ANDRE NATHAN COSTA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
4 resultados
Resultados de Busca
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- Effect of tocilizumab on clinical outcomes at 15 days in patients with severe or critical coronavirus disease 2019: randomised controlled trial(2021) VEIGA, Viviane C.; PRATS, Joao A. G. G.; FARIAS, Danielle L. C.; ROSA, Regis G.; DOURADO, Leticia K.; ZAMPIERI, Fernando G.; MACHADO, Flavia R.; LOPES, Renato D.; BERWANGER, Otavio; AZEVEDO, Luciano C. P.; AVEZUM, Alvaro; LISBOA, Thiago C.; ROJAS, Salomon S. O.; COELHO, Juliana C.; LEITE, Rodrigo T.; CARVALHO, Julio C.; ANDRADE, Luis E. C.; SANDES, Alex F.; PINTAO, Maria C. T.; CASTRO JR., Claudio G.; SANTOS, Sueli V.; ALMEIDA, Thiago M. L. de; COSTA, Andre N.; GEBARA, Otavio C. E.; FREITAS, Flavio G. Rezende de; PACHECO, Eduardo S.; MACHADO, David J. B.; MARTIN, Josiane; CONCEICAO, Fabio G.; SIQUEIRA, Suellen R. R.; DAMIANI, Lucas P.; ISHIHARA, Luciana M.; SCHNEIDER, Daniel; SOUZA, Denise de; CAVALCANTI, Alexandre B.; SCHEINBERG, PhillipOBJECTIVE To determine whether tocilizumab improves clinical outcomes for patients with severe or critical coronavirus disease 2019 (covid-19). DESIGN Randomised, open label trial. SETTING Nine hospitals in Brazil, 8 May to 17 July 2020. PARTICIPANTS Adults with confirmed covid-19 who were receiving supplemental oxygen or mechanical ventilation and had abnormal levels of at least two serum biomarkers (C reactive protein, D dimer, lactate dehydrogenase, or ferritin). The data monitoring committee recommended stopping the trial early, after 129 patients had been enrolled, because of an increased number of deaths at 15 days in the tocilizumab group. INTERVENTIONS Tocilizumab (single intravenous infusion of 8 mg/kg) plus standard care (n=65) versus standard care alone (n=64). MAIN OUTCOME MEASURE The primary outcome, clinical status measured at 15 days using a seven level ordinal scale, was analysed as a composite of death or mechanical ventilation because the assumption of odds proportionality was not met. RESULTS A total of 129 patients were enrolled (mean age 57 (SD 14) years; 68% men) and all completed follow-up. All patients in the tocilizumab group and two in the standard care group received tocilizumab. 18 of 65 (28%) patients in the tocilizumab group and 13 of 64 (20%) in the standard care group were receiving mechanical ventilation or died at day 15 (odds ratio 1.54, 95% confidence interval 0.66 to 3.66; P=0.32). Death at 15 days occurred in 11 (17%) patients in the tocilizumab group compared with 2 (3%) in the standard care group (odds ratio 6.42, 95% confidence interval 1.59 to 43.2). Adverse events were reported in 29 of 67 (43%) patients who received tocilizumab and 21 of 62 (34%) who did not receive tocilizumab. CONCLUSIONS In patients with severe or critical covid-19, tocilizumab plus standard care was not superior to standard care alone in improving clinical outcomes at 15 days, and it might increase mortality
conferenceObject Coronary Artery Disease Screening for Lung Transplant Candidates(2021) LIMA, M. L.; REIS, F. Pola Dos; PIRES, J. P.; CAMPOS, S. V.; ABDALLA, L. G.; FERNANDES, L. M.; CURY, C. B.; TEIXEIRA, R. O.; COSTA, A. N.; CARRARO, R. M.; PEGO-FERNANDES, P. M.conferenceObject Incidence and Outcomes of Tuberculosis among Thoracic Organ Transplant Recipients in an Endemic Country-15 Years of Evaluation(2021) CAMPOS, S. V.; REIS, F. Pola Dos; PIRES, J. P.; LIMA, M. L.; ABDALLA, L. G.; CURY, C. B.; FERNANDES, L. M.; TEIXEIRA, R. B.; COSTA, A. N.; CARRARO, R. M.; BACAL, F.; PEGO-FERNANDES, P. M.- A Case-Control Study of Paracoccidioidomycosis in Women: The Hormonal Protection Revisited(2021) BRITO, Tereza Graciano Nascimento de; TABORDA, Mariane; PROVENCI, Bruna; COSTA, Andre Nathan; BENARD, GilClinical observations have long suggested that women are protected against paracoccidioidomycosis. 17 beta-estradiol, the main female estrogen, inhibits conidia-to-yeast transformation (C-to-Y), which is required for the infection establishment. However, experiments in murine models have yielded conflicting results, suggesting that C-to-Y inhibition, alone, fails to explain the female-associated protection and that sexual hormones may also act by modulating the host's immune responses. Therefore, this issue remains unsolved. Strikingly, no studies have compared the severity of paracoccidioidomycosis between men and women. This retrospective case-control study compared 36 women with 72 age-matched men for clinical-demographic, laboratory, and chest imaging findings. Overall, paracoccidioidomycosis in women presented the main features described in the acute/subacute and chronic forms seen in men. Women also showed similar demographic features and clinical-laboratory and imaging severity scores as men. We additionally reviewed 58 paracoccidioidin skin test surveys undertaken by volunteers from endemic areas. Data accumulated from 10.873 tests showed that females and males are infected with similar magnitudes (21.9% vs. 25.2%) and that reactivity steadily increased with age, peaking after the age of 60. We discuss the paradox of similar infection rates but much lower disease prevalence in women, considering the current pathogenetic views of paracoccidioidomycosis, and we raise alternative hypotheses to account for this paradox.