE, Sarita; TEIXEIRA, Rosarito Coronel; EGEA, Viviana De; IRALA, Sandra; MEDINA, Angelica; SEQUERA, Guillermo; SOSA, Natalia; VAZQUEZ, Fatima; LLANOS-TEJADA, Felix K.; MANGA, Selene; VILLANUEVA-VILLEGAS, Renzo; ARAUJO, David; DUARTE, Raquel; MARQUES, Tania Sales; GRECU, Victor Ionel; SOCACI, Adriana; BARKANOVA, Olga; BOGORODSKAYA, Maria; BORISOV, Sergey; MARIANDYSHEV, Andrei; KALUZHENINA, Anna; VUKICEVIC, Tatjana Adzic; STOSIC, Maja; BEH, Darius; NG, Deborah; ONG, Catherine W. M.; SOLOVIC, Ivan; DHEDA, Keertan; GINA, Phindile; CAMINERO, Jose A.; GALVAO, Maria Luiza De Souza; DOMINGUEZ-CASTELLANO, Angel; GARCIA-GARCIA, Jose-Maria; PINARGOTE, Israel Molina; FERNANDEZ, Sarai Quiros; SANCHEZ-MONTALVA, Adrian; HUGUET, Eva Tabernero; MURGUIONDO, Miguel Zabaleta; BART, Pierre-Alexandre; MAZZA-STALDER, Jesica; D'AMBROSIO, Lia; KAMOLWAT, Phalin; BAKKO, Freya; BARNACLE, James; BIRD, Sophie; BROWN, Annabel; CHANDRAN, Shruthi; KILLINGTON, Kieran; MAN, Kathy; PAPINENI, Padmasayee; RITCHIE, Flora; TIBERI, Simon; UTJESANOVIC, Natasa; ZENNER, Dominik; HEARN, Jasie L.; HEYSELL, Scott; YOUNG, LauraBackground Longitudinal cohort data of patients with tuberculosis (TB) and coronavirus disease 2019 (COVID-19) are lacking. In our global study, we describe long-term outcomes of patients affected by TB and COVID-19. Methods We collected data from 174 centres in 31 countries on all patients affected by COVID-19 and TB between 1 March 2020 and 30 September 2022. Patients were followed-up until cure, death or end of cohort time. All patients had TB and COVID-19; for analysis purposes, deaths were attributed to TB, COVID-19 or both. Survival analysis was performed using Cox proportional risk-regression models, and the log-rank test was used to compare survival and mortality attributed to TB, COVID-19 or both. Results Overall, 788 patients with COVID-19 and TB (active or sequelae) were recruited from 31 countries, and 10.8% (n=85) died during the observation period. Survival was significantly lower among patients whose death was attributed to TB and COVID-19 versus those dying because of either TB or COVID-19 alone (p<0.001). Significant adjusted risk factors for TB mortality were higher age (hazard ratio (HR) 1.05, 95% CI 1.03-1.07), HIV infection (HR 2.29, 95% CI 1.02-5.16) and invasive ventilation (HR 4.28, 95% CI 2.34-7.83). For COVID-19 mortality, the adjusted risks were higher age (HR 1.03, 95% CI 1.02-1.04), male sex (HR 2.21, 95% CI 1.24-3.91), oxygen requirement (HR 7.93, 95% CI 3.44- 18.26) and invasive ventilation (HR 2.19, 95% CI 1.36-3.53). Conclusions In our global cohort, death was the outcome in >10% of patients with TB and COVID-19. A range of demographic and clinical predictors are associated with adverse outcomes.
- Twelve tips to manage a research project-advice for the young investigator(2023) FERNANDES, Flavia Fonseca; FERREIRA, Juliana Carvalho; PATINO, Cecilia Maria
- The Relevance of Dysautonomia on Exercise Responses(2023) LEITE, Guilherme Ward; ZIMMERMANN, Natalia de Alcantara; ALVES, Jose Leonidas; SALGE, Joao Marcos; ALBUQUERQUE, Andre Luis Pereira de
- Engaging stakeholders to level up COPD care in LMICs: lessons learned from the ""Breathe Well"" programme in Brazil, China, Georgia, and North Macedonia(2024) FERNANDES, Genevie; WILLIAMS, Sian; ADAB, Peymane; GALE, Nicola; JONG, Corina de; SOUSA, Jaime Correia de; CHENG, Kk; CHI, Chunhua; COOPER, Brendan G.; DICKENS, Andrew P.; ENOCSON, Alexandra; FARLEY, Amanda; JOLLY, Kate; JOWETT, Sue; MAGLAKELIDZE, Maka; MAGHLAKELIDZE, Tamaz; MARTINS, Sonia; SITCH, Alice; STAMENOVA, Aleksandra; STAVRIKJ, Katarina; STELMACH, Rafael; TURNER, Alice; PAN, Zihan; PANG, Hui; ZHANG, Jianxin; JORDAN, Rachel E.BackgroundEffective stakeholder engagement in health research is increasingly being recognised and promoted as an important pathway to closing the gap between knowledge production and its use in health systems. However, little is known about its process and impacts, particularly in low-and middle-income countries. This opinion piece draws on the stakeholder engagement experiences from a global health research programme on Chronic Obstructive Pulmonary Disease (COPD) led by clinician researchers in Brazil, China, Georgia and North Macedonia, and presents the process, outcomes and lessons learned.Main bodyEach country team was supported with an overarching engagement protocol and mentored to develop a tailored plan. Patient involvement in research was previously limited in all countries, requiring intensive efforts through personal communication, meetings, advisory groups and social media. Accredited training programmes were effective incentives for participation from healthcare providers; and aligning research findings with competing policy priorities enabled interest and dialogue with decision-makers. The COVID-19 pandemic severely limited possibilities for planned engagement, although remote methods were used where possible. Planned and persistent engagement contributed to shared knowledge and commitment to change, including raised patient and public awareness about COPD, improved skills and practice of healthcare providers, increased interest and support from clinical leaders, and dialogue for integrating COPD services into national policy and practice.ConclusionStakeholder engagement enabled relevant local actors to produce and utilise knowledge for small wins such as improving day-to-day practice and for long-term goals of equitable access to COPD care. For it to be successful and sustained, stakeholder engagement needs to be valued and integrated throughout the research and knowledge generation process, complete with dedicated resources, contextualised and flexible planning, and commitment.
- Brazilian Thoracic Association recommendations for the management of post-tuberculosis lung disease(2023) SILVA, Denise Rossato; SANTOS, Ana Paula; VISCA, Dina; BOMBARDA, Sidney; DALCOLMO, Margareth Maria Pretti; GALVAO, Tatiana; MIRANDA, Silvana Spindola de; PARENTEL, Ana Alice Amaral Ibiapina; RABAHI, Marcelo Fouad; SALES, Roberta Karla Barbosa de; MIGLIORI, Giovanni Battista; MELLO, Fernanda Carvalho de QueirozHistorically, all efforts against tuberculosis were focused on rapid diagnosis and effective treatment to break the chain of transmission of Mycobacterium tuberculosis. However, in the last few years, more and more evidence has been found on the dramatic consequences of the condition defined as post-tuberculosis lung disease (PTLD). Approximately one third of patients surviving pulmonary tuberculosis face considerable ongoing morbidities, including respiratory impairment, psychosocial challenges, and reduced health-related quality of life after treatment completion. Given the important global and local burden of tuberculosis, as well as the estimated burden of PTLD, the development of a consensus document by a Brazilian scientific society-Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)-was considered urgent for the prevention and management of this condition in order to allocate resources to and within tuberculosis services appropriately and serve as a guide for health care professionals. A team of eleven pulmonologists and one methodologist was created by the SBPT to review the current evidence on PTLD and develop recommendations adapted to the Brazilian context. The expert panel selected the topics on the basis of current evidence and international guidelines. During the first phase, three panel members drafted the recommendations, which were divided into three sections: definition and prevalence of PTLD, assessment of PTLD, and management of PTLD. In the second phase, all panel members reviewed, discussed, and revised the recommendations until a consensus was reached. The document was formally approved by the SBPT in a special session organized during the 2023 SBPT Annual Conference.
- Crafting a research protocol: a stepwise comprehensive approach(2023) FIGUEIREDO, Ricardo Gassmann; PATINO, Cecilia Maria; FERREIRA, Juliana Carvalho
- Lower platelet count and metastatic tumor are associated with increased risk of spontaneous bleeding in critically ill patients with cancer: An observational study(2023) KAYANO, Sandra Satoe; SANTANA, Pauliane Vieira; COLELLA, Rafael; COLELLA, Marina Pereira; CARUSO, PedroBackground: Thrombocytopenia is common in critically ill patients with cancer. However, the association of platelet count with spontaneous bleeding is controversial in critically ill patients and the association with cancer-related characteristics is unknown.Methods: This observational study includes patients with active cancer and severe thrombocytopenia. A logistic regression model adjusted for confounders was used to evaluate the association of daily platelet count and cancer-related characteristics (type of cancer and presence of metastasis) with spontaneous bleeding. Confounders were identified using directed acyclic graphs.Results: We screened 5822 patients, 255 (4.4%) met eligibility criteria resulting in 1401 daily observations. Fifty-three patients (20.8%) had spontaneous bleeding during the intensive care unit stay, 64% presenting minor, and 36% major bleeding. The adjusted odds ratio (OR) for spontaneous bleeding with platelet count between 49 and 20 x 10(9)/L was 4.6 (1.1-19.6), with platelet count between 19 and 10 x 10(9)/L was 14.2 (3.1-66.2), and with platelet count below 10 x 109/L was 39.6 (6.9-228.5). The adjusted OR for spontaneous bleeding in patients with hematologic malignancies was 0.6 (0.4-1.2), and 4.3 (2.0-9.0) for patients with metastatic tumor.Conclusions: In critically ill patients with active cancer and severe thrombocytopenia, lower counts of platelets and presence of metastasis are associated with increased risk of spontaneous bleeding, while hematologic malignancy is not associated with increased risk of spontaneous bleeding.
- Changes after 12 years of follow-up severe asthma patients cohort: higher obstruction and comorbidities, but significant better quality of life(2023) JR, N. G. Santos; LIMA, R. M.; ATHANAZIO, R. A.; PINTO, R. M. Carvalho; RABE, K.; CUKIER, A.; STELMACH, R.Background The Brazilian Cohort of Asthma Sao Paulo (BRASASP) had a well-characterized severe asthmatic in Brazil, with 12 years of follow-up under standard treatment. Methods Sequential assessment of patients with uncontrolled asthma from BRASASP cohort was carried out with 12 years of follow-up, performing exams and comparing with previous measurements. Results 50 from the 60 initial patients were reevaluated. Twelve years later, FEV1 and the FEV1/FVC ratio have significantly decreased, with a rate of loss of lung function of 11.8 and 14%, respectively, and worsening in small airway parameters such as RV/TLC. BMI, The Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ) scores haven't changed. However, exacerbations decreased by 56%. Mean daily inhaled corticosteroid use was similar over time, but daily oral corticosteroid use decreased, in addition to a significant reduction in induced sputum eosinophilic and neutrophilic profile and serum IgE. Rhinitis, sinusitis, and GERD were the main comorbidities. In quality of life according to respiratory questionnaire SGRQ, total score showed a huge improvement (62% of patients). Conclusions There was significant decrease in FEV1 and FEV1/FVC. Data of pulmonary functional small airway characteristics show globally affected airways. Although higher doses of medications, patients were still uncontrolled, but with reduction of exacerbations, daily use of oral corticosteroid, less eosinophils and neutrophils in induced sputum and lower levels of IgE. Improvement in quality of life in 62% of patients.
- Organizing pneumonia and COVID-19(2023) TONON, Carolina Rodrigues; TANNI, Suzana Erico; ROCHA, Juliana; GODOY, Irma; POLEGATO, Bertha Furlan; PEREIRA, Filipe Welson Leal; MARTINS, Danilo; PRUDENTE, Robson Aparecido; FRANCO, Estefania Thome; BRIZOLA, Fernando; BALDI, Bruno Guedes; OKOSHI, Marina PolitiOrganizing pneumonia (OP) is an interstitial lung disease, and can be cryptogenic, if no cause is identified, or secondary to several conditions. COVID-19-induced persistent inflammation can be associated with interstitial lung disease. We present a review of literature of OP and COVID-19-induced OP with an illustrative case. A 38-year-old man was admitted with COVID-19 that required mechanical ventilation for 56 days. Initial chest computed tomography (CT) revealed diffuse bilateral ground-glass opacities in the lungs with consolidation areas involving 75 % of the parenchyma. After weaning from MV, the patient still required oxygen supplementation. A new chest CT scan also showed extensive diffuse areas of consolidation and ground-glass opacity. OP was hypothesized and 40 mg/day prednisone initiated and continued for six months with resolution of lung functional and image abnormalities. Organizing pneumonia should be included in the differential diagnosis of COVID-19 patients with respiratory symptoms after partial pulmonary recovery. [Am J Med Sci 2023;366(6):458-463.]
- Systemic corticosteroids in fibrotic lung disease: a systematic review and meta-analysis(2023) PITRE, Tyler; KAWANO-DOURADO, Leticia; V, George Kachkovski; LEUNG, Darren; LEUNG, Gareth; DESAI, Kairavi; ZHAI, Chunjuan; ADAMS, Wendy; FUNKE-CHAMBOUR, Manuela; KREUTER, Michael; STEWART, Iain; RYERSON, Christopher J.; JENKINS, Gisli; ZERAATKAR, DenaObjectivesWe aimed to assess the available evidence for corticosteroids in fibrotic interstitial lung disease (fILD) to inform the randomised embedded multifactorial adaptive platform ILD.DesignSystematic review and meta-analysis.Data sourcesWe searched Embase, Medline, Cochrane CENTRAL and Web of Science databases from inception to April 17 2023.Eligibility criteriaWe included studies that compared corticosteroids with standard care, placebo or no treatment in adult patients with fILD.Data extraction and synthesisWe report on the change in forced vital capacity (FVC) and mortality. We used random-effects meta-analysis to estimate relative risk (RR) for dichotomous outcomes, and mean difference (MD) and standardised MDs for continuous outcomes, with 95% CIs.ResultsOf the 13 229 unique citations identified, we included 10 observational studies comprising 1639 patients. Corticosteroids had an uncertain effect on mortality compared with no treatment (RR 1.03 (95% CI 0.85 to 1.25); very low certainty evidence). The effect of corticosteroids on the rate of decline in FVC (% predicted) was uncertain when compared with no treatment (MD 4.29% (95% CI -8.26% to 16.83%); very low certainty evidence). However, corticosteroids might reduce the rate of decline in FVC in patients with non-idiopathic pulmonary fibrosis (IPF) fILD (MD 10.89% (95% CI 5.25% to 16.53%); low certainty evidence), while an uncertain effect was observed in patients with IPF (MD -3.80% (95% CI -8.94% to 1.34%); very low certainty evidence).ConclusionsThe current evidence on the efficacy and safety of corticosteroids in fILD is limited and of low certainty. Randomised trials are needed to address this significant research gap.
- Use of elexacaftor plus tezacaftor plus ivacaftor in individuals with cystic fibrosis and at least one F508del allele: a systematic review and meta-analysis(2023) SILVA FILHO, Luiz Vicente Ribeiro Ferreira da; ATHANAZIO, Rodrigo Abensur; TONON, Carolina Rodrigues; FERREIRA, Juliana Carvalho; TANNI, Suzana EricoObjective: To evaluate the effect of treatment with the combination of three cystic fibrosis transmembrane conductance regulator (CFTR) modulators-elexacaftor+tezac aftor+ivacaftor (ETI)-on important clinical endpoints in individuals with cystic fibrosis. Methods: This was a systematic review and meta-analysis of randomized clinical trials that compared the use of ETI in individuals with CF and at least one F508del allele with that of placebo or with an active comparator such as other combinations of CFTR modulators, following the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) recommendations and the Patients of interest, Intervention to be studied, Comparison of interventions, and Outcome of interest (PICO) methodology. We searched the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from their inception to December 26th, 2022. The risk of bias was assessed using the Cochrane risk-of-bias tool, and the quality of evidence was based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: We retrieved 54 studies in the primary search. Of these, 6 met the inclusion criteria and were analyzed (1,127 patients; 577 and 550 in the intervention and control groups, respectively). The meta-analysis revealed that the use of ETI increased FEV 1% [risk difference (RD), +10.47%; 95% CI, 6.88-14.06], reduced the number of acute pulmonary exacerbations (RD, -0.16; 95% CI, -0.28 to -0.04), and improved quality of life (RD, +14.93; 95% CI, 9.98-19.89) and BMI (RD, +1.07 kg/m(2); 95% CI, 0.90-1.25). Adverse events did not differ between groups (RD, -0.03; 95% CI, -0.08 to 0.01), and none of the studies reported deaths. Conclusions: Our findings demonstrate that ETI treatment substantially improves clinically significant, patientcentered outcomes.
- Delirium During Critical Illness and Subsequent Change of Treatment in Patients With Cancer: A Mediation Analysis(2024) VIZZACCHI, Barbara A.; DETTINO, Aldo L. A.; BESEN, Bruno A. M. P.; CARUSO, Pedro; JR, Antonio P. NassarOBJECTIVES: To assess whether delirium during ICU stay is associated with subsequent change in treatment of cancer after discharge.DESIGN: Retrospective cohort study.SETTING: A 50-bed ICU in a dedicated cancer center.PATIENTS: Patients greater than or equal to 18 years old with a previous proposal of cancer treatment (chemotherapy, target therapy, hormone therapy, immunotherapy, radiotherapy, oncologic surgery, and bone marrow transplantation).INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: We considered delirium present if Confusion Assessment Method for the ICU was positive. We assessed the association between delirium and modification of the treatment after discharge. We also performed a mediation analysis to assess both the direct and indirect (i.e., mediated by the development of functional dependence after discharge) of delirium on modification of cancer treatment and whether the modification of cancer treatment was associated with mortality at 1 year. We included 1,134 patients, of whom, 189 (16.7%) had delirium. Delirium was associated with the change in cancer treatment (adjusted odds ratio [OR], 3.80; 95% CI, 2.72-5.35). The association between delirium in ICU and change of treatment was both direct and mediated by the development of functional dependence after discharge. The proportion of the total effect of delirium on change of treatment mediated by the development of functional dependence after discharge was 33.0% (95% CI, 21.7-46.0%). Change in treatment was associated with increased mortality at 1 year (adjusted OR, 2.68; 95% CI, 2.01-3.60).CONCLUSIONS: Patients who had delirium during ICU stay had a higher rate of modification of cancer treatment after discharge. The effect of delirium on change in cancer treatment was only partially mediated by the development of functional dependence after discharge. Change in cancer treatment was associated with increased 1-year mortality.
- Clinical and morphological features of large-cell neuroendocrine carcinomas and small-cell lung carcinomas expressing the DLL3 and ASCL1 oncoproteins(2023) PRIETO, T. G.; BALDAVIRA, C. M.; MACHADO-RUGOLO, J.; OLIVIERI, E. H. R.; SILVA, E. C. A. da; SILVA, V. G.; ABSABER, A. M.; TAKAGAKI, T. Y.; CAPELOZZI, V. L.Intratumoral similarities and differences between large-cell neuroendocrine carcinomas (LCNECs) and small-cell lung carcinomas (SCLCs) are determined partially by the Notch signaling pathway, which controls the switch from neuroendocrine to slight/non-neuroendocrine cell fate. LCNECs are divided into two subgroups according to genomic alterations: type I LCNECs exhibit a neuroendocrine profile characterized by achaete-scute homolog 1 (ASCL1)high/delta-like protein 3 (DLL3)high/ NOTCHlow and type II LCNECs show the pattern ASCL1low/DLL3low/NOTCHhigh. Here, we used immunohistochemistry, transmission electron microscopy, and digital analysis to examine the role of the Notch ligand DLL3 as an immunomarker of the neuroendocrine state and ASCL1 as a regulator of cell-cell interactions in SCLCs and LCNECs. High DLL3 and ASCL1 expression was associated with atypical submicroscopic characteristics involving nuclear size, chromatin arrangement, Golgi apparatus, and endoplasmic reticulum, and was characteristic of type I LCNECs with similarity to SCLCs, whereas low DLL3 and ASCL1 expression was found in both SCLCs and type II LCNECs. In patients diagnosed at an early stage who did not have metastasis and who underwent chemotherapy, DLL3high and ASCL1high SCLCs and type I LCNECs were associated with a better prognosis and a lower risk of death. The present findings suggested that DLL3/ASCL1 are potential therapeutic targets and prognostic indicators in patients with SCLCs or LCNECs.