MARIA BEATRIZ DE MOLITERNO PERONDI

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13
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PAHC, Hospital das Clínicas, Faculdade de Medicina
FMUSP, Hospital das Clínicas, Faculdade de Medicina

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  • article 1 Citação(ões) na Scopus
    Discrepancies Between Clinical and Autopsy Diagnoses in Rapid Response Team-Assisted Patients: What Are We Missing?
    (2022) GIUGNI, Fernando Rabioglio; SALVADORI, Fernanda Aburesi; SMEILI, Luciana Andrea Avena; MARCILIO, Izabel; PERONDI, Beatriz; MAUAD, Thais; PAIVA, Edison Ferreira de; DUARTE-NETO, Amaro Nunes
    Objectives The rapid response team (RRT) assists hospitalized patients with sudden clinical deterioration. There is scarce evidence of diagnostic accuracy in this scenario, but it is possible that a considerable rate of misdiagnosis exists. Autopsy remains a valuable tool for assessing such question. This study aimed to compare clinical (premortem) and autopsy (postmortem) diagnoses in patients assisted by the RRT and describe major discrepancies. Methods We reviewed 104 clinical data and autopsies from patients assisted by the RRT during a cardiac arrest event in a tertiary care hospital in Brazil. Clinical and autopsy diagnostic discrepancies were classified using the Goldman criteria. Other clinical and pathological data were described, and the group with major diagnostic discrepancies was further analyzed. Results We found 39 (37.5%) patients with major diagnostic discrepancies. Most frequent immediate causes of death in this group determined by autopsy were sepsis (36%), pulmonary embolism (23%) and hemorrhagic shock (21%). Pulmonary embolism was the cause of death significantly more frequent in the major discrepancy group than in the minor discrepancy group (23% versus 3%, P = 0.002). We individually described all major diagnostic discrepancies. Conclusions We found a high rate (37.5%) of major misdiagnosis in autopsies from patients assisted by the RRT in a tertiary teaching hospital. Pulmonary embolism was the most inaccurate fatal diagnosis detected by autopsy.
  • bookPart
    Hemorragia digestiva
    (2018) PERONDI, Maria Beatriz Moliterno; BELLO, Fernanda Paixão Silveira
  • article 47 Citação(ões) na Scopus
    Carbapenem-resistant Enterobacteriaceae in patients admitted to the emergency department: prevalence, risk factors, and acquisition rate
    (2017) SALOMAO, M. C.; GUIMARAES, T.; DUAILIBI, D. F.; PERONDI, M. B. M.; LETAIF, L. S. H.; MONTAL, A. C.; ROSSI, F.; CURY, A. P.; DUARTE, A. J. S.; LEVIN, A. S.; BOSZCZOWSKI, I.
    Background: Carbapenem-resistant Enterobacteriaceae (CRE) have been reported worldwide and are associated with high mortality rates. Intestinal colonization acts as a reservoir and fosters exchange of resistance mechanisms. Aim: To investigate the prevalence of patients harbouring CRE on hospital admission, risk factors associated, and the acquisition rate within the emergency department (ED). Methods: This was a cross-sectional survey with 676 patients consecutively admitted to the ED study during the months of May to July 2016. A questionnaire was performed and rectal swabs were collected from patients on admission, for culture and for multiplex real-time polymerase chain reaction (PCR). If the patient was hospitalized for more than one week in the ED, samples were taken again to determine the acquisition rate of CRE. Findings: Forty-six patients were colonized; all positive PCR were Klebsiella pneumoniae carbapenemase. The acquisition rate was 18%. Previous exposure to healthcare in the last year, liver disease, and use of antibiotics in the last month were risk factors for colonization. Six patients with no previous exposure to healthcare were CRE-colonized on admission, suggesting transmission of CRE within the community. Conclusion: Screening of high-risk patients on admission to the ED is a strategy to early identify CRE carriage and may contribute to control CRE dissemination.
  • bookPart
    Recomendações das atividades físicas e esportivas
    (2013) PINTO, Ana Lucia de Sá; PERONDI, Maria Beatriz Moliterno
  • article 31 Citação(ões) na Scopus
    Elevated C-Reactive Protein and Spontaneous Bacterial Peritonitis in Children With Chronic Liver Disease and Ascites
    (2014) PRETO-ZAMPERLINI, Marcela; FARHAT, Sylvia Costa Lima; PERONDI, Maria Beatriz Moliterno; PESTANA, Adriana Pozzi; CUNHA, Patricia Salles; PUGLIESE, Renata Pereira Sustovich; SCHVARTSMAN, Claudio
    Objectives:The aims of this study were to compare laboratory indices of spontaneous bacterial peritonitis (SBP) and noninfected ascites in children with chronic liver disease and to determine the infectious agents involved in SBP.Methods:The medical records of 90 children with chronic liver disease and ascites studied between January 2005 and August 2011 were reviewed for laboratory data of diagnostic significance in SBP. Standard laboratory tests included blood cell count, coagulation indices, liver and renal function tests, C-reactive protein (CRP), serum sodium concentration, serum albumin, and serum cultures. Ascitic fluid obtained from 152 paracentesis procedures was assayed for cytology, Gram stains, neutrophil counts, and bacteriological cultures.Results:The SBP group manifested significantly lower albumin levels and elevated CRP levels, prothrombin times, international normalized ratios, and leukocyte number (P<0.05 in each case). CRP was shown to be an independent variable in the prediction of SBP. Values of serum creatinine, sodium concentration, urea, total bilirubin and differential leukocyte shift were comparable in SBP and noninfected ascites. Streptococcus pneumoniae was the most prevalent infectious agent in the ascitic fluid (44%).Conclusions:CRP may be useful in early detection and monitoring of SBP in children with liver disease.
  • bookPart
    Crise hipertensiva
    (2023) BURCKART, Karina; Sá, Fernanda Viveiros Moreira de; PERONDI, Maria Beatriz de Moliterno
  • article 18 Citação(ões) na Scopus
    A decision-aid tool for ICU admission triage is associated with a reduction in potentially inappropriate intensive care unit admissions
    (2019) RAMOS, Joao Gabriel Rosa; RANZANI, Otavio T.; PERONDI, Beatriz; DIAS, Roger Daglius; JONES, Daryl; CARVALHO, Carlos Roberto Ribeiro; VELASCO, Irineu Tadeu; FORTE, Daniel Neves
    Purpose: Intensive care unit (ICU) admission triage occurs frequently and often involves highly subjective decisions that may lead to potentially inappropriate ICU admissions. In this study, we evaluated the effect of implementing a decision-aid tool for ICU triage on ICU admission decisions. Methods: This was a prospective, before-after study. Urgent ICU referrals to ten ICUs in a tertiary hospital in Brazil were assessed before and after the implementation of the decision-aid tool. Our primary outcome was the proportion of potentially inappropriate ICU referrals (defined as priority 4B or 5 referrals, accordingly to the Society of Critical Care Medicine guidelines of 1999 and 2016, respectively) admitted to the ICU within 48 h. We conducted multivariate analyses to adjust for potential confounders and evaluated the interaction between phase and triage priority. Results: Of the 2201 patients analyzed, 1184 (53.8%) patients were admitted to the ICU. After adjustment for confounders, implementation of the decision-aid tool was associated with a reduction in potentially inappropriate ICU admissions using either the 1999 [adjOR (95% CI) = 0.36 (0.13-0.97)] or 2016 [adjOR (95%CI) = 0.35 (0.13-0.96)] definitions. Conclusion: Implementation of a decision-aid tool for ICU triage was associated with a reduction in potentially inappropriate ICU admissions. (C) 2019 Published by Elsevier Inc.
  • article 45 Citação(ões) na Scopus
    Severe yellow fever in Brazil: clinical characteristics and management
    (2019) HO, Yeh-Li; JOELSONS, Daniel; LEITE, Gabriel F. C.; MALBOUISSON, Luiz M. S.; SONG, Alice T. W.; PERONDI, Beatriz; ANDRADE, Lucia C.; PINTO, Lecio F.; D'ALBUQUERQUE, Luiz A. C.; SEGURADO, Aluisio A. C.
    Background: Little is known about clinical characteristics and management of severe yellow fever as previous yellow fever epidemics often occurred in times or areas with little access to intensive care units (ICU). We aim to describe the clinical characteristics of severe yellow fever cases requiring admission to the ICU during the 2018 yellow fever outbreak in Sao Paulo, Brazil. Furthermore, we report on preliminary lessons learnt regarding clinical management of severe yellow fever. Methods: Retrospective descriptive cohort study. Demographic data, laboratory test results on admission, clinical follow-up, and clinical outcomes were evaluated. Results: From 10 January to 11 March 2018, 79 patients with laboratory confirmed yellow fever were admitted to the ICU in a tertiary hospital in Sao Paolo because of rapid clinical deterioration. On admission, the median AST was 7,000 IU/L, ALT 3,936 IU/L, total bilirubin 5.3 ml/dL, platelet 74 x 10(3)/mm(3), INR 2.24 and factor V 37%. Seizures occurred in 24% of patients, even without substantial intracranial hypertension. The high frequency of pancreatitis and rapidly progressive severe metabolic acidosis were notable findings. 73% of patients required renal replacement therapy. The in-hospital fatality rate was 67%. Patients with diabetes mellitus had a higher case fatality rate (CFR) of 80%, while patients without diabetes had a CFR of 65%. Leading causes of death were severe gastrointestinal bleeding, epileptic status, severe metabolic acidosis, necrohemorrhagic pancreatitis, and multiorgan failure. Conclusions: Severe yellow fever is associated with a high CFR. The following management lessons were learnt: Anticonvulsant drugs in patients with any symptoms of hepatic encephalopathy or arterial ammonia levels >70 mu mol/L was commenced which reduced the frequency of seizures from 28% to 17%. Other new therapy strategies included early institution of plasma exchange. Due to the high frequency of gastric bleeding, therapeutic doses of intravenous proton pump inhibitors should be administered.
  • article 15 Citação(ões) na Scopus
    Setting up hospital care provision to patients with COVID-19: lessons learnt at a 2400-bed academic tertiary center in SAo Paulo, Brazil
    (2020) PERONDI, Beatriz; MIETHKE-MORAIS, Anna; MONTAL, Amanda C.; HARIMA, Leila; SEGURADO, Aluisio C.
    As of August 30, 2020, Brazil ranked second among countries with the highest number of COVID-19 cases, with the city of SAo Paulo as the national epidemic epicenter. Local public healthcare institutions were challenged to respond to a fast-growing hospital demand, reengineering care provision to optimize clinical outcomes and minimize intra-hospital coronavirus infection. In this paper we describe how the largest public hospital complex in Latin America faced this unprecedented burden, managing severe COVID-19 cases while sustaining specialized care to patients with other conditions. In our strategic plan a 900 bed hospital was exclusively designated for COVID-19 care and continuity of care to those not infected with coronavirus ensured in other inpatient facilities. After 152 days, 4241 patients with severe COVID-19 were hospitalized, 70% of whom have already been discharged, whereas the remaining Institutes of the complex successfully maintained high complexity inpatient and urgent/emergency care to non-COVID-19 patients. (C) 2020 Sociedade Brasileira de Infectologia.
  • article 4 Citação(ões) na Scopus
    Epidemiologic Surveillance in an academic hospital during the COVID-19 pandemic in Sao Paulo, Brazil: the key role of epidemiologic engagement in operational processes
    (2020) MARCILIO, Izabel; MIETHKE-MORAIS, Anna; HARIMA, Leila; MONTAL, Amanda C.; PERONDI, Beatriz; AYRES, Jose Ricardo de Carvalho Mesquita; GOUVEIA, Nelson; BONFA, Eloisa; NOVAES, Hillegonda Maria Dutilh