LUZ MARINA GOMEZ GOMEZ
Projetos de Pesquisa
Unidades Organizacionais
LIM/51 - Laboratório de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina
4 resultados
Resultados de Busca
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- 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.
- Evening preference correlates with regional brain volumes in the anterior occipital lobe(2021) EVANS, SL.; LEOCADIO-MIGUEL, M. A.; TAPOROSKI, T. P.; GOMEZ, L. M.; HORIMOTO, A. R. V. R.; ALKAN, E.; BEIJAMINI, F.; PEDRAZZOLI, M.; KNUTSON, K. L.; KRIEGER, J. E.; VALLADA, H. P.; STERR, A.; PEREIRA, A. C.; NEGRAO, A. B.; SCHANTZ, M. vonChronotype or diurnal preference is a questionnaire-based measure influenced both by circadian period and by the sleep homeostat. In order to further characterize the biological determinants of these measures, we used a hypothesis-free approach to investigate the association between the score of the morningness-eveningness questionnaire (MEQ) and the Munich chronotype questionnaire (MCTQ), as continuous variables, and volumetric measures of brain regions acquired by magnetic resonance imaging (MRI). Data were collected from the Baependi Heart Study cohort, based in a rural town in South-Eastern Brazil. MEQ and anatomical 1.5-T MRI scan data were available from 410 individuals, and MCTQ scores were available from a subset of 198 of them. The average MEQ (62.2 +/- 10.6) and MCTQ (average MSFsc 201 +/- 85 min) scores were suggestive of a previously reported strong general tendency toward morningness in this community. Setting the significance threshold at P > .002 to account for multiple comparisons, we observed a significant association between lower MEQ score (eveningness) and greater volume of the left anterior occipital sulcus (beta = -0.163, p = .001) of the occipital lobe. No significant associations were observed for MCTQ. This may reflect the smaller dataset for MCTQ, and/or the fact that MEQ, which asks questions about preferred timings, is more trait-like than the MCTQ, which asks questions about actual timings. The association between MEQ and a brain region dedicated to visual information processing is suggestive of the increasingly recognized fluidity in the interaction between visual and nonvisual photoreception and the circadian system, and the possibility that chronotype includes an element of masking.
- Double-blind, Randomized, Placebo-controlled Trial With N-acetylcysteine for Treatment of Severe Acute Respiratory Syndrome Caused by Coronavirus Disease 2019 (COVID-19)(2021) ALENCAR, Julio Cesar Garcia de; MOREIRA, Claudia de Lucena; MULLER, Alicia Dudy; CHAVES, Cleuber Esteves; FUKUHARA, Marina Akemi; SILVA, Elizabeth Aparecida da; MIYAMOTO, Maria de Fatima Silva; PINTO, Vanusa Barbosa; BUENO, Caue Gasparotto; LAZAR NETO, Felippe; GOMEZ, Luz Marina Gomez; MENEZES, Maria Clara Saad; MARCHINI, Julio Flavio Meirelles; MARINO, Lucas Oliveira; BRANDAO NETO, Rodrigo Antonio; SOUZA, Heraldo PossoloBackground: A local increase in angiotensin 2 after inactivation of angiotensin-converting enzyme 2 by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may induce a redox imbalance in alveolar epithelium cells, causing apoptosis, increased inflammation and, consequently, impaired gas exchange. We hypothesized that N-acetylcysteine (NAC) administration could restore this redox homeostasis and suppress unfavorable evolution in patients with coronavirus disease 2019 (COVID-19). Methods: This was a double-blind, randomized, placebo-controlled, single-center trial conducted at the Emergency Department of Hospital das Clinicas, Sao Paulo, Brazil, to determine whether NAC in high doses can avoid respiratory failure in patients with COVID-19. We enrolled 135 patients with severe COVID-19 (confirmed or suspected), with an oxyhemoglobin saturation <94% or respiratory rate >24 breaths/minute. Patients were randomized to receive NAC 21 g (similar to 300 mg/kg) for 20 hours or dextrose 5%. The primary endpoint was the need for mechanical ventilation. Secondary endpoints were time of mechanical ventilation, admission to the intensive care unit (ICU), time in ICU, and mortality. Results: Baseline characteristics were similar between the 2 groups, with no significant differences in age, sex, comorbidities, medicines taken, and disease severity. Also, groups were similar in laboratory tests and chest computed tomography scan findings. Sixteen patients (23.9%) in the placebo group received endotracheal intubation and mechanical ventilation, compared with 14 patients (20.6%) in the NAC group (P = .675). No difference was observed in secondary endpoints. Conclusions: Administration of NAC in high doses did not affect the evolution of severe COVID-19.
- Lower peripheral blood Toll-like receptor 3 expression is associated with an unfavorable outcome in severe COVID-19 patients(2021) MENEZES, Maria Clara Saad; VEIGA, Alicia Dudy Muller; LIMA, Thais Martins de; ARIGA, Suely Kunimi Kubo; BARBEIRO, Hermes Vieira; MOREIRA, Claudia de Lucena; PINTO, Agnes Araujo Sardinha; BRANDAO, Rodrigo Antonio; MARCHINI, Julio Flavio; ALENCAR, Julio Cesar; MARINO, Lucas Oliveira; GOMEZ, Luz Marina; CAMARA, Niels Olsen Saraiva; SOUZA, Heraldo P.The role of innate immunity in COVID-19 is not completely understood. Therefore, this study explored the impact of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection on the expression of Pattern Recognition Receptors (PRRs) in peripheral blood cells and their correlated cytokines. Seventy-nine patients with severe COVID-19 on admission, according to World Health Organization (WHO) classification, were divided into two groups: patients who needed mechanical ventilation and/or deceased (SEVERE, n=50) and patients who used supplementary oxygen but not mechanical ventilation and survived (MILD, n=29); a control group (CONTROL, n=17) was also enrolled. In the peripheral blood, gene expression (mRNA) of Toll-like receptors (TLRs) 3, 4, 7, 8, and 9, retinoic-acid inducible gene I (RIGI), NOD-like receptor family pyrin domain containing 3 (NLRP3), interferon alpha (IFN-alpha), interferon beta (IFN-beta), interferon gamma (IFN-gamma), interferon lambda (IFN-lambda), pro-interleukin(IL)-1 beta (pro-IL-1 beta), and IL-18 was determined on admission, between 5-9 days, and between 10-15 days. Circulating cytokines in plasma were also measured. When compared to the COVID-19 MILD group, the COVID-19 SEVERE group had lower expression of TLR3 and overexpression of TLR4.