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Beliero AM, Lázaro APP, Zaranza MDS, Lima GMC, Guimarães ÁR, Aragão NL, Meneses GC, Holanda MA, Albuquerque PLMM, da Silva GB, Fernandes PFCBC. ELMO CPAP: an innovative type of ventilatory support for COVID-19-related acute respiratory distress syndrome. J Bras Pneumol 2024; 49:e20230227. [PMID: 38232252 PMCID: PMC10769475 DOI: 10.36416/1806-3756/e20230227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/27/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVE To assess whether the use of ELMO, a helmet for noninvasive ventilation created in Brazil, had a positive impact on the prognosis of patients with hypoxemic respiratory failure caused by severe COVID-19. METHODS This is a retrospective study of 50 critically ill COVID-19 patients. Epidemiological, clinical, and laboratory data were collected on ICU admission, as well as before, during, and after ELMO use. Patients were divided into two groups (success and failure) according to the outcome. RESULTS ELMO use improved oxygenation parameters such as Pao2, Fio2, and the Pao2/Fio2 ratio, and this contributed to a gradual reduction in Fio2, without an increase in CO2, as determined by arterial blood gas analysis. Patients in the success group had significantly longer survival (p < 0.001), as determined by the Kaplan-Meier analysis, less need for intubation (p < 0.001), fewer days of hospitalization, and a lower incidence of acute kidney injury in comparison with those in the failure group. CONCLUSIONS The significant improvement in oxygenation parameters, the longer survival, as reflected by the reduced need for intubation and by the mortality rate, and the absence of acute kidney injury suggest that the ELMO CPAP system is a promising tool for treating ARDS and similar clinical conditions.
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Affiliation(s)
- Andréa Mazza Beliero
- . Instituto Dr. José Frota, Prefeitura Municipal de Fortaleza, Fortaleza (CE) Brasil
- . Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade Estadual do Ceará, Fortaleza (CE) Brasil
| | - Ana Paula Pires Lázaro
- . Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
- . Curso de Medicina, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
| | - Marza de Sousa Zaranza
- . Instituto Dr. José Frota, Prefeitura Municipal de Fortaleza, Fortaleza (CE) Brasil
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Giovanna Mazza Cruz Lima
- . Curso de Medicina, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
| | - Álvaro Rolim Guimarães
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Nilcyeli Linhares Aragão
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Gdayllon Cavalcante Meneses
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Marcelo Alcantara Holanda
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
- . Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Polianna Lemos Moura Moreira Albuquerque
- . Curso de Medicina, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
- . Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Geraldo Bezerra da Silva
- . Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
- . Curso de Medicina, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
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Braga FNHF, das Chagas Medeiros MM, Junior ABV, de Sousa Lima ME, Barros LCM, Pontes MX, de Sousa Lima AW, Fernandes PFCBC. Proteinuria and serum creatinine after 12 months of treatment for lupus nephritis as predictors of long-term renal outcome: a case-control study. Adv Rheumatol 2022; 62:2. [PMID: 34983697 DOI: 10.1186/s42358-021-00232-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lupus nephritis (LN) is a major source of morbidity and mortality in patients with systemic lupus erythematosus (SLE), with 10-25% of patients progressing to end-stage renal disease (ESRD). OBJECTIVE This study aims to elucidate the predictive capabilities of 24-h proteinuria (24PTU) and serum creatinine (sCr) after 12 months of treatment with respect to long-term renal outcomes in LN in a single-center cohort of LN patients. METHODS A retrospective analysis was performed on 214 patients diagnosed with LN followed in our center. Values of 24PTU and sCr were assessed at baseline and after 3, 6 and 12 months, and after 5 years and/or the last evaluation. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 for 3 months or longer. End-stage renal disease (ESRD) was defined as the need for permanent dialysis. Receiver operating characteristics curves (ROC) were used to test the best cut-off value of 24PTU and sCr at 12 months who predict bad long-term renal outcomes. RESULTS: The mean follow-up period was 11.2 ± 7.2 years. The best cut-off values for 24PTU and sCr as predictor of CKD were, respectively, 0.9 g/24 h and 0.9 mg/dL. ROC curve for 24PTU had a slightly lower performance than ROC curve for sCr as predictor for CKD (PTU AUC = 0.68; sCr AUC = 0.70), but sensitivity and specificity were better for 24PTU (24PTU: sensitivity = 63.5%, specificity = 71.2%; sCr: sensitivity = 54.8%, specificity = 75.3%). When the outcome was ESRD the best cut-off points were 0.9 g/24hs and 1.3 mg/dL for 24PTU and sCr, respectively, and the curve performance was better for 24PTU (PTU AUC = 0.72; sCr AUC = 0.61). CONCLUSIONS In this ethnically diverse population with LN followed for a long time (> 10 years), levels of 24PTU > 0.9/day at 12 months was a good predictor of bad long-term renal outcome. The serum creatinine > 0.9 mg/dL and > 1.3 mg/dL at 12 months were also good predictors of CKD and ESRD, respectively. Patients with 24PTU < 0.9 g/day and sCr < 1.3 mg/dL at 12 months are not likely to develop ESRD because of the high negative predictive values (NPV) (93.2% and 82%). 24PTU and sCr are relevant as components for a treat-to-target strategy for LN treatment, since their high NPV corroborates their importance as good predictors of long-term renal outcome.
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Affiliation(s)
| | - Marta Maria das Chagas Medeiros
- Hospital Universitário Walter Cantídio, Universidade Federal Do Ceará, Rua Capitão Francisco Pedro 1290, Rodolfo Teófilo, Fortaleza, Ceará, Brazil
| | - Antonio Brazil Viana Junior
- Hospital Universitário Walter Cantídio, Universidade Federal Do Ceará, Rua Capitão Francisco Pedro 1290, Rodolfo Teófilo, Fortaleza, Ceará, Brazil
| | - Matheus Eugênio de Sousa Lima
- Centro de Ciências da Saúde, Universidade Estadual Do Ceará, Avenida Dr. Silas Munguba, 1700, Itaperi, Fortaleza, Ceará, Brazil
| | - Levi Coelho Maia Barros
- Centro de Ciências da Saúde, Universidade Estadual Do Ceará, Avenida Dr. Silas Munguba, 1700, Itaperi, Fortaleza, Ceará, Brazil
| | - Marcelo Ximenes Pontes
- Centro de Ciências da Saúde, Universidade Estadual Do Ceará, Avenida Dr. Silas Munguba, 1700, Itaperi, Fortaleza, Ceará, Brazil
| | - Allysson Wosley de Sousa Lima
- Centro de Ciências da Saúde, Universidade Estadual Do Ceará, Avenida Dr. Silas Munguba, 1700, Itaperi, Fortaleza, Ceará, Brazil
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de Sandes-Freitas TV, Mazzali M, Manfro RC, de Andrade LGM, Vicari AR, de Sousa MV, Medina Pestana JO, Garcia VD, de Carvalho DRDBM, de Matos Esmeraldo R, de Oliveira CMC, Simão DR, Deboni LM, David-Neto E, Cavalcanti FCB, Pacheco-Silva Á, Ferreira GF, Madeira RL, Bignelli AT, Meira GSG, Lasmar EP, Keitel E, de Azevedo Matuck T, da Costa SD, Nga HS, Fernandes PFCBC, Narciso HR, Vieira MA, Agena F, Fonseca IB, de Matos ACC, Bastos J, Villaça SS, Hokazono SR, Silva ARB, Lasmar M, Tedesco-Silva H. Exploring the causes of the high incidence of delayed graft function after kidney transplantation in Brazil: a multicenter study. Transpl Int 2021; 34:1093-1104. [PMID: 33742470 DOI: 10.1111/tri.13865] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/17/2021] [Accepted: 03/13/2021] [Indexed: 11/30/2022]
Abstract
This retrospective multicenter (n = 18) cohort study evaluated the incidence, risk factors, and the impact of delayed graft function (DGF) on 1-year kidney transplant (KT) outcomes. Of 3992 deceased donor KT performed in 2014-2015, the incidence of DGF was 54%, ranging from 29.9% to 87.7% among centers. Risk factors (lower-bound-95%CI OR upper-bound-95%CI ) were male gender (1.066 1.2491.463 ), diabetic kidney disease (1.053 1.2961.595 ), time on dialysis (1.005 1.0071.009 ), retransplantation (1.035 1.3971.885 ), preformed anti-HLA antibodies (1.011 1.3831.892 ), HLA mismatches (1.006 1.0661.130 ), donor age (1.011 1.0171.023 ), donor final serum creatinine (sCr) (1.239 1.3171.399 ), cold ischemia time (CIT) (1.031 1.0431.056 ), machine perfusion (0.401 0.5420.733 ), and induction therapy with rabbit antithymocyte globulin (rATG) (0.658 0.8000.973 ). Duration of DGF > 4 days was associated with inferior renal function and DGF > 14 days with the higher incidences of acute rejection, graft loss, and death. In conclusion, the incidence and duration of DGF were high and associated with inferior graft outcomes. While late referral and poor donor maintenance account for the high overall incidence of DGF, variability in donor and recipient selection, organ preservation method, and type of induction agent may account for the wide variation observed among transplant centers.
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Affiliation(s)
- Tainá Veras de Sandes-Freitas
- Departmento de Medicina Clínica, Universidade Federal do Ceará, Fortaleza, CE, Brazil.,Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - Marilda Mazzali
- Hospital de Clínicas da Universidade de Campinas, Campinas, SP, Brazil
| | | | | | | | | | - José Osmar Medina Pestana
- Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, SP, Brazil.,Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | | | | | - Elias David-Neto
- Hospital de Clínicas da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Álvaro Pacheco-Silva
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | | | | | | | | | - Elizete Keitel
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Silvana Daher da Costa
- Departmento de Medicina Clínica, Universidade Federal do Ceará, Fortaleza, CE, Brazil.,Hospital Geral de Fortaleza, Fortaleza, CE, Brazil.,Hospital Universitário Walter Cantídio, Fortaleza, CE, Brazil
| | - Hong Si Nga
- Departmento de Medicina Interna, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | | | | | | | - Fabiana Agena
- Hospital de Clínicas da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Ana Cristina Carvalho de Matos
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Juliana Bastos
- Santa Casa de Misericórdia de Juiz de Fora, Juiz de Fora, MG, Brazil
| | | | | | | | - Marcus Lasmar
- Hospital Universitário Ciências Médicas, Belo Horizonte, MG, Brazil
| | - Hélio Tedesco-Silva
- Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, SP, Brazil.,Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Macedo IODO, Amorim FDB, Girão ES, Silva SL, Fernandes PFCBC, Oliveira CMC. Actinomicose em receptor de transplante renal: relato de caso e revisão da literatura. Rev Med UFC 2021. [DOI: 10.20513/2447-6595.2021v61n1e41444p1-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A actinomicose é uma doença rara, infecciosa, granulomatosa crônica, progressiva, e causada, na maioria dos casos, pela bactéria Gram-positiva e anaeróbia Actinomyces israelii. A doença pode assemelhar-se a outros processos infecciosos e até mesmo neoplásicos, dificultando seu diagnóstico e comprometendo o êxito terapêutico, e às vezes evoluindo para sérias complicações. Os autores relatam o caso de uma paciente de 54 anos, transplantada renal há 4 anos, apresentando uma lesão em região hipotenar na mão direita. Foi realizada investigação com exames de imagem e biópsia, tendo como diagnóstico actinomicose cutânea primária. O objetivo desse trabalho é discutir sobre uma patologia rara e de localização incomum, em uma paciente imunossuprimida, ressaltando a importância do diagnóstico precoce e preciso para o sucesso terapêutico.
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de Sandes-Freitas TV, Costa SD, de Andrade LGM, Girão CM, Fernandes PFCBC, de Oliveira CMC, Esmeraldo RDM. The Impact of Hypothermic Pulsatile Machine Perfusion Versus Static Cold Storage: A Donor-Matched Paired Analysis in a Scenario of High Incidence of Delayed Kidney Graft Function. Ann Transplant 2020; 25:e927010. [PMID: 33318465 PMCID: PMC7749524 DOI: 10.12659/aot.927010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The present study analyzed the impact of hypothermic pulsatile machine perfusion (MP) following a long period of static cold (SC) storage in the peculiar Brazilian scenario of high incidence of delayed graft function (DGF), despite good donor characteristics. MATERIAL AND METHODS A retrospective analysis, with a 1-year follow-up, of 206 recipients of donor-matched paired kidneys was performed. Of the 206 donor kidneys, 103 were maintained exclusively in static cold storage (SC group) and 103 were kept on machine perfusion after a period of SC preservation (MP group). All donors were brain dead. RESULTS Only 4.9% of the kidneys were from expanded-criteria donors. Static cold ischemia time (CIT) in the SC group was 20.8±4.1 hours vs. 15.8±6.2 hours in the MP group (P<0.001). Dynamic CIT in the MP group was 12.3±5.7 hours. MP significantly reduced DGF incidence (29.1% vs. 55.3%, P<0.001), and this effect was confirmed in multivariable analysis (OR, 1.115; 95% CI, 1.033-1.204, P=0.001). No differences were observed between the groups with regard to DGF duration, length of hospital stay, incidence of primary nonfunction and acute rejection, graft loss, death, or renal function. CONCLUSIONS In this Brazilian setting, MP following a long period of SC preservation was associated with reduced DGF incidence in comparison with SC storage without MP.
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Affiliation(s)
- Tainá Veras de Sandes-Freitas
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.,Transplant Division, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - Silvana Daher Costa
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.,Transplant Division, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | | | - Celi Melo Girão
- Transplant Division, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | | | - Claudia Maria Costa de Oliveira
- Transplant Division, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil.,Transplant Division, Walter Cantídio University Hospital, Fortaleza, CE, Brazil
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Amorim FDB, Macedo IODO, Girão ES, Silva SLD, Fernandes PFCBC, Oliveira CMCD. Histoplasmose intestinal em pacientes transplantados renais: relato de casos e revisão da literatura. Rev Med UFC 2020. [DOI: 10.20513/2447-6595.2020v60n4p49-53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A histoplasmose é uma micose sistêmica, que afeta principalmente pacientes imunocomprometidos, com apresentação clínica inespecífica. A forma de apresentação é focal ou disseminada, esta última muitas vezes fatal. Os autores relatam dois casos de histoplasmose intestinal em pacientes transplantados renais, com baixo índice de suspeição clínica, que foram diagnosticados através de biópsia das lesões e que apresentaram uma evolução favorável, devido ao tratamento precoce com anfotericina B lipossomal e manutenção com itraconazol. Diante de casos com manifestações clínicas variadas e atípicas, esta doença deve ser incluída na investigação diagnóstica de imunossuprimidos.
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Martins BCC, Mesquita KHC, da Costa IHF, Chaves EF, Firmino PYM, Fernandes PFCBC, Fonteles MMDF. Impact of Cost of Adverse Events After Kidney Transplantation. J Young Pharm 2020. [DOI: 10.5530/jyp.2020.12.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Costa SD, de Andrade LGM, Barroso FVC, de Oliveira CMC, Daher EDF, Fernandes PFCBC, Esmeraldo RDM, de Sandes-Freitas TV. The impact of deceased donor maintenance on delayed kidney allograft function: A machine learning analysis. PLoS One 2020; 15:e0228597. [PMID: 32027717 PMCID: PMC7004552 DOI: 10.1371/journal.pone.0228597] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/18/2020] [Indexed: 12/23/2022] Open
Abstract
Background This study evaluated the risk factors for delayed graft function (DGF) in a country where its incidence is high, detailing donor maintenance-related (DMR) variables and using machine learning (ML) methods beyond the traditional regression-based models. Methods A total of 443 brain dead deceased donor kidney transplants (KT) from two Brazilian centers were retrospectively analyzed and the following DMR were evaluated using predictive modeling: arterial blood gas pH, serum sodium, blood glucose, urine output, mean arterial pressure, vasopressors use, and reversed cardiac arrest. Results Most patients (95.7%) received kidneys from standard criteria donors. The incidence of DGF was 53%. In multivariable logistic regression analysis, DMR variables did not impact on DGF occurrence. In post-hoc analysis including only KT with cold ischemia time<21h (n = 220), urine output in 24h prior to recovery surgery (OR = 0.639, 95%CI 0.444–0.919) and serum sodium (OR = 1.030, 95%CI 1.052–1.379) were risk factors for DGF. Using elastic net regularized regression model and ML analysis (decision tree, neural network and support vector machine), urine output and other DMR variables emerged as DGF predictors: mean arterial pressure, ≥ 1 or high dose vasopressors and blood glucose. Conclusions Some DMR variables were associated with DGF, suggesting a potential impact of variables reflecting poor clinical and hemodynamic status on the incidence of DGF.
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Affiliation(s)
- Silvana Daher Costa
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Walter Cantídio University Hospital, Fortaleza, Ceará, Brazil
- Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
| | | | | | | | | | | | | | - Tainá Veras de Sandes-Freitas
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
- * E-mail:
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Oliveira DDS, Mesquita JL, Garcia YDO, Rosales YMZ, Lemes RPG, Rocha Filho FD, Fernandes PFCBC, Duarte PMA, Pitombeira MDS, Duarte FB. Interstitial nephritis associated with nivolumab in a patient with hodgkin lymphoma. ACTA ACUST UNITED AC 2019; 65:934-936. [PMID: 31389500 DOI: 10.1590/1806-9282.65.7.934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/20/2019] [Indexed: 11/22/2022]
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da Costa IHF, Silva RME, Carlos JDO, Silva MCA, Pinheiro MKC, Martins BCC, Fernandes PFCBC, Guedes MM. Potentially inappropriate medications in older kidney transplant recipients: a Brazilian prevalence study. Int J Clin Pharm 2019; 41:888-894. [PMID: 31093938 DOI: 10.1007/s11096-019-00842-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 05/03/2019] [Indexed: 12/20/2022]
Abstract
Background Older kidney transplant recipients take a larger number of medications than younger patients, but there is currently no evidence that this affects health outcomes or that is it associated with potentia medicine-related problems. Objective To evaluate the prevalence and number of potentially inappropriate medications in older kidney transplant recipients and also the possible associated factors (sex, age, comorbidities, number of medications, etc.). Setting A renal post-transplant ambulatory outpatient clinic of a university hospital in Fortaleza, Brazil. Method PIMs were defined according to the Beers criteria, version 2015. Medications were classified following the Anatomical Therapeutic Chemical Classification System. Chi squared tests and analysis of variance were used for the analyses. Main outcome measure Prevalence of potentially inappropriate medications and medication groups with higher prevalence rates of PIMs, including associated factors. Results Among 143 kidney transplant recipients, 77.6% had at least one potentially inappropriate medication as part of their prescription regime. Medication groups that were most implicated in PIM are medicines that act on the alimentary tract and metabolism (55.9%), cardiovascular system (32.2%) and nervous system (21.7%). We detected a high prevalence (63.6%) of self-medication (use of OTC medicines without indication of a healthcare professional) among the population studied. There was a statistically significant association between the number of prescribed medications and the presence of potentially inappropriate medication in the prescription regime (P < 0.01). Conclusion Our data draw attention to the need of medicine therapy management by clinical pharmacists and clinicians in this group of patients and also assessing the real clinical impacts of these medications in the prescription regimes of elderly renal transplant patients.
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Affiliation(s)
- Iwyson Henrique Fernandes da Costa
- Programa de Residência Integrada Multiprofissional em Assistência Hospitalar à saúde, Assistência em Transplantes da Universidade Federal do Ceará, Fortaleza, Brazil. .,Hospital Universitário Walter Cantídio, Rua Capitão Francisco Pedro 1290, Rodolfo Teófilo, Fortaleza, Ceará, 60430-372, Brazil.
| | - Renan Morais E Silva
- Programa de Residência Integrada Multiprofissional em Assistência Hospitalar à saúde, Assistência em Transplantes da Universidade Federal do Ceará, Fortaleza, Brazil
| | - Juliana de Oliveira Carlos
- Programa de Residência Integrada Multiprofissional em Assistência Hospitalar à saúde, Assistência em Transplantes da Universidade Federal do Ceará, Fortaleza, Brazil
| | - Maria Cleonice Araújo Silva
- Programa de Residência Integrada Multiprofissional em Assistência Hospitalar à saúde, Assistência em Transplantes da Universidade Federal do Ceará, Fortaleza, Brazil
| | - Maria Karine Cavalcante Pinheiro
- Programa de Residência Integrada Multiprofissional em Assistência Hospitalar à saúde, Assistência em Transplantes da Universidade Federal do Ceará, Fortaleza, Brazil
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Filho JCCL, Ogawa MY, de Souza Andrade TH, de Andrade Cordeiro Gadelha S, Fernandes PFCBC, Queiroz AL, Daher EDF. Spectrum of acute kidney injury associated with cocaine use: report of three cases. BMC Nephrol 2019; 20:99. [PMID: 30894132 PMCID: PMC6427899 DOI: 10.1186/s12882-019-1279-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/06/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The consequences of cocaine use are multisystemic, such as, for instance, renal failure, hepatotoxicity and pulmonary toxicity, with renal alterations being the focus of the present study. The use of substances that modify the base composition of cocaine (or adulterants) aiming to potentiate its effects also has an impact on these manifestations. The present study aims to report three cases with different diagnosis of acute kidney injury related to cocaine use. CASE PRESENTATION Case 01 - A 30-year-old female patient, who regularly used cocaine, started to have lower-limb edema, which showed a progressive and ascending evolution, affecting the face a few days later, associated with an isolated febrile episode and oligoanuria. The presence of cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA) was verified: reactive 1:80, with renal biopsy compatible with rapidly progressive glomerulonephritis (RPGN). Case 02 - A 34-year-old female patient, with difficult-to-control hypertension and a frequent user of cocaine, showed generalized sudden edema together with diffuse and progressive pruritus associated with oliguria, fever, nausea, and vomiting. Schistocyte screening was positive, with negative direct Coombs test, and negative serologies for hepatitis B, C and HIV, as well as negative anti-double-stranded DNA, Anti-SSA and Anti-SSB. The renal biopsy was compatible with thrombotic microangiopathy, associated with moderate interstitial fibrosis and acute tubular necrosis Case 03 - A 25-year-old male patient who had been a cocaine user for 5 years had a sudden onset of generalized disabling myalgia (especially in the lower limbs) associated with recent frontotemporal headache, palpitation, dizziness, and a non-measured febrile episode; the patient had used cocaine at the night before symptom onset. CPK was 1731 U/L.The final probable diagnosis was AKI secondary to cocaine-induced rhabdomyolysis. CONCLUSIONS In conclusion basically, 05 etiologies of acute kidney injury should always be remembered: rhabdomyolysis, thrombotic microangiopathy, vasculitis, acute interstitial nephritis and renal infarction. Emphasis should be given to rhabdomyolysis due to its higher prevalence. Considering the increasing rates of cocaine use, especially with the use of adulterating substances, these pathologies will likely be increasingly prevalent.
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Affiliation(s)
- José Célio Costa Lima Filho
- Nephrology Training Program, Department of Nephrology, Walter Cantídio University Hospital, Fortaleza, Brazil.
| | - Maurício Yukio Ogawa
- Medical Sciences Graduate Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Tacilla Hanny de Souza Andrade
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Estadual University of Ceará, Fortaleza, Brazil
| | | | | | - Anaiara Lucena Queiroz
- Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Elizabeth De Francesco Daher
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Estadual University of Ceará, Fortaleza, Brazil.,Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
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12
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Sarmento LR, Fernandes PFCBC, Pontes MX, Correia DBS, Chaves VCB, Carvalho CFDA, Arnaud TL, Santos MHSD, Barreto LCB, Moliterno LAA. Prevalence of clinically validated primary causes of end-stage renal disease (ESRD) in a State Capital in Northeastern Brazil. ACTA ACUST UNITED AC 2018; 40:130-135. [PMID: 29782632 PMCID: PMC6533992 DOI: 10.1590/2175-8239-jbn-3781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 07/22/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Knowledge of validated primary causes of end-stage renal disease (ESRD) is extremely relevant in the realm of public health. The literature lacks validated studies on the primary causes of ESRD. OBJECTIVE The aim of this study was to estimate the prevalence of the causes of ESRD in a State Capital in Northeastern Brazil. METHODS This cross-sectional study was based on the analysis of medical records of patients on hemodialysis at five specialized centers in Fortaleza, CE, Brazil. Deaths and patients referred to other centers outside Fortaleza were excluded from the study. The data of 830 patients were initially collected, but 818 remained enrolled after the exclusion criteria were applied, the equivalent to 48% of the patents on dialysis in the city. RESULTS 61.1% of the patients were males. Twenty-two percent of all enrolled individuals were aged 60-69 years. Patient mean age was 55.7 ± 16 years. The most common validated cause of ESRD was unknown (35.3%), followed by diabetes mellitus (26.4%), adult polycystic kidney disease (6.2%), graft failure (6.2%), obstructive uropathy (5.7%), and primary glomerulonephritis (5.3%). Before validation, primary hypertension was the most frequent cause of chronic kidney disease (22.9%), decreased to 3.8% after validation. CONCLUSION The data contradicted national studies reporting primary hypertension as the main cause of chronic kidney disease (CKD). A high rate of unknown causes and categorization bias were observed mainly in relation to primary hypertension as a cause of CKD, which affects the overall prevalence of causes of ESRD in patients on dialysis.
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de Cerqueira JBG, de Oliveira CMC, Silva BGB, Santos LCO, Fernandes AG, Fernandes PFCBC, Maia EL. Kidney Transplantation Using Gonadal Vein for Venous Anastomosis in Patients With Iliac Vein Thrombosis or Stenosis: A Series of Cases. Transplant Proc 2018; 49:1280-1284. [PMID: 28735994 DOI: 10.1016/j.transproceed.2017.02.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 02/20/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Kidney transplantation is the treatment of choice for patients with end-stage renal disease. The standard surgery uses the recipient's iliac vessels for vascular anastomosis. Thrombosis and/or stenosis of the iliac vein, which are possible complications of multiple vascular access points for dialysis, can be detected intraoperatively, constituting a surgical challenge. An infrequently reported option is the use of the gonadal vein. OBJECTIVES This study aims to evaluate the outcomes of venous anastomosis in the gonadal vein in patients with iliac vein thrombosis and/or stenosis submitted to kidney transplantation. METHODS We reviewed the records of five adult recipients with iliac vein thrombosis and/or stenosis detected intraoperatively during emergency kidney transplantation with deceased donor due to vascular access failure from February 2013 to December 2014. Antithrombotic prophylaxis was not performed. We evaluated the postoperative complications, length of stay, early graft echo-Doppler, and renal function during the first year postoperatively. RESULTS Delayed graft function occurred in three cases. Two patients developed postoperative infection requiring antibiotics. One patient required reoperation due to post-renal biopsy complications. The mean length of stay was 31.2 days and the mean serum creatinine levels at discharge, at 6 months, and at 12 months postoperatively were 1.42 mg/dL, 0.86 mg/dL, and 0.82 mg/dL, respectively. All patients had normal ultrasonography. There were no losses of graft or deaths during follow-up. CONCLUSION Venous anastomosis using the gonadal vein in kidney transplantation for patients with iliac vein thrombosis and/or stenosis showed good clinical and surgical results, showing this method to be a viable alternative to venous drainage in these complex patients.
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Affiliation(s)
- J B G de Cerqueira
- Department of Surgery, Division of Urology, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brasil.
| | - C M C de Oliveira
- Division of Nephrology, Hospital Universitário Walter Cantídio, Federal University of Ceará, Fortaleza, CE, Brasil
| | - B G B Silva
- Undergraduate Medical Students of School of Medicine, Federal University of Ceará, Fortaleza, CE, Brasil
| | - L C O Santos
- Undergraduate Medical Students of School of Medicine, Federal University of Ceará, Fortaleza, CE, Brasil
| | - A G Fernandes
- Department of Surgery, Division of Urology, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brasil
| | - P F C B C Fernandes
- Division of Nephrology, Hospital Universitário Walter Cantídio, Federal University of Ceará, Fortaleza, CE, Brasil
| | - E L Maia
- Department of Surgery, Division of Urology, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brasil
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Rodrigues Dos Santos BG, Amaral ES, Fernandes PFCBC, Oliveira CMC, Rodrigues JLN, Perdigão Neto LV, Girão ES. Urinary Tract Infections and Surgical Site Infections due to Carbapenem-Resistant Enterobacteriaceae in Renal Transplant. Transplant Proc 2017; 48:2050-5. [PMID: 27569943 DOI: 10.1016/j.transproceed.2016.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/06/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Carbapenem-resistant Enterobacteriaceae (CRE) are emerging pathogens. Recent publications have shown that renal transplant recipients are a population at risk for CRE infections. Management of these infections in this population is complex, requiring frequent use of nephrotoxic antimicrobial agents. Differentiating between urinary tract infection (UTI) and surgical site infection (SSI) in renal transplant recipients is sometimes difficult. The aim of this study was to describe CRE UTIs and SSIs in renal transplant recipients and to evaluate the impact of these infections on renal graft and patient survival. RESULTS Between January 2010 and October 2015, a total of 428 renal transplants were performed; 25 UTIs and 9 SSIs were identified. Median time between transplantation and diagnosis of CRE infection was 26 days; 29 cases (85.29%) were considered early infections. Of the 34 CRE isolates, 100% were sensitive to amikacin and colistin. Polymyxins were the most commonly used antimicrobial agent (27 cases [79.41%]). Nephrotoxicity was found in 4 (15.38%) of 26 cases. Combination therapy was used in 19 cases (55.88%), with a cure rate of 74%; monotherapy was used in 15 cases (44.11%), with a cure rate of 86%. Among the 25 cases of UTI, the cure rate was 100%, and recurrence occurred in 4 cases (16%). Among the 9 cases of SSI, 7 (77.7%) had negative outcomes (nephrectomy or death). CONCLUSIONS We observed that CRE UTIs had a high therapeutic success rate, low recurrence, and low mortality. However, CRE SSIs were associated with high morbidity and mortality, with high graft loss. Polymyxins and aminoglycosides, despite the risk of nephrotoxicity, had little impact on renal graft function, and are thus a safe therapeutic alternative to treat these infections.
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Affiliation(s)
- B G Rodrigues Dos Santos
- Universidade Federal do Ceará, Fortaleza, Ceará, Brazil; Hospital Universitário Walter Cantídio, Fortaleza, Ceará, Brazil; Hospital São José de Doenças Infecciosas - Fortaleza, Ceará, Brazil.
| | - E S Amaral
- Universidade Estadual do Ceará, Fortaleza, Ceará, Brazil
| | - P F C B C Fernandes
- Hospital Universitário Walter Cantídio, Fortaleza, Ceará, Brazil; Universidade Estadual do Ceará, Fortaleza, Ceará, Brazil
| | - C M C Oliveira
- Hospital Universitário Walter Cantídio, Fortaleza, Ceará, Brazil
| | - J L N Rodrigues
- Universidade Federal do Ceará, Fortaleza, Ceará, Brazil; Hospital Universitário Walter Cantídio, Fortaleza, Ceará, Brazil
| | - L V Perdigão Neto
- Hospital das Clinicas da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - E S Girão
- Hospital Universitário Walter Cantídio, Fortaleza, Ceará, Brazil; Hospital São José de Doenças Infecciosas - Fortaleza, Ceará, Brazil
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Martins BCC, Souza TRD, Luna ÂMPT, Fonteles MMDF, Firmino PYM, Fernandes PFCBC, Garcia JHP, Oliveira CMCD, Néri EDR. Pharmaceutical care in transplant patients in a university hospital: pharmaceutical interventions. BRAZ J PHARM SCI 2013. [DOI: 10.1590/s1984-82502013000400005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A descriptive and prospective study was conducted on the pharmaceutical care in the post-transplant outpatient clinic of Hospital Universitario Walter Cantidio of Universidade Federal do Ceará (HUWC/UFC), in Fortaleza- Ceará in the period of April to October of 2011. The aim of the present study was to describe the pharmaceutical interventions performed in a Pharmaceutical Care service structured in the liver and kidney transplant outpatient clinic of an academic hospital. The Pharmaceutical interventions (PI) were classified according to Sabater et al.(2005), with significance based on Riba et al.(2000) and the Negative Outcomes associated with Medication (NOM) established at the Third Consensus of Granada. Statistical analyses were performed using the Epi Info v.3.5.1 program and hypothesis tests were done with the SigmaPlot v.10.0 program. A chi-squared (X²) test was utilized for statistical analysis of the sample. A total of 97 patients were followed, where 54 problems related to medications were identified and 139 PI performed. The main PI were in education of the patient about treatment (n=111; 80%) (p<0.05), while the significance of all interventions were appropriate, where 83.4% (n=116) of PI performed in the study period were shown to be "significant" (p<0.05). Through pharmaceutical care, the pharmacist is capable of monitoring the pharmacotherapeutic treatment and intervening when necessary, while being part of the multiprofessional team caring for the transplant patient.
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Santos MCL, Horta BL, Amaral JJFD, Fernandes PFCBC, Galvão CM, Fernandes AFC. Association between stress and breast cancer in women: a meta-analysis. CAD SAUDE PUBLICA 2010; 25 Suppl 3:S453-63. [PMID: 20027392 DOI: 10.1590/s0102-311x2009001500010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 09/23/2009] [Indexed: 11/22/2022] Open
Abstract
The objective of the current meta-analysis was to verify the association between stressful life events and primary breast cancer incidence in women. A total of 618 studies from 1982-2007 were found in the PubMed, LILACS, and Cochrane Library databases. Methodological quality was evaluated according to the Downs & Black criteria. Eight studies were selected (six case-controls and two cohorts). The studies were grouped in three analyses, two of which based on the categories widowhood and divorce and the other based on self-rated intensity and frequency of stressful events. Relative risks were: widowhood 1.04 (95%CI: 0.75-1.44; p = 0.800); divorce 1.03 (95%: 0.72-1.48; p = 0.850); and intensity/frequency of stress 1.73 (95%CI: 0.98-3.05; p = 0.059). We conclude that stressful life events as a whole are not associated with risk of breast cancer in women. However, it is not possible to rule out high-intensity stress as a risk factor for breast cancer.
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Frassinetti Castelo Branco Camurça Fernandes P, Bezerra Da Silva G, De Sousa Barros FA, Costa Oliveira CM, Kubrusly M, Evangelista JB. Treatment of steroid-resistant nephrotic syndrome with cyclosporine: study of 17 cases and a literature review. J Nephrol 2005; 18:711-20. [PMID: 16358229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Cyclosporine (CsA) has been used in steroid-resistant idiopathic nephrotic syndrome (INS) in many previous studies. OBJECTIVE To evaluate if CsA is a therapeutic option for steroid-resistant nephrotic syndrome. METHODS We performed a retrospective cohort study to evaluate the effects of CsA in 17 steroid-resistant INS patients. The main laboratorial data, before and after the use of CsA, and the response to CsA were evaluated. A literature review on this subject was also done. RESULTS Patient age ranged from 2-43 yrs. Pre-treatment renal biopsy demonstrated focal segmental glomerulosclerosis (FSGS) (64%), membranous nephropathy (MGN) (12%), mesangial glomerulonephritis (MSGN) (12%) and minimal change disease (MCD) (12%). Pre-treatment laboratory tests showed a mean 24-hr proteinuria of 4372 +/- 2686 mg/dL. Treatment with CsA was given for a minimum of 3 months and a maximum of 98 months. Mean 24-hr proteinuria declined from 3181 +/- 2277 before CsA to 915 +/- 1140 mg/24 hr after CsA (p<0.001). Remission was seen in 70.5% of patients, being 52.9% complete and 17.6% partial. The adverse effects observed were nephrotoxicity (11.7%), hypertrichosis (5.8%) and gingival hyperplasia (5.8%). Relapses were seen in eight patients (47%), with posterior remission in six patients (75%). CONCLUSION Data from the literature suggest that CsA is a good therapeutic option for patients with steroid-resistant INS, being effective in reducing proteinuria. The beneficial effect of CsA demonstrated in our study was limited due to its design and the small sample size.
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