ALEX JONES FLORES CASSENOTE
Projetos de Pesquisa
Unidades Organizacionais
LIM/24 - Laboratório de Oncologia Experimental, Hospital das Clínicas, Faculdade de Medicina
7 resultados
Resultados de Busca
Agora exibindo 1 - 7 de 7
- Attitude and knowledge of medical students toward donation after circulatory death(2021) MARTINO, Rodrigo Bronze de; GUIDOTTE, Diogo Visconti; WAISBERG, Daniel Reis; SANTOS, Alexandre Guerra dos; CASSENOTE, Alex Jones Flores; ARANTES, Rubens Macedo; HADDAD, Luciana Bertocco; GALVAO, Flavio Henrique; CARNEIRO-D'ALBUQUERQUE, Luiz AugustoOBJECTIVE: A survey among medical students in a Brazilian public university was performed to investigate the acceptance of organ donation in Brazil, particularly donation after circulatory death (DCD). METHODS: A questionnaire including 26 objectives and Likert scale questions was validated and sent to all medical students of our institution. The answers were analyzed considering the whole set of individuals as well as by dividing the medical students into two groups: less graduated students and more graduated students. RESULTS: From 1050 students, 103 spontaneous answers (9.8%) were retrieved after 3 weeks. A total of 89.3% agreed totally with deceased donor organ donation and 8.7% agreed partially. However, only 50.5% of the students agreed totally and 31.1% agreed partially to living donation. Students revealed that 82.6% know the concept of brain death. On the other hand, 71.8% of them declared not knowing the concept of planned withdrawal of life-sustaining therapy, mainly cardiorespiratory support. A total of 85.4% of students agreed totally with donation after brain death and 11.7% agreed partially. However, when questioned about donation in awaiting circulatory death after a planned withdrawal of life-sustaining therapy, only 18.4% agreed totally and 32% agreed partially. Both groups of less and more graduated students showed similar results. CONCLUSIONS: Our study found a clear lack of information and consequently in acceptance of DCD. Education in the field of end-oflife management may improve not only the acceptance of DCD donation but also the whole understanding of planned withdrawal of life-sustaining therapy.
- Factors Associated with Mortality and Graft Failure in Liver Transplants: A Hierarchical Approach(2015) HADDAD, Luciana; CASSENOTE, Alex Jones Flores; ANDRAUS, Wellington; MARTINO, Rodrigo Bronze de; ORTEGA, Neli Regina de Siqueira; ABE, Jair Minoro; D'ALBUQUERQUE, Luiz Augusto CarneiroBackground Liver transplantation has received increased attention in the medical field since the 1980s following the introduction of new immunosuppressants and improved surgical techniques. Currently, transplantation is the treatment of choice for patients with end-stage liver disease, and it has been expanded for other indications. Liver transplantation outcomes depend on donor factors, operating conditions, and the disease stage of the recipient. A retrospective cohort was studied to identify mortality and graft failure rates and their associated factors. All adult liver transplants performed in the state of Sao Paulo, Brazil, between 2006 and 2012 were studied. Methods and Findings A hierarchical Poisson multiple regression model was used to analyze factors related to mortality and graft failure in liver transplants. A total of 2,666 patients, 18 years or older, (1,482 males; 1,184 females) were investigated. Outcome variables included mortality and graft failure rates, which were grouped into a single binary variable called negative outcome rate. Additionally, donor clinical, laboratory, intensive care, and organ characteristics and recipient clinical data were analyzed. The mortality rate was 16.2 per 100 person-years (py) (95% CI: 15.1-17.3), and the graft failure rate was 1.8 per 100 py (95% CI: 1.5-2.2). Thus, the negative outcome rate was 18.0 per 100 py (95% CI: 16.9-19.2). The best risk model demonstrated that recipient creatinine >= 2.11 mg/dl [RR = 1.80 (95% CI: 1.56-2.08)], total bilirubin >= 2.11 mg/dl [RR = 1.48 (95% CI: 1.27-1.72)], Na+ >= 141.01 mg/dl [RR = 1.70 (95% CI: 1.47-1.97)], RNI >= 2.71 [RR = 1.64 (95% CI: 1.41-1.90)], body surface >= 1.98 [RR = 0.81 (95% CI: 0.68-0.97)] and donor age >= 54 years [RR = 1.28 (95% CI: 1.11-1.48)], male gender [RR = 1.19(95% CI: 1.03-1.37)], dobutamine use [RR = 0.54 (95% CI: 0.36-0.82)] and intubation >= 6 days [RR = 1.16 (95% CI: 1.10-1.34)] affected the negative outcome rate. Conclusions The current study confirms that both donor and recipient characteristics must be considered in post-transplant outcomes and prognostic scores. Our data demonstrated that recipient characteristics have a greater impact on post-transplant outcomes than donor characteristics. This new concept makes liver transplant teams to rethink about the limits in a MELD allocation system, with many teams competing with each other. The results suggest that although we have some concerns about the donors features, the recipient factors were heaviest predictors for bad outcomes.
conferenceObject Impact of Donor Age and Time on Mechanical Ventilation on Outcomes of Liver Transplantation in Brazil(2014) HADDAD, Luciana; CASSENOTE, Alex; OLIVEIRA, Cristina C.; ANDRAUS, Wellington; D'ALBUQUERQUE, Luiz Augusto Carneiro- COVID-19-related hospital cost-outcome analysis: The impact of clinical and demographic factors(2021) MIETHKE-MORAIS, Anna; CASSENOTE, Alex; PIVA, Heloisa; TOKUNAGA, Eric; COBELLO, Vilson; GONCALVES, Fabio Augusto Rodrigues; LOBO, Renata dos Santos; TRINDADE, Evelinda; D'ALBUQUERQUE, Luiz Augusto Carneiro; HADDAD, LucianaIntroduction: Although patients' clinical conditions have been shown to be associated with coronavirus disease (COVID-19) severity and outcome, their impact on hospital costs are not known. This economic evaluation of COVID-19 admissions aimed to assess direct and fixed hospital costs and describe their particularities in different clinical and demographic conditions and outcomes in the largest public hospital in Latin America, located in Sao Paulo, Brazil, where a whole institute was exclusively dedicated to COVID-19 patients in response to the pandemic. Methods: This is a partial economic evaluation performed from the hospital's perspective and is a prospective, observational cohort study to assess hospitalization costs of suspected and confirmed COVID-19 patients admitted between March 30 and June 30, 2020, to Hospital das Clinicas of the University of Sao Paulo Medical School (HCFMUSP) and followed until discharge, death, or external transfer. Micro- and macro-costing methodologies were used to describe and analyze the total cost associated with each patient's underlying medical conditions, itinerary and outcomes as well as the cost components of different hospital sectors. Results: The average cost of the 3254 admissions (51.7% of which involved intensive care unit stays) was US$12,637.42. The overhead cost was its main component. Sex, age and underlying hypertension (US$14,746.77), diabetes (US$15,002.12), obesity (US$18,941.55), chronic renal failure (US$15,377.84), and rheumatic (US$17,764.61), hematologic (US $15,908.25) and neurologic (US$15,257.95) diseases were associated with higher costs. Age strata >69 years, reverse transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19, comorbidities, use of mechanical ventilation or dialysis, surgery and outcomes remained associated with higher costs. Conclusion: Knowledge of COVID-19 hospital costs can aid in the development of a comprehensive approach for decision-making and planning for future risk management. (C) 2021 Sociedade Brasileira de Infectologia.
- Liver Elastography in Acute Cellular Rejection After Liver Transplantation(2020) NACIF, Lucas Souto; GOMES, Caroline de Cassia; PARANAGUA-VEZOZZO, Denise; CASSENOTE, Alex Jones Flores; PINHEIRO, Rafael Soares; WAISBERG, Daniel Reis; ROCHA-SANTOS, Vinicius; MARTINO, Rodrigo Bronze de; ARANTES, Rubens Macedo; DUCATTI, Liliana; HADDAD, Luciana; GALVAO, Flavio; ANDRAUS, Wellington; CARRILHO, Flair Jose; D'ALBUQUERQUE, Luiz Carneiro
- The Cost-Effectiveness of Congenital Adrenal Hyperplasia Newborn Screening in Brazil: A Comparison Between Screened and Unscreened Cohorts(2021) MIRANDA, Mirela Costa de; HADDAD, Luciana Bertocco de Paiva; TRINDADE, Evelinda; CASSENOTE, Alex; HAYASHI, Giselle Y.; DAMIANI, Durval; COSTA, Fernanda Cavalieri; MADUREIRA, Guiomar; MENDONCA, Berenice Bilharinho de; BACHEGA, Tania A. S. S.Background: Newborn screening for congenital adrenal hyperplasia (CAH-NBS) is not yet a worldwide consensus, in part due to inconclusive evidence regarding cost-effectiveness because the analysis requires an understanding of the short- and long-term costs of care associated with delayed diagnosis. Objective: The present study aimed to conduct a cost-effectiveness analysis (CEA) to compare the costs associated with CAH-NBS and clinical diagnosis. Methods: A decision model comparing the two strategies was tested by sensitivity analysis. The cost analysis perspective was the public health system. Unscreened patients' data were extracted from medical records of Hospital das Clinicas, Sao Paulo, and screened data were extracted from the NBS Referral Center of Sao Paulo. The population comprised 195 classical patients with CAH, clinically diagnosed and confirmed by hormonal/CYP21A2 analysis, and 378,790 newborns screened during 2017. Adverse outcomes related to late diagnosis were measured in both cohorts, and the incremental cost-effectiveness ratio (ICER) was calculated. We hypothesized that CAH-NBS would be cost-effective. Results: Twenty-five screened infants were confirmed with CAH (incidence: 1:15,135). The mortality rate was estimated to be 11% in unscreened infants, and no deaths were reported in the screened cohort. Comparing the unscreened and screened cohorts, mean serum sodium levels were 121.2 mEq/L (118.3-124.1) and 131.8 mEq/L (129.3-134.5), mean ages at diagnosis were 38.8 and 17 days, and hospitalization occurred in 76% and 58% of the salt-wasting patients with the in the two cohorts, respectively. The NBS incremental cost was US$ 771,185.82 per death averted, which yielded an ICER of US$ 25,535.95 per discounted life-year saved. Conclusions: CAH-NBS is important in preventing CAH mortality/morbidity, can reduce costs associated with adverse outcomes, and appears cost-effective.
- Early Graft Dysfunction Evaluation by Indocyanine Green Plasma Clearance Rate in the Immediate Postoperative Period After Liver Transplantation(2020) GONZALEZ, Esteban Horacio; NACIF, Lucas Souto; CASSENOTE, Alex Jones Flores; PINHEIRO, Rafael Soares; ROCHA-SANTOS, Vinicius; MARTINO, Rodrigo Bronze de; WAISBERG, Daniel Reis; ARANTES, Rubens Macedo; DUCATTI, Liliana; HADDAD, Luciana; GALVAO, Flavio; ANDRAUS, Wellington; D'ALBUQUERQUE, Luiz Carneiro