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
10 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 10
- 2018 recommendations for the management of community acquired pneumonia(2019) CORREA, Ricardo de Amorim; COSTA, Andre Nathan; LUNDGREN, Fernando; MICHELIN, Lessandra; FIGUEIREDO, Mara Rubia; HOLANDA, Marcelo; GOMES, Mauro; TEIXEIRA, Paulo Jose Zimermann; MARTINS, Ricardo; SILVA, Rodney; ATHANAZIO, Rodrigo Abensur; SILVA, Rosemeri Maurici da; PEREIRA, Monica Corso
- Itraconazole Serum Trough Concentrations Using Oral Capsules for the Treatment of Chronic Pulmonary Aspergillosis: What is the Target?(2023) OLIVEIRA, Vitor Falcao de; TABORDA, Mariane; ARCIERI, Vitor Ciampone; KRUSCHEWSKY, Wdson Luis Lima; COSTA, Andre Nathan; DUARTE, Nilo Jose Coelho; ROMANO, Paschoalina; EBNER, Persio de Almeida Rezende; MAGRI, Adriana Satie Goncalves Kono; ABDALA, Edson; LEVIN, Anna S. S.; MAGRI, Marcello Mihailenko ChavesBackgroundIn regions where there is only itraconazole capsule as a therapeutic option for treatment of chronic pulmonary aspergillosis (CPA), measuring the serum concentrations becomes even more important for therapeutic success.ObjectiveEvaluate the initial itraconazole serum trough concentrations after the administration of oral capsule of itraconazole for the treatment of CPA.MethodsThe measurement was performed at least 7-days after initiation of therapy. The standard treatment at our institution was a 200 mg capsule every 12 h. We defined that an adequate serum trough concentration of itraconazole during treatment was 1-4 mg/L.ResultsThis study recruited 28 patients. The median value was 0.30 mg/L (IQR 0.01-0.70). Only 11% (n = 3) had adequate serum concentrations based on guideline recommendation. All patients with clinical deterioration had itraconazole serum levels <= 0.8 mg/L.ConclusionThe initial serum concentrations of itraconazole after capsule formulation administration were low. Increasing the dose should be considered when the itraconazole concentration is low, especially if it is <= 0.8 mg/L, and the patient presents with clinical deterioration. Larger studies are needed to evaluate the adequate concentrations recommended for CPA.
- Sensitivity of Antigen, Serology, and Microbiology Assays for Diagnosis of the Subtypes of Chronic Pulmonary Aspergillosis at a Teaching Hospital in Sao Paulo, Brazil(2023) OLIVEIRA, Vitor Falcao de; VIANA, Joshua Araujo; SAWAMURA, Marcio Valente Yamada; MAGRI, Adriana Satie Goncalves Kono; COSTA, Andre Nathan; ABDALA, Edson; MARIANI, Alessandro Wasum; BENARD, Gil; MAGRI, Marcello Mihailenko ChavesChronic pulmonary aspergillosis (CPA) is divided into five subtypes. The diagnosis of CPA is complicated due to poor sensitivity of the laboratory tests. Diagnostic performance of different antigen, serological, and microbiologi-cal methods in subtypes of CPA is unknown. The purpose of this study was to evaluate the diagnostic performance in different subtypes of CPA. A total of 91 participants with CPA were included, and the study was performed at Hospital das Clinicas of University of Sao Paulo. Bronchoalveolar lavage galactomannan (73%, 11/15), serology by immunodiffu-sion test (81%, 61/75), and histology (78%, 39/50) had the best sensitivity. The counterimmunoelectrophoresis (CIE) titers had a significant statistical difference between the CPA subtypes (P < 0.001), in which the forms chronic fibrosing pulmonary aspergillosis (CFPA) and subacute invasive aspergillosis (SAIA) had higher titers: 1/64 (interquartile range [IQR]: 1/32-1/256) and 1/64 (1/32-1/128).C-reactive protein generally presented lower values (median 15 mg/L, IQR: 6-33), with higher values in SAIA and lower values for Aspergillus nodule. Overall, we found a low diagnostic sensitivity of current tests. Regarding the CPA subtypes, we did not find great differences in the performance of the tests, but it is observed that the inflammatory markers and CIE titers tend to be higher in forms of the more extensive lung parenchyma involvement, such as SAIA and CFPA.
- Recommended for the management of pneumonia acquired in the community 2018 (vol, 45, pg, 405, 2018)(2018) CORREA, Ricardo de Amorim; COSTA, Andre Nathan; LUNDGREN, Fernando; MICHELIN, Lessandra; FIGUEIREDO, Mara Rubia; HOLANDA, Marcelo; GOMES, Mauro; TEIXEIRA, Paulo Jose Zimermann; MARTINS, Ricardo; SILVA, Rodney; ATHANAZIO, Rodrigo Abensur; SILVA, Rosemeri Maurici da; PEREIRA, Monica Corso
conferenceObject Cryobiopsy in the Diagnosis of Lung Allograft Rejection: Brazilian Case Series(2022) BELON, Carlos E. F.; OKUNO, Elissa A.; CAMPOS, Silvia V.; RODRIGUES, Ascedio J.; LIMA, Evelisse; SCORDAMAGLIO, Paulo R.; CAMARGO, Priscila C. L. B.; TEIXEIRA, Ricardo H. O. B.; CARRARO, Rafael M.; COSTA, Andre N.; PIRES, Juliana P.; REIS, Flavio P.; FERNANDES, Lucas M.; ABDALLA, Luis G.; FERNANDES, Paulo M. P.; FILHO, Mauro R.; SANTOS, Samuel L.- Epipericardial fat necrosis: increasing the rate of diagnosis by disseminating knowledge within a single institution(2018) GIASSI, Karina de Souza; COSTA, André Nathan; KAIRALLA, Ronaldo Adib; PARGA FILHO, José Rodrigues
- Brazilian initial experience with lung transplantation due to irreversible lung fibrosis post-COVID-19 in a national reference center: a cohort study(2022) REIS, Flavio Pola dos; FERNANDES, Lucas Matos; ABDALLA, Luis Gustavo; CAMPOS, Silvia Vidal; CAMARGO, Priscila Cilene Leon Bueno de; SANTOS, Samuel Lucas dos; AGUIAR, Ivana Teixeira de; PIRES, Juliana Patricia; COSTA, Andre Nathan; CARRARO, Rafael Medeiros; TEIXEIRA, Ricardo Henrique de Oliveira Braga; PEGO-FERNANDES, Paulo ManuelBACKGROUND: Lung transplantation (LTx) has been discussed as an option for treating irreversible lung fibrosis post-coronavirus disease 2019 (COVID-19), in selected cases. OBJECTIVES: To report on the initial experience and management of end-stage lung disease due to COVID-19 at a national center reference in Brazil. DESIGN AND SETTING: Cohort study conducted at a national reference center for lung transplantation. METHODS: Medical charts were reviewed regarding patients'demographics and pre-COVID-19 characteristics, post-LTx due to COVID-19. RESULTS: Between March 2020 and September 2021, there were 33 cases of LTx. During this period, we evaluated 11 cases of severe COVID-19-related acute respiratory distress syndrome (ARDS) that were potentially candidates for LTx. Among these, LTx was only indicated for three patients ( 9.1%). All of these patients were on venovenous extracorporeal membrane oxygenation ( ECMO), and the procedure that they underwent was central venoarterial ECMO. All three patients were still alive after the first 30 postoperative days. However, patient #1 and patient #2 subsequently died due to fungal sepsis on the 47th and 52nd postoperative days, respectively. Patient #3 was discharged on the 30th postoperative day. CONCLUSIONS: LTx is feasible among these complex patients. Survival over the first 30 days was 100%, and this favors surgical feasibility. Nonetheless, these were critically ill patients.
- Endobronchial histoplasmosis mimicking primary bronchogenic carcinoma during the COVID-19 pandemic(2022) D'AMBROSIO, Paula Duarte; COSTA, Andre Nathan; SCORDAMAGLIO, Paulo Rogerio; TERRA, Ricardo Mingarini
- Challenges, Characteristics, and Outcomes of Chronic Pulmonary Aspergillosis: A 11-Year Experience in A Middle-Income Country(2023) OLIVEIRA, Vitor Falcao de; VIANA, Joshua Araujo; SAWAMURA, Marcio Valente Yamada; MAGRI, Adriana Satie Goncalves Kono; BENARD, Gil; COSTA, Andre Nathan; ABDALA, Edson; MARIANI, Alessandro Wasum; MAGRI, Marcello Mihailenko ChavesObjectives Chronic pulmonary aspergillosis (CPA) is a research priority in fungal diseases with a need for new studies to reduce misdiagnosis with more common diseases, discuss improvement in diagnostic methods and better characterize gaps in antifungal and surgical treatments to improve clinical outcomes. Methods In this retrospective study, we reviewed medical records of patients diagnosed with CPA from January 2010 to June 2021 at University of Sao Paulo, Sao Paulo, Brazil. We evaluated clinical characteristics, radiological findings, serology, treatment, and outcomes. Results The study included 91 participants, with 43 (47.3%) patients who underwent surgery and 69 (75.8%) received antifungal therapy. We found a predominance of middle-aged adults (median 51 years), males (n = 58, 64%) with lower BMI (median 21.3 kg/m(2)). The most common underlying lung disease was pulmonary tuberculosis (n = 70, 76.9%). The commonest symptoms were cough (n = 67, 74%), haemoptysis, and dyspnea (n = 63, 70%). The most common chest computerized tomography abnormalities were cavity (n = 86, 94.5%), with a predominance of mycetomas (n = 78, 91%). The serology was positive in 81% (61/75). The one-year mortality was low (3.3%). Clinical improvement and stability occurred in 89% of participants for constitucional symptoms and 86% for pulmonary symptoms. While serological improvement and stability occurred in 71%. Radiological improvement and stability occurred in 75%. Conclusion We observed a good outcome after 1-year follow-up, in which the majority had improvement or stability of pulmonary and constitutional symptoms, decrease in CIE titers and low mortality.
- 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.