SHIEH HUEI HSIN
Projetos de Pesquisa
Unidades Organizacionais
PAINT-62, Hospital Universitário
4 resultados
Resultados de Busca
Agora exibindo 1 - 4 de 4
- Risk factors for neurological complications and sequelae in childhood acute bacterial meningitis(2012) SHIEH, Huei H.; RAGAZZI, Selma L. B.; GILIO, Alfredo E.
- Analysis of invasive pneumonia-causing strains of Streptococcus pneumoniae: serotypes and antimicrobial susceptibility(2011) YOSHIOKA, Cristina R. M.; MARTINEZ, Marina B.; BRANDILEONE, Maria C. C.; RAGAZZI, Selma B.; GUERRA, Maria L. L. S.; SANTOS, Silvia R.; SHIEH, Huei H.; GILIO, Alfredo E.Objectives: To identify the most common pneumococcal serotypes in children hospitalized with invasive pneumonia, correlate isolated serotypes with those included in conjugate vaccines, and ascertain the sensitivity of the isolated pneumococcal strains to penicillin and other antibiotics. Methods: From January 2003 to October 2008, a retrospective study of hospitalized children with a diagnosis of Streptococcus pneumoniae pneumonia was conducted at the university hospital of Universidade de Sao Paulo. Criteria for inclusion were: age greater than 29 days and less than 15 years, radiological and clinical diagnosis of pneumonia, and isolation of Streptococcus pneumoniae in blood cultures and/or pleural effusion. Results: The study included 107 children. The most common serotypes were 14 (36.5%), 1 (16%), 5 (14.6%), 6B (6.3%) and 3 (4.2%). The proportion of identified serotypes contained in the heptavalent, 10-valent and 13-valent conjugate vaccines was 53.1, 86.5, and 96.9%, respectively. Pneumococcal strains were sensitive to penicillin (minimum inhibitory concentration, MIC <= 2 mu g/mL) in 100 cases (93.5%) and displayed intermediate resistance (MIC = 4 mu g/mL) in 7 cases (6.5%). No strains were penicillin-resistant (MIC >= 8 mu g/mL) according to the Clinical and Laboratory Standards Institute 2008 standards. Tested isolates were highly sensitive to vancomycin, rifampicin, ceftriaxone, clindamycin, erythromycin, and chloramphenicol. Conclusions: Our results confirm a significant potential impact of conjugate vaccines, mainly 10-valent and 13-valent, on invasive pneumonia. Furthermore, susceptibility testing results show that penicillin is still the treatment of choice for invasive pneumonia in our setting.
- Epidemiology and Outcomes of Acute Respiratory Distress Syndrome in Children According to the Berlin Definition: A Multicenter Prospective Study(2015) BARREIRA, Eliane R.; MUNOZ, Gabriela O. C.; CAVALHEIRO, Priscilla O.; SUZUKI, Adriana S.; DEGASPARE, Natalia V.; SHIEH, Huei H.; MARTINES, Joao A. D. S.; FERREIRA, Juliana C.; LANE, Christianne; CARVALHO, Werther B.; GILIO, Alfredo E.; PRECIOSO, Alexander R.Objectives: In 2012, a new acute respiratory distress syndrome definition was proposed for adult patients. It was later validated for infants and toddlers. Our objective was to evaluate the prevalence, outcomes, and risk factors associated with acute respiratory distress syndrome in children up to 15 years according to the Berlin definition. Design: A prospective, multicenter observational study from March to September 2013. Setting: Seventy-seven PICU beds in eight centers: two private hospitals and six public academic hospitals in Brazil. Patients: All children aged 1 month to 15 years admitted to the participating PICUs in the study period. Interventions: None. Measurements and Main Results: All children admitted to the PICUs were daily evaluated for the presence of acute respiratory distress syndrome according to the American-European - Consensus Conference and Berlin definitions. Of the 562 patients included, acute respiratory distress syndrome developed in 57 patients (10%) and 58 patients (10.3%) according to the Berlin definition and the American-European Consensus Conference definition, respectively. Among patients with acute respiratory distress syndrome according to the Berlin definition, nine patients (16%) were mild, 21 (37%) were moderate, and 27 (47%) were severe. Compared with patients without acute respiratory distress syndrome, patients with acute respiratory distress syndrome had significantly higher severity scores, longer PICU and hospital length of stay, longer duration of mechanical ventilation, and higher mortality (p < 0.001). The presence of two or more comorbidities and admission for medical reasons were associated with development of acute respiratory distress syndrome. Comparisons across the three the Berlin categories showed significant differences in the number of ventilator-free days (21, 20, and 5 d, p = 0.001) and mortality for severe acute respiratory distress syndrome (41%) in comparison with mild (0) and moderate (15%) acute respiratory distress syndrome(p = 0.02). No differences in PICU or hospital stay were observed across the groups. Conclusions: The Berlin definition can identify a subgroup of patients with distinctly worse outcomes, as shown by the increased mortality and reduced number of ventilator-free days in pediatric patients with severe acute respiratory distress syndrome.
- Double-Blind Prospective Randomized Controlled Trial of Dopamine Versus Epinephrine as First-Line Vasoactive Drugs in Pediatric Septic Shock(2015) VENTURA, Andrea M. C.; SHIEH, Huei Hsin; BOUSSO, Albert; GOES, Patricia F.; FERNANDES, Iracema de Cassia F. O.; SOUZA, Daniela C. de; PAULO, Rodrigo Locatelli Pedro; CHAGAS, Fabiana; GILIO, Alfredo E.Objectives: The primary outcome was to compare the effects of dopamine or epinephrine in severe sepsis on 28-day mortality; secondary outcomes were the rate of healthcare-associated infection, the need for other vasoactive drugs, and the multiple organ dysfunction score. Design: Double-blind, prospective, randomized controlled trial from February 1, 2009, to July 31, 2013. Setting: PICU, Hospital Universitario da Universidade de SAo Paulo, Brazil. Patients: Consecutive children who are 1 month to 15 years old and met the clinical criteria for fluid-refractory septic shock. Exclusions were receiving vasoactive drug(s) prior to hospital admission, having known cardiac disease, having already participated in the trial during the same hospital stay, refusing to participate, or having do-not-resuscitate orders. Interventions: Patients were randomly assigned to receive either dopamine (5-10 g/kg/min) or epinephrine (0.1-0.3 g/kg/min) through a peripheral or intraosseous line. Patients not reaching predefined stabilization criteria after the maximum dose were classified as treatment failure, at which point the attending physician gradually stopped the study drug and started another catecholamine. Measurements and Main Results: Physiologic and laboratory data were recorded. Baseline characteristics were described as proportions and mean ( sd) and compared using appropriate statistical tests. Multiple regression analysis was performed, and statistical significance was defined as a p value of less than 0.05. Baseline characteristics and therapeutic interventions for the 120 children enrolled (63, dopamine; 57, epinephrine) were similar. There were 17 deaths (14.2%): 13 (20.6%) in the dopamine group and four (7%) in the epinephrine group (p = 0.033). Dopamine was associated with death (odds ratio, 6.5; 95% CI, 1.1-37.8; p = 0.037) and healthcare-associated infection (odds ratio, 67.7; 95% CI, 5.0-910.8; p = 0.001). The use of epinephrine was associated with a survival odds ratio of 6.49. Conclusions: Dopamine was associated with an increased risk of death and healthcare-associated infection. Early administration of peripheral or intraosseous epinephrine was associated with increased survival in this population. Limitations should be observed while interpreting these results.