LEWIS FLETCHER BUSS
Projetos de Pesquisa
Unidades Organizacionais
LIM/46 - Laboratório de Parasitologia Médica, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Accelerated vs regular approval, differences in study characteristics of lung cancer treatments approved by the US Food and Drug Administration(2020) RIBEIRO, Tatiane; BUSS, Lewis; ALI, Sanni; NOBRE, Moacyr- Serial interval distribution of SARS-CoV-2 infection in Brazil(2021) PRETE JR., Carlos A.; BUSS, Lewis; DIGHE, Amy; PORTO, Victor Bertollo; CANDIDO, Darlan da Silva; GHILARDI, Fabio; PYBUS, Oliver G.; OLIVEIRA, Wanderson K. de; CRODA, Julio H. R.; SABINO, Ester C.; FARIA, Nuno Rodrigues; DONNELLY, Christl A.; NASCIMENTO, Vitor H.
- Higher risk of death from COVID-19 in low-income and non-White populations of SAo Paulo, Brazil(2021) LI, Sabrina L.; PEREIRA, Rafael H. M.; JR, Carlos A. Prete; ZAREBSKI, Alexander E.; EMANUEL, Lucas; ALVES, Pedro J. H.; PEIXOTO, Pedro S.; V, Carlos K. Braga; SANTOS, Andreza Aruska de Souza; SOUZA, William M. de; BARBOSA, Rogerio J.; BUSS, Lewis F.; MENDRONE, Alfredo; ALMEIDA-NETO, Cesar de; FERREIRA, Suzete C.; SALLES, Nanci A.; MARCILIO, Izabel; WU, Chieh-Hsi; GOUVEIA, Nelson; NASCIMENTO, Vitor H.; SABINO, Ester C.; FARIA, Nuno R.; MESSINA, Jane P.IntroductionLittle evidence exists on the differential health effects of COVID-19 on disadvantaged population groups. Here we characterise the differential risk of hospitalisation and death in SAo Paulo state, Brazil, and show how vulnerability to COVID-19 is shaped by socioeconomic inequalities.MethodsWe conducted a cross-sectional study using hospitalised severe acute respiratory infections notified from March to August 2020 in the Sistema de Monitoramento Inteligente de SAo Paulo database. We examined the risk of hospitalisation and death by race and socioeconomic status using multiple data sets for individual-level and spatiotemporal analyses. We explained these inequalities according to differences in daily mobility from mobile phone data, teleworking behaviour and comorbidities.ResultsThroughout the study period, patients living in the 40% poorest areas were more likely to die when compared with patients living in the 5% wealthiest areas (OR: 1.60, 95% CI 1.48 to 1.74) and were more likely to be hospitalised between April and July 2020 (OR: 1.08, 95% CI 1.04 to 1.12). Black and Pardo individuals were more likely to be hospitalised when compared with White individuals (OR: 1.41, 95% CI 1.37 to 1.46; OR: 1.26, 95% CI 1.23 to 1.28, respectively), and were more likely to die (OR: 1.13, 95% CI 1.07 to 1.19; 1.07, 95% CI 1.04 to 1.10, respectively) between April and July 2020. Once hospitalised, patients treated in public hospitals were more likely to die than patients in private hospitals (OR: 1.40%, 95% CI 1.34% to 1.46%). Black individuals and those with low education attainment were more likely to have one or more comorbidities, respectively (OR: 1.29, 95% CI 1.19 to 1.39; 1.36, 95% CI 1.27 to 1.45).ConclusionsLow-income and Black and Pardo communities are more likely to die with COVID-19. This is associated with differential access to quality healthcare, ability to self-isolate and the higher prevalence of comorbidities.
- Intense SARS-CoV-2 transmission among affluent Manaus residents preceded the second wave of the epidemic in Brazil(2021) BUSS, Lewis F.; SABINO, Ester C.
- Healthcare-associated infections on the intensive care unit in 21 Brazilian hospitals during the early months of the coronavirus disease 2019 (COVID-19) pandemic: An ecological study(2023) PORTO, Ana Paula M.; BORGES, Igor C.; BUSS, Lewis; MACHADO, Anna; BASSETTI, Bil R.; COCENTINO, Brunno; BICALHO, Camila S.; CARRILHO, Claudia; RODRIGUES, Cristhieni; NETO, Eudes A. S.; GIRAO, Evelyne S.; PIASTRELLI, Filipe; SAPIENZA, Giovanna; VARKULJA, Glaucia; KOLBE, Karin; PASSOS, Luciana; ESTEVES, Patricia; GITIRANA, Pollyana; FEIJO, Regia D. F.; COUTINHO, Rosane L.; GUIMARAES, Thais; FERRAZ, Tiago L. L.; LEVIN, Anna S.; COSTA, Silvia F.Objective: The coronavirus disease 2019 (COVID-19) pandemic has caused a global health crisis and may have affected healthcare-associated infection (HAI) prevention strategies. We evaluated the impact of the COVID-19 pandemic on HAI incidence in Brazilian intensive care units (ICUs). Methods: In this ecological study, we compared adult patients admitted to the ICU from April through June 2020 (pandemic period) with the same period in 2019 (prepandemic period) in 21 Brazilian hospitals. We used the Wilcoxon signed rank-sum test in a pairwise analysis to compare the following differences between the pandemic and the prepandemic periods: microbiologically confirmed central-line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) incidence density (cases per 1,000 central line and ventilator days, respectively), the proportion of organisms that caused HAI, and antibiotic consumption (DDD). Results: We detected a significant increase in median CLABSI incidence during the pandemic: 1.60 (IQR, 0.44-4.20) vs 2.81 (IQR, 1.35-6.89) (P = .002). We did not detect a significant difference in VAP incidence between the 2 periods. In addition, we detected a significant increase in the proportion of CLABSI caused by Enterococcus faecalis and Candida spp during the pandemic, although only the latter retained statistical significance after correction for multiple comparisons. We did not detect a significant change in ceftriaxone, piperacillin-tazobactam, meropenem, or vancomycin consumption between the studied periods. Conclusions: There was an increase in CLABSI incidence in Brazilian ICUs during the first months of COVID-19 pandemic. Additionally, we detected an increase in the proportion of CLABSI caused by E. faecalis and Candida spp during this period. CLABSI prevention strategies must be reinforced in ICUs during the COVID-19 pandemic.
- Surveillance of hemorrhagic fever and/or neuroinvasive disease: challenges of diagnosis(2021) ARAUJO, Leonardo Jose Tadeu de; GONZALEZ, Lorenzo Lang; BUSS, Lewis Fletcher; GUERRA, Juliana Mariotti; GOMEZ, David Salas; FERREIRA, Camila Santos da Silva; CIRQUEIRA, Cinthya Santos; GHILLARDI, Fabio; WITKIN, Steven S.; SABINO, Ester CerdeiraOBJECTIVE: To evaluate the performance of post mortem laboratory analysis in identifying the causes of hemorrhagic fever and/or neuroinvasive disease in deaths by arbovirus infection. METHODS: Retrospective cross-sectional study based on the differential analysis and final outcome obtained in patients whose samples underwent laboratory testing for arboviruses at the Pathology Center of the Adolfo Lutz Institute, in Sao Paulo, Brazil. RESULTS: Of the 1355 adults clinically diagnosed with hemorrhagic fever and/or neuroinvasive disease, the most commonly attributed cause of death and the most common final outcome was dengue fever. Almost half of the samples tested negative on all laboratory tests conducted. CONCLUSION: The failure to identify the causative agent in a great number of cases highlights a gap in the diagnosis of deaths of unknown etiology. Additional immunohistochemical and molecular assessments need to be added to the post-mortem protocol if all laboratory evaluations performed fail to identify a causative agent. While part of our findings may be due to technical issues related to sample fixation, better information availability when making the initial diagnosis is crucial. Including molecular approaches might lead to a significant advancement in diagnostic accuracy.
- Access to colposcopy in the state of Sao Paulo, Brazil: probabilistic linkage study of administrative data(2022) BUSS, Lewis Fletcher; CURY, Lise; RIBEIRO, Caroline Madalena; SILVA, Gulnar Azevedo e; ELUF NETO, JoseCervical cancer screening is a multistage process, therefore access to both the primary test and subsequent diagnostic procedures is essential. Considering women undergoing screening on the public health system in the state of Sao Paulo, Brazil, we aimed to estimate the proportion of women accessing colposcopy within six months of an abnormal smear result. We retrieved records from two administrative databases, the Information System on Uterine Cervical Cancer (SISCOLO) that contains smear results and the Outpatient Information System of the Brazilian Unified National Health System (SIA/SUS) that records colposcopies. A reference cohort consisted of women, aged 25 years or older, with an abnormal smear result between May 1, 2014, and June 30, 2014. We excluded prevalent cases. We linked the reference cohort and records in the SIA/SUS extending to December 31, 2014. After excluding prevalent cases, 1,761 women with abnormal cytology results were left. A total of 700 (39.8%) women were linked to a colposcopy record within the follow-up period; this dropped to 671 (38.1%) women when follow-up was censored at six months. We could notice a slightly higher attendance in women living in the metropolitan region of Sao Paulo compared with residents of the rest of the state. We found no association between colposcopy attendance and age or cytology class. These results emphasize that access to colposcopy in the public health system in Sao Paulo is limited. This compromises the quality of screening, and the issue needs to be prioritized in service planning.
conferenceObject Accelerated vs regular approval pathways: Differences in study characteristics in the approval of lung cancer treatments by the FDA from 2006 to 2018(2020) RIBEIRO, Tatiane; BUSS, Lewis; ALI, Sanni; NOBRE, Moacyr