SYLVIA COSTA LIMA FARHAT
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
LIM/05 - Laboratório de Poluição Atmosférica Experimental, Hospital das Clínicas, Faculdade de Medicina
LIM/05 - Laboratório de Poluição Atmosférica Experimental, Hospital das Clínicas, Faculdade de Medicina
22 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 22
- Point-of-care lung ultrasound score for predicting escalated care in children with respiratory distress(2023) GIORNO, Eliana P. C.; FORONDA, Flavia K.; PAULIS, Milena De; GHOSN, Danielle S. N. Bou; COUTO, Thomaz B.; SA, Fernanda V. M.; FRAGA, Andrea M. A.; FARHAT, Sylvia C. L.; PRETO-ZAMPERLINI, Marcela; SCHVARTSMAN, ClaudioPurpose: Respiratory distress due to lower respiratory illnesses is a leading cause of death in children. Early rec-ognition of high-risk populations is critical for the allocation of adequate resources. Our goal was to assess whether the lung ultrasound (US) score obtained at admission in children with respiratory distress predicts the need for escalated care. Methods: This prospective study included 0-18-year-old patients with respiratory distress admitted to three emergency departments in the state of Sao Paulo, Brazil, between July 2019 and September 2021. The enrolled patients underwent lung US performed by a pediatric emergency physician within two hours of arrival. Lung ul-trasound scores ranging from 0 to 36 were computed. The primary outcome was the need for high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), or mechanical ventilation within 24 h. Results: A total of 103 patients were included. The diagnoses included wheezing (33%), bronchiolitis (27%), pneu-monia (16%), asthma (9%), and miscellaneous (16%). Thirty-five patients (34%) required escalated care and had a higher lung ultrasound score: median 13 (0-34) vs 2 (0-21), p < 0.0001; area under the curve (AUC): 0.81 (95% confidence interval [CI]: 0.71-0.90). The best cut-off score derived from Youden's index was seven (sensitivity: 71.4%; specificity: 79.4%; odds ratio (OR): 9.6 [95% CI: 3.8-24.7]). A lung US score above 12 was highly specific and had a positive likelihood ratio of 8.74 (95% CI:3.21-23.86). Conclusion: An elevated lung US score measured in the first assessment of children with any type of respiratory distress was predictive of severity as defined by the need for escalated care with HFNC, NIV, or mechanical ventilation.
- Point-Of-Care Ultrasound for Lung Assessment in Patients With Severe Scoliosis and Chest Deformities: An Emergency Department Case Series(2020) GIORNO, Eliana Paes de Castro; PRETO-ZAMPERLINI, Marcela; WEERDENBURG, Kirstin; FERRAZ, Isabel de Siqueira; LEITE, Marcia Marques; FARHAT, Sylvia Costa Lima; SCHVARTSMAN, Claudio
- Teaching medical students to choose wisely through simulation(2022) MORATO, Thayza Marcelly Rodrigues; MENDES, Pedro Henrique Magalhaes; GHOSN, Danielle Saad Nemer Bou; COUTO, Thomaz Bittencourt; MAI, Paulo Victor Ferreira; FARHAT, Sylvia Costa Lima; SCHVARTSMAN, Claudio; CAVALCANTI, Nara VasconcelosThe Choosing Wisely (CW) campaign aims to encourage dialog among physicians and patients about the costs and benefits of medical care. The purpose of the present study was to describe the implementation of the CW campaign among medical students in the pediatrics clerkship using different teaching strategies and to evaluate the students' perception and performance. A prospective, interventionist, open study with a control group was conducted. All sixth-year undergraduate medical students that were on their pediatric clerkship at the Emergency Department during the study period were invited to participate. The study consisted of two strategies: a remote video class about the CW initiative and in situ simulation training. By the end of the rotation, all participants were evaluated through an Objective Structured Clinical Examination (OSCE). A total of 50 students were included, of which 24 watched only the online video (control group) and 26 were exposed to both the online video and the simulation scenarios (intervention group). Students in the intervention group had a significantly higher total score in the OSCE compared to students in the control group (median 90 vs 90; range 78-100 vs 50-100; p: 0.047). Median scores of behavioral items of the OSCE grouped together were significantly higher in the intervention group compared to the control group (median 60 vs 50; range 40-60 vs 20-60; p: 0.002). Conclusion: Simulation training about principles of the CW campaign had a greater impact on behavioral aspects of undergraduate students. This learning strategy was well accepted by participants.
- Changing the view: impact of simulation-based mastery learning in pediatric tracheal intubation with videolaryngoscopy(2021) COUTO, Thomaz Bittencourt; REIS, Amelia G.; FARHAT, Sylvia C. L.; CARVALHO, Vitor E. L.; SCHVARTSMAN, ClaudioObjective: To determine the effect of a training program using simulation-based mastery learning on the performance of residents in pediatric intubations with videolaryngoscopy. Method: Retrospective cohort study carried out in a tertiary pediatric hospital between July 2016 and June 2018 evaluating a database that included the performance of residents before and after training, as well as the outcome of tracheal intubations. A total of 59 pediatric residents were evaluated in the pre-training with a skills' checklist in the scenario with an intubation simulator; subsequently, they were trained individually using a simulator and deliberate practice in the department itself. After training, the residents were expected to have a minimum passing grade (90/100) in a simulated scenario. The success of the first attempted intubation, use of videolaryngoscopy, and complications in patients older than 1 year of age during the study period were also recorded in clinical practice. Results: Before training, the mean grade was 77.5/100 (SD 15.2), with only 23.7% (14/59) of residents reaching the minimum passing grade of 90/100. After training, 100% of the residents reached the grade, with an average of 94.9/100 (SD 3.2), p < 0.01, with only 5.1% (3/59) needing more practice time than that initially allocated. The success rate in the first attempt at intubation in the emergency department with videolaryngoscopy was 77.8% (21/27). The rate of adverse events associated with intubations was 26% (7/27), representing a serious event. Conclusions: Simulation-based mastery learning increased residents' skills related to intubation and allowed safe tracheal intubations with video laryngoscopy. (C) 2020 Sociedade Brasileira de Pediatria.
- 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, ClaudioObjectives: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.
- Hypotonic solution decreases serum sodium in infants with moderate bronchiolitis(2014) RODRIGUES, Regina M.; SCHVARTSMAN, Benita G. S.; FARHAT, Sylvia C. L.; SCHVARTSMAN, ClaudioAimTo investigate the influence of hypotonic parenteral hydration on serum and urinary sodium and osmolality in infants with moderate bronchiolitis. MethodsWe studied 36 infants (mean age 3.72.3months), with a diagnosis of moderate bronchiolitis admitted to a paediatric emergency unit in SAo Paulo, Brazil. Patients received a standard parenteral hypotonic solution, according to Holliday and Segar, during the first 24h, due to respiratory distress. The disease was monitored by a respiratory severity score (RDAI-Respiratory Distress Assessment Instrument), respiratory rate and oxygen saturation. Serum and urinary sodium and osmolality were monitored at admission, 24 and 48h after admission. ResultsAll respiratory parameters improved during hospitalisation. Serum sodium and osmolality dropped after 24h (136.8 +/- 2.8 and 135.8 +/- 2.6mEq/L, p=0.031; 283.4 +/- 4.1 and 281.6 +/- 3.9 mOsm/kg, p=0.004 respectively) as well as urinary osmolality (486.8 +/- 243.4 mOsm/kg and 355.7 +/- 205.0 mOsm/kg, p<0.001) when compared to admission. ConclusionThis study reinforces the occurrence of hyponatraemia in bronchiolitis even in patients with moderate disease and highlights the risk of serum sodium drop caused by hypotonic parenteral hydration.
- Seven-day cumulative effects of air pollutants increase respiratory ER visits up to threefold(2017) SCHVARTSMAN, Claudio; PEREIRA, Luiz Alberto Amador; BRAGA, Alfesio Luiz Ferreira; FARHAT, Sylvia Costa LimaObjective: Children are especially vulnerable to respiratory injury induced by exposure to air pollutants. In the present study, we investigate periods of up to 7 days, and evaluate the lagged effects of exposure to air pollutants on the daily number of children and adolescents visiting the emergency room (ER) for the treatment of lower respiratory obstructive diseases (LROD), in the city of SAo Paulo, Brazil. Methods: Daily records of LROD-related ER visits by children and adolescents under the age of 19, from January 2000 to December 2007 (2,922 days) were included in the study. Time-series regression models (generalized linear Poisson) were used to control for short- and long-term trends, as well as for temperature and relative humidity. Third-degree polynomial lag models were used to estimate both lag structures and the cumulative effects of air pollutants. Effects of air pollutants were expressed as the percentage increase in LROD-related ER visits. Results: We observed an acute effect at the same day of exposure to air pollutants; however, the cumulative effects of air pollutants on the number of LROD-related ER visits was almost threefold greater than the one observed at the same day of exposure to PM10, SO2, and NO2 mainly in children aged 5 years and under. The 7-day cumulative effect of SO2 reached 11.0% (95% CI: 5.0-16.7) increase in visits. Conclusion and Relevance: This study highlights the effects of intermediate-term exposure to air pollutants on LROD in children. Pediatr Pulmonol. 2017;52:205-212. (c) 2016 Wiley Periodicals, Inc.
- SARS-CoV-2 and rhinovirus infections: are there differences in clinical presentation, laboratory abnormalities, and outcomes in the pediatric population?(2022) PEREIRA, Maria Fernanda Badue; SUGUITA, Priscila; LITVINOV, Nadia; FARHAT, Sylvia Costa Lima; PAULA, Camila Sanson Yoshino de; LAZARI, Carolina dos Santos; BEDE, Pedro Vale; FRAMIL, Juliana Valeria de Souza; BUENO, Catarina; BRANAS, Priscila Cristina Abduch Adas; GUIMARAES, Irina Monteiro da Costa; LEITE, Marcia Marques; NAVEGA, Ana Carolina Barsaglini; NANBU, Danilo Yamamoto; SCHVARTSMAN, Claudio; PINHO, Joao Renato Rebello; SILVA, Clovis Artur Almeida; MARQUES, Heloisa Helena de SousaThis study aims to assess COVID-19 and other respiratory viruses in pediatric patients. Between April 17 and September 30, 2020, we collected 1,566 respiratory samples from 1,044 symptomatic patients who were younger than 18 years old to assess SARS-CoV-2 infection. Of these, 919 were analyzed for other respiratory pathogens (ORP). Patients with laboratory-confirmed COVID-19 or ORP were included. We evaluated 76 pediatric COVID-19 infections and 157 other respiratory virus infections. Rhinovirus occurred in 132/157 (84%). COVID-19 patients who were significantly older, had more fevers, headaches and pneumonia than those with ORP. The median white blood cell count was lower in patients with SARS-CoV-2 than in those with ORP (6,470 versus 8,170; p=0.02). COVID-19 patients had significantly worse symptoms than those with ORP.
- How to incorporate telemedicine in medical residency: A Brazilian experience in pediatric emergency(2023) SEVERINI, Rafael da Silva Giannasi; MARCOVICI, Michelle; FARHAT, Sylvia Costa Lima; BIVANCO-LIMA, Danielle; COUTO, Thomaz Bittencourt; AMARANTE, Ana Carolina; RODRIGUES, Katharina Reichmann; GHOSN, Danielle Saad Nemer Bou; SCHVARTSMAN, ClaudioIntroduction:The exponential growth of telehealth services during the COVID-19 pandemic led to the implementa-tion of a telemedicine care service in a tertiary university pediatric hospital. It brought the need to develop a train-ing aimed at remote care within the pediatric emergency rotation program.Objective: To describe the implementation of a telemedicine training for pediatric residents and present the pre-liminary results.Methods: Descriptive prospective study (pre and post), with 40 resident physicians of the first year of pediatrics. Reaction Assessments were applied before and after training, in addition to a resident physician perception ques-tionnaire at the end of the training.Results: There was a significant difference in the resident's perception of experience and safety after initial train-ing. Most rated the proposal as good or excellent, considered teaching telemedicine relevant and that this experi-ence contributed to their learning on the subject.Conclusion: This study describes an innovative proposal for training in telemedicine. The preliminary results were encouraging, demonstrating the program's potential in training future pediatricians.
- Gastrointestinal manifestations are associated with severe pediatric COVID-19: A study in tertiary hospital(2021) PAULA, Camila Sanson Yoshino de; PALANDRI, Giovanna Gavros; FONSECA, Taiane Siraisi; VENDRAMINI, Thais Cristina Annibale; FARHAT, Sylvia Costa Lima; PEREIRA, Maria Fernanda Badue; LITVINOV, Nadia; TOMA, Ricardo Katsuya; SA, Fernanda Viveiros Moreira de; RODRIGUES, Katharina Reichmann; SCHVARTSMAN, Claudio; FORSAIT, Silvana; SAKITA, Neusa Keico; KANUNFRE, Kelly Aparecida; ROCHA, Mussya Cisotto; SANTOS, Emilly Henrique dos; OKAY, Thelma Suely; PINHO, Joao Renato Rebello; CARVALHO, Werther Brunow de; CARNEIRO-SAMPAIO, Magda; SILVA, Clovis Artur Almeida; MARQUES, Heloisa Helena de Sousa; EISENCRAFT, Adriana Pasmanik; ROSSI JUNIOR, Alfio; DELGADO, Artur Figueiredo; LEAL, Gabriela Nunes; FRAMIL, Juliana Valeria de Souza; GIBELLI, Maria Augusta Bento Cicaroni; JORGE, Patricia Palmeira Daenekas
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