LUZ MARINA GOMEZ GOMEZ
Projetos de Pesquisa
Unidades Organizacionais
LIM/51 - Laboratório de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina
13 resultados
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conferenceObject COVID-19 and H1N1 Pneumonia: Reanalysis and Comparison of Two Cohorts(2022) SORICE, E.; STERNLICHT, J.; SANTOS, L. B.; BRANDAO, R.; MARINO, L.; MARCHINI, J.; ALENCAR, J.; GOMEZ, L.; SOUZA, H.- Mortality and other outcomes of patients with coronavirus disease pneumonia admitted to the emergency department: A prospective observational Brazilian study(2021) BRANDAO NETO, Rodrigo A.; MARCHINI, Julio F.; MARINO, Lucas O.; ALENCAR, Julio C. G.; LAZAR NETO, Felippe; RIBEIRO, Sabrina; SALVETTI, Fernando V.; RAHHAL, Hassan; GOMEZ, Luz Marina Gomez; BUENO, Caue G.; FARIA, Carine C.; CUNHA, Victor P. da; PADRAO, Eduardo; VELASCO, Irineu T.; SOUZA, Heraldo Possolo deBackground The first cases of coronavirus disease (COVID-19) in Brazil were diagnosed in February 2020. Our Emergency Department (ED) was designated as a COVID-19 exclusive service. We report our first 500 confirmed COVID-19 pneumonia patients. Methods From 14 March to 16 May 2020, we enrolled all patients admitted to our ED that had a diagnosis of COVID-19 pneumonia. Infection was confirmed via nasopharyngeal swabs or tracheal aspirate PCR. The outcomes included hospital discharge, invasive mechanical ventilation, and in-hospital death, among others. Results From 2219 patients received in the ED, we included 506 with confirmed COVID-19 pneumonia. We found that 333 patients were discharged home (65.9%), 153 died (30.2%), and 20 (3.9%) remained in the hospital. A total of 300 patients (59.3%) required ICU admission, and 227 (44.9%) needed invasive ventilation. The multivariate analysis found age, number of comorbidities, extension of ground glass opacities on chest CT and troponin with a direct relationship with all-cause mortality, whereas dysgeusia, use of angiotensin converting enzyme inhibitor or angiotensin-ii receptor blocker and number of lymphocytes with an inverse relationship with all-cause mortality Conclusions This was a sample of severe patients with COVID-19, with 59.2% admitted to the ICU and 41.5% requiring mechanical ventilator support. We were able to ascertain the outcome in majority (96%) of patients. While the overall mortality was 30.2%, mortality for intubated patients was 55.9%. Multivariate analysis agreed with data found in other studies although the use of angiotensin converting enzyme inhibitor or angiotensin-ii receptor blocker as a protective factor could be promising but would need further studies.
- Distinct Outcomes in COVID-19 Patients with Positive or Negative RT-PCR Test(2022) MENEZES, Maria Clara Saad; PESTANA, Diego Vinicius Santinelli; FERREIRA, Juliana Carvalho; CARVALHO, Carlos Roberto Ribeiro de; FELIX, Marcelo Consorti; MARCILIO, Izabel Oliva; SILVA, Katia Regina da; COBELLO JUNIOR, Vilson Cobello; MARCHINI, Julio Flavio; ALENCAR, Julio Cesar; GOMEZ, Luz Marina Gomez; MAUA, Denis Deratani; SOUZA, Heraldo PossoloIdentification of the SARS-CoV-2 virus by RT-PCR from a nasopharyngeal swab sample is a common test for diagnosing COVID-19. However, some patients present clinical, laboratorial, and radiological evidence of COVID-19 infection with negative RT-PCR result(s). Thus, we assessed whether positive results were associated with intubation and mortality. This study was conducted in a Brazilian tertiary hospital from March to August of 2020. All patients had clinical, laboratory, and radiological diagnosis of COVID-19. They were divided into two groups: positive (+) RT-PCR group, with 2292 participants, and negative (-) RT-PCR group, with 706 participants. Patients with negative RT-PCR testing and an alternative most probable diagnosis were excluded from the study. The RT-PCR(+) group presented increased risk of intensive care unit (ICU) admission, mechanical ventilation, length of hospital stay, and 28-day mortality, when compared to the RT-PCR(-) group. A positive SARS-CoV-2 RT-PCR result was independently associated with intubation and 28 day in-hospital mortality. Accordingly, we concluded that patients with a COVID-19 diagnosis based on clinical data, despite a negative RT-PCR test from nasopharyngeal samples, presented more favorable outcomes than patients with positive RT-PCR test(s).
- Performance of NEWS, qSOFA, and SIRS Scores for Assessing Mortality, Early Bacterial Infection, and Admission to ICU in COVID-19 Patients in the Emergency Department(2022) ALENCAR, Julio; GOMEZ, Luz Marina Gomez; CORTEZ, Andre Lazzeri; SOUZA, Heraldo Possolo de; LEVIN, Anna Sara; SALOMAO, Matias ChiarastelliSARS-CoV-2 infection has a wide spectrum of presentations, from asymptomatic to pneumonia and sepsis. Risk scores have been used as triggers for protocols that combine several interventions for early management of sepsis. This study tested the accuracy of the score SIRS, qSOFA, and NEWS in predicting outcomes, including mortality and bacterial infection, in patients admitted to the emergency department (ED) during the COVID-19 pandemic. We described 2,473 cases of COVID-19 admitted to the ED of the largest referral hospital for severe COVID-19 in Brazil during the pandemic. SIRS, qSOFA and NEWS scores showed a poor performance as prognostic scores. However, NEWS score had a high sensitivity to predict in-hospital death (0.851), early bacterial infection (0.851), and ICU admission (0.868), suggesting that it may be a good screening tool for severe cases of COVID-19, despite its low specificity.
- Timing to Intubation COVID-19 Patients: Can We Put It Off until Tomorrow?(2022) ALENCAR, Julio Cesar Garcia de; STERNLICHT, Juliana Martes; VEIGA, Alicia Dudy Muller; MARCHINI, Julio Flavio Meirelles; FERREIRA, Juliana Carvalho; CARVALHO, Carlos Roberto Ribeiro de; MARCILIO, Izabel; SILVA, Katia Regina da; COBELLO JUNIOR, Vilson; FELIX, Marcelo Consorti; GOMEZ, Luz Marina Gomez; SOUZA, Heraldo Possolo de; MAUA, Denis DerataniBackground: The decision to intubate COVID-19 patients receiving non-invasive respiratory support is challenging, requiring a fine balance between early intubation and risks of invasive mechanical ventilation versus the adverse effects of delaying intubation. This present study analyzes the association between intubation day and mortality in COVID-19 patients. Methods: We performed a unicentric retrospective cohort study considering all COVID-19 patients consecutively admitted between March 2020 and August 2020 requiring invasive mechanical ventilation. The primary outcome was all-cause mortality within 28 days after intubation, and a Cox model was used to evaluate the effect of time from onset of symptoms to intubation in mortality. Results: A total of 592 (20%) patients of 3020 admitted with COVID-19 were intubated during study period, and 310 patients who were intubated deceased 28 days after intubation. Each additional day between the onset of symptoms and intubation was significantly associated with higher in-hospital death (adjusted hazard ratio, 1.018; 95% CI, 1.005-1.03). Conclusion: Among patients infected with SARS-CoV-2 who were intubated and mechanically ventilated, delaying intubation in the course of symptoms may be associated with higher mortality. Trial registration: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068).
conferenceObject Brazilian Airway Registry COoperation: The First 1,000 Emergency Intubations of the BARCO Study(2023) MAIA, I. W. A.; ALENCAR, J.; MARCHINI, J.; SILVA, E. L. O. J.; GOMES, L.; MARINO, L.; VAISBERG, V.; STANZANI, G.; NOGUEIRA, C.; KROEFF, B.; SOUZA, H.conferenceObject Brazilian Airway Registry COoperation: Comparison Between Intubations Performed by Emergency Physicians or Non-Emergency Physicians(2023) BETONI, H.; MAIA, I. W. A.; MARCHINI, J.; ALENCAR, J.; MARINO, L.; OLIVEIRA, G.; ALONSO, G.; STANZANI, G.; VAISBERG, V.; GOMEZ, L.; SOUZA, H.conferenceObject Brazilian Airway Registry COoperation: Comparison Between Intubations Performed With or Without Videolaryngoscope(2023) OLIVEIRA, G.; MAIA, I. W. A.; ALENCAR, J.; ALONSO, G.; BETONI, H.; GOMES, L.; MARCHINI, J.; MARINO, L.; SOUZA, H.; VAISBERG, V.; STANZANI, G.conferenceObject Neuronal Death-associated Proteins S100B, Tau and Neuron Specific Enolase Association to Sepsis-related Organ Dysfunction and Death in the Elderly: A Prospective Single Center Cohort Study(2022) VAISBERG, V.; ALENCAR, Garcia J. de; SARDINHA, A.; CARVALHO, M. de; GOMEZ, L. G.; ITO, G.; MAIA, I. A.; MARINO, L.; MARCHINI, J.; SOUZA, H. de- Brain injury biomarkers do not predict delirium in acutely ill older patients: a prospective cohort study(2023) ALENCAR, Julio Cesar Garcia de; GARCEZ, Flavia Barreto; PINTO, Agnes Araujo Sardinha; SILVA, Lucas Oliveira Junqueira e; SOLER, Lucas de Moraes; FERNANDEZ, Shirley Steffany Munoz; VAISBERG, Victor Van; GOMEZ, Luz Marina Gomez; RIBEIRO, Sandra Maria Lima; AVELINO-SILVA, Thiago Junqueira; SOUZA, Heraldo PossoloDelirium is a common, serious, and often preventable neuropsychiatric emergency mostly characterized by a disturbance in attention and awareness. Systemic insult and inflammation causing blood-brain-barrier (BBB) damage and glial and neuronal activation leading to more inflammation and cell death is the most accepted theory behind delirium's pathophysiology. This study aims to evaluate the relationship between brain injury biomarkers on admission and delirium in acutely ill older patients. We performed a prospective cohort study which analyzed plasma S100B levels at admission in elderly patients. Our primary outcome was delirium diagnosis. Secondary outcomes were association between S100B, NSE and Tau protein and delirium diagnosis and patients' outcomes (admissions to intensive care, length of hospital stay, and in-hospital mortality). We analyzed 194 patients, and 46 (24%) developed delirium, 25 on admission and 21 during hospital stay. Median of S100B at admission in patients who developed delirium was 0.16 and median was 0.16 in patients who didn't develop delirium (p: 0.69). Levels S100B on admission did not predict delirium in acutely ill elderly patients.Trial registration: The study was approved by the local institutional review board (CAPPESq, no. 77169716.2.0000.0068, October 11, 2017) and registered in Brazilian Clinical Trials Registry (ReBEC, no. RBR-233bct).