MARIANA BATISTA PEREIRA
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conferenceObject Impact of optimizing of heart failure therapy in cardiac remodeling reversal: morphological, electrical and functional analysis(2013) SAMUEL, M. Avila; AYUB-FERREIRA, S. M.; ISSA, V. S.; VIEIRA, M. L. C.; GUIMARAES, G. V.; BELLI, J. F. C.; PEREIRA, M. B.; VALETTE, T. N.; BOCCHI, E. A.- The Real Importance of Pre-Existing Comorbidities on Long-Term Mortality after Acute Kidney Injury(2012) PEREIRA, Mariana B.; ZANETTA, Dirce M. T.; ABDULKADER, Regina C. R. M.Background: The causes of death on long-term mortality after acute kidney injury (AKI) have not been well studied. The purpose of the study was to evaluate the role of comorbidities and the causes of death on the long-term mortality after AKI. Methodology/Principal Findings: We retrospectively studied 507 patients who experienced AKI in 2005-2006 and were discharged free from dialysis. In June 2008 (median: 21 months after AKI), we found that 193 (38%) patients had died. This mortality is much higher than the mortality of the population of Sao Paulo City, even after adjustment for age. A multiple survival analysis was performed using Cox proportional hazards regression model and showed that death was associated with Khan's index indicating high risk [adjusted hazard ratio 2.54 (1.38-4.66)], chronic liver disease [1.93 (1.15-3.22)], admission to non-surgical ward [1.85 (1.30-2.61)] and a second AKI episode during the same hospitalization [1.74 (1.12-2.71)]. The AKI severity evaluated either by the worst stage reached during AKI (P=0.20) or by the need for dialysis (P=0.12) was not associated with death. The causes of death were identified by a death certificate in 85% of the non-survivors. Among those who died from circulatory system diseases (the main cause of death), 59% had already suffered from hypertension, 34% from diabetes, 47% from heart failure, 38% from coronary disease, and 66% had a glomerular filtration rate <60 previous to the AKI episode. Among those who died from neoplasms, 79% already had the disease previously. Conclusions: Among AKI survivors who were discharged free from dialysis the increased long-term mortality was associated with their pre-existing chronic conditions and not with the severity of the AKI episode. These findings suggest that these survivors should have a medical follow-up after hospital discharge and that all efforts should be made to control their comorbidities.
- Carambola como causa de lesão renal aguda(2014) SCARANELLO, Karilla Lany; ALVARES, Valeria Regina de Cristo; CARNEIRO, Daniely Maria Queiroz; BARROS, Flávio Henrique Soares; GENTIL, Thais Marques Sanches; THOMAZ, Myriam José; PEREIRA, Benedito Jorge; PEREIRA, Mariana Batista; LEME, Graziella Malzoni; DIZ, Mary Carla Esteves; LARANJA, Sandra Maria RodriguesThe star fruit belongs to the family Oxalidacea, species Averrhoa carambola. It is rich in minerals, vitamin A, C, B complex vitamins and oxalic acid. Recent studies show that the toxicity of the fruit differs between the patients and may be explained by single biological responses, age, and the intake quantity of the neurotoxin in each fruit in addition to glomerular filtration rate given by each patient. Additionally, the nephrotoxicity caused by the fruit is dose-dependent and may lead to the deposition of crystals of calcium oxalate intratubular, as well as by direct injury to the renal tubular epithelium, leading to apoptosis of the same. We report the case of a patient who after ingestion of the juice and fresh fruit, developed acute renal failure requiring dialysis, evolving with favourable outcome and recovery of renal function.
- Comparison of screening methods for conductive hearing loss identification in children: low-cost proposal(2012) SAMELLI, A. G.; RABELO, C. M.; PEREIRA, M. B.; PORTELA, M. N.; SANCHES, S. G. G.; NEVES-LOBO, I. F.Objective To evaluate the effectiveness of two screening methods (imitanciometry screening and questionnaire) to identify children at risk for conductive hearing loss, comparing this data with complete audiologic evaluation. Methods Of 507 children aged between three and six, 111 completed all procedures. The observational methods used were: imitanciometry screening, a questionnaire to identify risk factors for hearing loss and complete audiologic evaluation. Results obtained in the first two instruments were compared with results from complete audiologic evaluation (gold standard). From these comparisons, sensitivity and specificity, accuracy, positive and negative predictive values, and odds ratio were determined for the two screening methods and for the combination of both methods. Results The two methods applied in series (questionnaire and after imitanciometry screening) showed a greater odds ratio and better correlation between sensitivity and proportion of false-positives (ROC curve). Conclusion Combining the two tests in series improved screening accuracy. This combination was the best tool for identifying children at risk for conductive hearing loss.