LETICIA BARBOSA KAWANO DOURADO
Projetos de Pesquisa
Unidades Organizacionais
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
9 resultados
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conferenceObject Radiographic Fibrosis Is Associated with Accelerated Lung Function Decline in Patients with Hypersensitivity Pneumonitis(2020) KAWANO-DOURADO, L. C.; ARIMURA, F. E.; RODRIGUES, S. C.; SPONHOLZ, M.; LIMA, M. S.; BEDER, T.; STORRER, K. M.; SAWAMURA, M.; CATUNDA, L. G.; CARVALHO, A. Castro De; SANTOS, P. C. C.; BASILIO, C. C.; SANCHEZ, G. J. S.; NAKAGAWA, R. H.; MONTEIRO, J. T. C.; SANTOS, R. K.; PINHEIRO, M. F. S.; CUNHA, T. M.; JOHANNSON, K. A.; KAIRALLA, R. A.- A living WHO guideline on drugs for covid-19(2020) LAMONTAGNE, Francois; AGORITSAS, Thomas; MACDONALD, Helen; LEO, Yee-Sin; DIAZ, Janet; AGARWAL, Arnav; APPIAH, John Adabie; ARABI, Yaseen; BLUMBERG, Lucille; CALFEE, Carolyn S.; CAO, Bin; CECCONI, Maurizio; COOKE, Graham; DUNNING, Jake; GEDULD, Heike; GEE, Patrick; MANAI, Hela; HUI, David S.; KANDA, Seema; KAWANO-DOURADO, Leticia; KIM, Yae-Jean; KISSOON, Niranjan; KWIZERA, Arthur; LAAKE, Jon Henrik; MACHADO, Flavia R.; QADIR, Nida; SARIN, Rohit; SHEN, Yinzhong; ZENG, Linan; BRIGNARDELLO-PETERSEN, Romina; LYTVYN, Lyubov; SIEMIENIUK, Reed; ZERAATKAR, Dena; BARTOSZKO, Jessica; GE, Long; MAGUIRE, Brittany; ROCHWERG, Bram; GUYATT, Gordon; VANDVIK, Per OlavCLINICAL QUESTION What is the role of drug interventions in the treatment and prevention of covid-19? RECOMMENDATIONS The first version on this living guidance focuses on corticosteroids. It contains a strong recommendation for systemic corticosteroids in patients with severe and critical covid-19, and a weak or conditional recommendation against systemic corticosteroids in patients with non-severe covid-19. Corticosteroids are inexpensive and are on the World Health Organisation list of essential medicines. HOW this guideline was created This guideline reflects an innovative collaboration between the WHO and the MAGIC Evidence Ecosystem Foundation, driven byan urgent need for global collaboration to provide trustworthy and living covid-19 guidance. A standing international panel of content experts, patients, clinicians, and methodologists, free from relevant conflicts of interest, produce recommendations for clinical practice. The panel follows standards, methods, processes, and platforms for trustworthy guideline development using the GRADE approach. We apply an individual patient perspective while considering contextual factors (that is, resources, feasibility, acceptability, equity) for countries and healthcare systems. THE EVIDENCE A living systematic review and network meta-analysis, supported by a prospective meta-analysis, with data from eight randomised trials (7184 participants) found that systemic corticosteroids probably reduce 28 day mortality in patients with critical covid-19 (moderate certainty evidence; 87 fewer deaths per 1000 patients (95% confidence interval 124 fewer to 41 fewer)), and also in those with severe disease (moderate certainty evidence; 67 fewer deaths per 1000 patients (100 fewer to 27 fewer)). In contrast, systemic corticosteroids may increase the risk of death in patients without severe covid-19 (low certainty evidence; absolute effect estimate 39 more per 1000 patients, (12 fewer to 107 more)). Systemic corticosteroids probably reduce the need for invasive mechanical ventilation, and harms are likely to be minor (indirect evidence). UNDERSTANDING THE RECOMMENDATIONS The panel made a strong recommendation for use of corticosteroids in severe and critical covid-19 because there is a lower risk of death among people treated with systemic corticosteroids (moderate certainty evidence), and they believe that all or almost all fully informed patients with severe and critical covid-19 would choose this treatment. In contrast, the panel concluded that patients with non-severe covid-19 would decline this treatment because they would be unlikely to benefit and may be harmed. Moreover, taking both a public health and a patient perspective, the panel warned that indiscriminate use of any therapy for covid-19 would potentially rapidly deplete global resources and deprive patients who may benefit from it most as potentially lifesaving therapy. UPDATES This is a living guideline. Work is under way to evaluate other interventions. New recommendations will be published as updates to this guideline. READERS NOTE This is version 1 of the living guideline, published on 4 September (BMJ 2020;370:m3379) version 1. Updates will be labelled as version 2, 3 etc. When citing this article, please cite the version number. SUBMITTED August 28 ACCEPTED August 31
- Brazilian guidelines for the pharmacological treatment of idiopathic pulmonary fibrosis. Official document of the Brazilian Thoracic Association based on the GRADE methodology(2020) BADDINI-MARTINEZ, Jose; FERREIRA, Juliana; TANNI, Suzana; ALVES, Luis Renato; CABRAL JUNIOR, Benedito Francisco; CARVALHO, Carlos Roberto Ribeiro; CEZARE, Talita Jacon; COSTA, Claudia Henrique da; GAZZANA, Marcelo Basso; JEZLER, Sergio; KAIRALLA, Ronaldo Adib; KAWANO-DOURADO, Leticia; LIMA, Mariana Silva; MANCUZO, Eliane; MOREIRA, Maria Auxiliadora Carmo; RODRIGUES, Marcelo Palmeira; RODRIGUES, Silvia Carla Sousa; RUBIN, Adalberto Sperb; RUFINO, Rogerio Lopes; STEIDLE, Leila John Marques; STORRER, Karin; BALDI, Bruno Guedes
- Gender equity in interstitial lung disease(2020) KAWANO-DOURADO, Leticia; GLASSBERG, Marilyn K.; MOLINA-MOLINA, Maria; STREK, Mary E.; WIJSENBEEK, Marlies; JOHANNSON, Kerri A.
conferenceObject Rheumatoid Arthritis Associated Interstitial Lung Disease: The Progressive Phenotype Is Associated with Recurrent Infection Episodes(2020) SERRA, J. P.; MOLINA, C. de Assis; SABBAG, M. L.; RANGEL, D. A. D.; BONFIGLIOLI, K.; SAWAMURA, M.; NAKAGAWA, R. H.; KAIRALLA, R. A.; KAWANO-DOURADO, L.- Baseline Characteristics and Progression of a Spectrum of Interstitial Lung Abnormalities and Disease in Rheumatoid Arthritis(2020) KAWANO-DOURADO, Leticia; DOYLE, Tracy J.; BONFIGLIOLI, Karina; SAWAMURA, Marcio V. Y.; NAKAGAWA, Renato H.; ARIMURA, Fabio E.; LEE, Hye J.; RANGEL, Diana Arrais de Souza; BUENO, Cleonice; CARVALHO, Carlos R. R.; SABBAG, Maria Laura; MOLINA, Camila; ROSAS, Ivan O.; KAIRALLA, Ronaldo A.BACKGROUND Interstitial lung abnormalities (ILA) and interstitial lung disease (ILD) are seen in up to 60% of individuals with rheumatoid arthritis (RA), some of which will progress to have a significant impact on morbidity and mortality rates. Better characterization of progressive interstitial changes and identification of risk factors that are associated with progression may enable earlier intervention and improved outcomes. RESEARCH QUESTION. What are baseline characteristics associated with RA-ILD progression? STUDY DESIGN AND METHOD! We performed a retrospective study in which all clinically indicated CT chest scans in adult individuals with RA from 2014 to 2016 were evaluated for interstitial changes, and the data were further subdivided into ILA and ILD based on clinical record review. Progression was determined visually and subsequently semiquantified. RESULTS. Those individuals with a spectrum of interstitial changes (64 of 293) were older male smokers and less likely to be receiving biologics/small molecule disease-modifying antirheumatic drugs. Of 44% of the individuals with ILA, 46% had had chest CT scans performed for nonpulmonary indications. Of the 56 individuals with ILA/ILD with sequential CT scans, 38% had evidence of radiologic progression over 4.4 years; 29% of of individuals with ILA progressed. Risk factors for progressive ILA/ILD included a subpleural distribution and higher baseline involvement. INTERPRETATION. Of 293 individuals with RA with clinically indicated CT scans, interstitial changes were observed in 22%, one-half of whom had had a respiratory complaint at the time of imaging; radiologic progression was seen in 38%. Of individuals with progressive ILA, one-half had had baseline CT scans performed for nonpulmonary indications. Subpleural distribution and higher baseline ILA/ILD extent were risk factors associated with progression. Prospective longi- tudinal studies of RA-ILA are necessary.
- Exposure assessment tools for hypersensitivity pneumonitis: An official American thoracic society workshop report(2020) JOHANNSON, K.A.; ROSE, C.S.; BARNES, H.; BELLANGER, A.-P.; DALPHIN, J.-C.; PéREZ, E.R. Fernández; FLAHERTY, K.R.; HUANG, Y.-C.T.; JONES, K.D.; KAWANO-DOURADO, L.; KENNEDY, K.; MILLERICK-MAY, M.; MIYAZAKI, Y.; MORISSET, J.; MORELL, F.; RAGHU, G.R.; ROBBINS, C.; SACK, C.S.; SALISBURY, M.L.; SELMAN, M.; VASAKOVA, M.; WALSH, S.L.F.; PROBLEMS, Occupational American Thoracic Society Assembly on Environmental and Population Health and the Assembly on ClinicalThis report is based on proceedings from the Exposure Assessment Tools for Hypersensitivity Pneumonitis (HP) Workshop, sponsored by the American Thoracic Society, that took place on May 18, 2019, in Dallas, Texas. The workshop was initiated by members from the Environmental, Occupational, and Population Health and Clinical Problems Assemblies of the American Thoracic Society. Participants included international experts from pulmonary medicine, occupational medicine, radiology, pathology, and exposure science. The meeting objectives were to 1) define currently available tools for exposure assessment in evaluation of HP, 2) describe the evidence base supporting the role for these exposure assessment tools in HP evaluation, 3) identify limitations and barriers to each tool's implementation in clinical practice, 4) determine which exposure assessment tools demonstrate the best performance characteristics and applicability, and 5) identify research needs for improving exposure assessment tools for HP. Specific discussion topics included history-taking and exposure questionnaires, antigen avoidance, environmental assessment, specific inhalational challenge, serum-specific IgG testing, skin testing, lymphocyte proliferation testing, and a multidisciplinary team approach. Priorities for research in this area were identified. Copyright © 2020 by the American Thoracic Society
- METHOTREXATE AND RHEUMATOID ARTHRITIS ASSOCIATED INTERSTITIAL LUNG DISEASE(2020) JUGE, P. A.; LEE, J. S.; LAU, J.; KAWANO, L.; ROJAS-SERRANO, J.; SEBASTIANI, M.; KODURI, G.; MATTESON, E.; BONFIGLIOLI, K.; SAWAMURA, M.; KAIRALLA, R.; CAVAGNA, L.; CASSIONE, E. Bozzalla; MANFREDI, A.; MEJIA, M.; HENRIQUEZ, P. Rodriguez; GONZALEZ-PEREZ, M. I.; FALFAN-VALENCIA, R.; BUENDIA-ROLDAN, I.; PEREZ-RUBIO, G.; EBSTEIN, E.; GAZAL, S.; BORIE, R.; OTTAVIANI, S.; KANNENGIESSER, C.; WALLAERT, B.; UZUNHAN, Y.; NUNES, H.; VALEYRE, D.; KERMANAC'H, N. Saidenberg; BOISSIER, M. C.; STERVINOU, L. Wemeau; FLIPO, R. M.; MARCHAND-ADAM, S.; RICHETTE, P.; ALLANORE, Y.; DROMER, C.; TRUCHETET, M. E.; RICHEZ, C.; SCHAEVERBEKE, T.; LIOTE, H.; THABUT, G.; DEANE, K.; SOLOMON, J.; DOYLE, T.; RYU, J. H.; ROSAS, I. O.; HOLERS, V. M.; BOILEAU, C.; DEBRAY, M. P.; PORCHER, R.; SCHWARTZ, D. A.; VASSALLO, R.; CRESTANI, B.; DIEUDE, P.
- Remdesivir for severe covid-19: a clinical practice guideline(2020) ROCHWERG, Bram; AGARWAL, Arnav; ZENG, Linan; LEO, Yee-Sin; APPIAH, John Adabie; AGORITSAS, Thomas; BARTOSZKO, Jessica; BRIGNARDELLO-PETERSEN, Romina; ERGAN, Begum; GE, Long; GEDULD, Heike; GERSHENGORN, Hayley B.; MANAI, Hela; HUANG, Minhua; LAMONTAGNE, Francois; KANDA, Seema; KAWANO-DOURADO, Leticia; KURIAN, Linda; KWIZERA, Arthur; MURTHY, Srinivas; QADIR, Nida; SIEMIENIUK, Reed; SILVESTRE, Maria Asuncion; VANDVIK, Per Olav; YE, Zhikang; ZERAATKAR, Dena; GUYATT, GordonCLINICAL QUESTION What is the role of remdesivir in the treatment of severe covid-19? This guideline was triggered by the ACTT-1 trial published in the New England Journal of Medicine on 22 May 2020. CURRENT PRACTICE Remdesivir has received worldwide attention as a potentially effective treatment for severe covid-19. After rapid market approval in the US, remdesivir is already being used in clinical practice. RECOMMENDATIONS The guideline panel makes a weak recommendation for the use of remdesivir in severe covid-19 while recommending continuation of active enrolment of patients into ongoing randomised controlled trials examining remdesivir. HOW THIS GUIDELINE WAS CREATED An international panel of patients, clinicians, and methodologists produced these recommendations in adherence with standards for trustworthy guidelines using the GRADE approach. The recommendations are based on a linked systematic review and network meta-analysis. The panel considered an individual patient perspective and allowed contextual factors (such as resources) to be taken into account for countries and healthcare systems. THE EVIDENCE The linked systematic review (published 31 Jul 2020) identified two randomised trials with 1300 participants, showing low certainty evidence that remdesivir may be effective in reducing time to clinical improvement and may decrease mortality in patients with severe covid-19. Remdesivir probably has no important effect on need for invasive mechanical ventilation. Remdesivir may have little or no effect on hospital length of stay. UNDERSTANDING THE RECOMMENDATION Most patients with severe covid-19 would likely choose treatment with remdesivir given the potential reduction in time to clinical improvement. However, given the low certainty evidence for critical outcomes and the fact that different perspectives, values, and preferences may alter decisions regarding remdesivir, the panel issued a weak recommendation with strong support for continued recruitment in randomised trials.