ARTUR FIGUEIREDO DELGADO

(Fonte: Lattes)
Índice h a partir de 2011
16
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina

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  • article 4 Citação(ões) na Scopus
    A vancomicina administrada na dose empírica garante a cobertura de pacientes pediátricos contra patógenos Gram-positivos?
    (2020) PIRES, Frederico Ribeiro; PAULA, Stefano Ivani de; DELGADO, Artur Figueiredo; CARVALHO, Werther Brunow de; DUARTE, Nilo José Coelho; MORALES JÚNIOR, Ronaldo; SANTOS, Silvia Regina Cavani Jorge
    Abstract Objective: To investigate the vancomycin effectiveness against gram-positive pathogens with the minimum inhibitory concentration of 1mg/L in pediatric patients based on the area under the curve and the minimum inhibitory concentration ratio > 400. Methods: A population of 22 pediatric patients (13 boys) admitted to the pediatric intensive care unit with preserved renal function was stratified in two groups (G1 < 7 years and G2 ≥ 7 years). After the fourth dose administered of vancomycin (10 - 15mg/kg every 6 hours) was administered, two blood samples were collected (third and fifth hours), followed by serum measurement by immunoassays to investigate the pharmacokinetics and antimicrobial coverage. Results: There was no difference between the groups regarding dose, trough level or area under the curve. Coverage against gram-positive pathogens with a minimum inhibitory concentration of 1mg/L occurred in only 46% of patients in both groups. The pharmacokinetics in both groups were altered relative to the reference values, and the groups differed in regard to increased total body clearance and shortening of the biological half-life, which were more pronounced in younger patients. Conclusion: A minimum empirical dose of 60mg/kg per day should be prescribed for pediatric patients in intensive care units with preserved renal function. The use of the ratio between the area under the curve and minimum inhibitory concentration in the evaluation of vancomycin coverage is recommended to achieve the desired outcome, since the pharmacokinetics are altered in these patients, which may impact the effectiveness of the antimicrobial.
  • article 11 Citação(ões) na Scopus
    Lymphocyte count as a sign of immunoparalysis and its correlation with nutritional status in pediatric intensive care patients with sepsis: A pilot study
    (2016) MANZOLI, Talita Freitas; DELGADO, Artur Figueiredo; TROSTER, Eduardo Juan; CARVALHO, Werther Brunow de; ANTUNES, Ana Caroline Barreto; MARQUES, Desiree Mayara; ZAMBERLAN, Patricia
    OBJECTIVES: Developing malnutrition during hospitalization is well recognized worldwide, and children are at a relatively higher risk for malnutrition than adults. Malnutrition can lead to immune dysfunction, which is associated with a higher mortality rate due to sepsis, the most frequent cause of death in pediatric intensive care units (PICUs). The aim of this study was to investigate whether malnourished patients are more likely to have relative or absolute lymphopenia and, consequently, worse prognoses. METHODS: We enrolled 14 consecutive patients with sepsis whose legal representatives provided written informed consent. Patients were classified as normal or malnourished based on anthropometric measurements. As an additional evaluation of nutritional status, serum albumin and zinc were measured on the 1 st and 7 th days of hospitalization. Lymphocyte count was also measured on the 1 st and 7 th days. Clinicaltrials. gov: NCT02698683. RESULTS: Malnutrition prevalence rates were 33.3% and 42.8% based on weight and height, respectively. Laboratory analyses revealed a reduction of serum albumin in 100% of patients and reduction of zinc in 93.3% of patients. A total of 35% of patients had fewer than 500 lymphocytes/mm(3) on their first day in the PICU. Lymphocyte counts and zinc concentrations significantly increased during hospitalization. CONCLUSIONS: Nutritional evaluations, including anthropometric measurements, were not correlated with lymphocyte counts. Lymphocyte counts concomitantly increased with zinc levels, suggesting that micronutrient supplementation benefits patients with sepsis.
  • article 5 Citação(ões) na Scopus
    Lipid profiles of children and adolescents with inflammatory response in a paediatric emergency department
    (2016) MURAMOTO, Giovana; DELGADO, Artur Figueiredo; SOUZA, Eloisa Correa de; GILIO, Alfredo Elias; CARVALHO, Werter Brunow de; MARANHAO, Raul Cavalcante
    Background: To compare the lipid profile between patients with and without inflammatory process in according nutritional status, gender and age. Methods: One hundred and twenty-four children and adolescents in the emergency department were separated into two groups according to the levels of C-reactive protein (CRP). Total cholesterol, high-density lipoprotein (HDL) and low-density lipoprotein (LDL), triglycerides (TG) and albumin in patients with CRP < 5 mg/L were compared with patients with CRP >= 5 mg/L. Nutritional status was assessed by anthropometric measurements. Results: Patients were mostly classified as well-nourished (76.5%) and had low levels of HDL (70%). There was no significant difference in lipid profile between the two groups of CRP. Linear regression analysis, however, it became clear that for each increase of 1 mg/L in the values of CRP expected an average reduction of 0.072 mg/dL of HDL, the 0.083 mg/dL of LDL, the 0.002 g/dL albumin and an average increase of 0.564 mg/dL of TG. Conclusions: Patients with an inflammatory process exhibit changes in the serum levels of the lipids HDL, LDL and TG that are related to the degree of inflammation. These changes occurred regardless of nutritional status.
  • article 9 Citação(ões) na Scopus
    The Latin American and Spanish Survey on Nutrition in Pediatric Intensive Care (ELAN-CIP2)
    (2019) CAMPOS-MINO, Santiago; CID, Jesus Lopez-Herce; DELGADO, Artur Figueiredo; BENAVIDES, Eliana Munoz; COSS-BU, Jorge A.; VILLAVICENCIO, Pedro Mestre; IRAMAIN, Ricardo; VILLARUEL, Sayani Valdez; NIEVA, Ana; VARGAS, Ana; LOPEZ, Pilar Arias; FERNANDEZ, Analia; SILVESTRE, Andrea; BOTTA, Priscila; TORRES, Silvio Fabio; COSTA, Caroline Abud Drumond; GARCIA, Pedro Celiny Ramos; PIVA, Jefferson; CABEDO, Maria Thereza De Cordes; LUGLIO, Michele; ZAMBERLAN, Patricia; GUZMAN, Gustavo; LOBOGUERRERO, Fanny Garcia; FERNANDEZ, Mauricio; CASSALETT, Gabriel; PEREZ, German; MONTES, Miguel Ruz; VELASQUEZ, Rocio Porras; PEREZ, Victor; CASTRO, Santiago Ramirez; VILLAVICENCIO, Pedro Mestre; WEGNER, Adriana; ORDENES, Nadia; DESSAUER, Bettina Von; CORS, Carolina; GONZALES, Marcos; BENAVIDES, Eliana Munoz; QUIROZ, Miguel Angel Saavedra; PERALTA, Felipe Verscheure; ROQUE, Jorge; ROSICH, Patricia Del Rosario; CAMPOS-MINO, Santiago; MONTALVO, Erika; PESANTES, Xavier Paez; BARQUIN, Luis Augusto Moya; RIVAS, Ricardo Alfredo Mack; ROMAN, Carlos; ORTIZ, Cesar Antonio Ramos; MONSREAL, Miguel Ignacio Flores; VILLARUEL, Sayani Valdez; GONZALEZ, Sonia Vargas; JIMENEZ, Hassel Jimmy; BRACHO, Carlos; SAMUDIO, Lissa; PALPAN, Beatriz Atachagua; PALOMO, Patricia; ESCALANTE-KANASHIRO, Raffo; ARANA, Rosa; NUNEZ, Antonio Rodriguez; CID, Jesus Lopez-Herce; FERNANDEZ, Yolanda Lopez; MENCHACA, Amanda; LOPEZ, Claudia Madrid
    Objective: To characterize the practices of nutritional support in Latin American and Spanish PICUs. Design: Survey with a questionnaire sent to Latin American Society of Pediatric Intensive Care members. Setting: PICUs of participant hospitals. Patients: Critically ill children between 1 month and 18 years old. Interventions: None. Measurements and Main Results: Forty-seven surveys from 17 countries were analyzed. Sixty-seven percent of PICUs were from university-affiliated hospitals, with a median of 380 admissions/yr. Sixty-eight percent and 48.9% had a nutritional support team and nutritional support protocol, respectively. Seventy-five percent completed nutritional evaluations, with 34.2% at admission. PICUs with high-volume admissions were likely to have a nutritional support team (p < 0.005), and university-affiliated hospitals showed a trend of having a nutritional support team (p = 0.056). Measured, estimated, and ideal weights were used in 75%, 14.6%, and 10.4%, respectively. Energy requirements were calculated using Holliday & Segar and Schofield equations in 90% of the PICUs; 43% used correction factors. Only three PICUs had indirect calorimetry. At day 3 of initiation of nutritional support, 57.3% of PICUs provided at least 50% of the calculated energy requirement, and 91.5% at day 5. Protein needs were estimated according to American Society for Parenteral and Enteral Nutrition and European Society for Clinical Nutrition and Metabolism/European Society for Paediatric Gastroenterology Hepatology and Nutrition guidelines in 55.3% and 40.4%, respectively. Enteral nutrition was the preferred feeding method, initiated in 97.7% at 48 hours. The feeding route was gastric (82.9%), by bolus (42.5%) or continuous (57.4%). Monitoring methods included gastric residual measurement in 55.3%. Enteral nutrition was discontinued in 82.8% when gastric residual was 50% of the volume. Prokinetics were used in 68%. More than half of PICUs used parenteral nutrition, with 95.8% of them within 72 hours. Parenteral nutrition was administered by central vein in 93.6%. Undernourished children received parenteral nutrition sooner, whether or not enteral nutrition intolerance was present. When enteral nutrition was not tolerated beyond 72 hours, parenteral nutrition was started in 57.4%. Parenteral nutrition was initiated when enteral nutrition delivered less than 50% in 97%. Conclusions: Nutritional practices are heterogeneous in Latin American PICUs, but the majority use nutritional support strategies consistent with international guidelines.
  • article 1 Citação(ões) na Scopus
    Effects of serum sodium and chloride levels in the outcome of critically ill pediatric patients in the post-operative period of liver transplantation
    (2023) LUGLIO, Michele; CARVALHO, Werther B. de; TANNURI, Uenis; TANNURI, Ana Cristina A.; MATSURA, Rodrigo Hideki; FRANCA, Gardenia Morais; DELGADO, Artur F.
    BackgroundSodium and chloride disturbances have attracted increasing attention in recent years. Many pathophysiological effects are associated with hyperchloremia, including reduction in mean arterial pressure and acute renal disease. Pediatric patients undergoing liver transplantation are at risk of developing various electrolyte and biochemical abnormalities, with an impact on their postoperative outcomes.ObjectiveTo analyze the impacts of serum sodium and chloride levels on prognosis of Pediatric Liver Transplant receptors.MethodsThis was a retrospective analytical observational study performed in a single transplant reference center in Sao Paulo, Brazil. Included patients were pediatric patients who underwent liver transplantation between January 2015 and July 2019. Statistical regression analysis and General Estimating Equations analysis were performed to evaluate the impacts of sodium and chloride disturbances on the development of acute renal failure and mortality.ResultsA total of 143 patients were included in this study. The main diagnosis was Biliary Atresia (62.9%). Twenty-seven patients died (18.9%), and graft dysfunction was the main cause of death (29.6%). The only variable individually associated with 28-days mortality was PIM-3 score (HR 1.59, CI 95% 1.165-2.177, p = 0.004). Forty-one patients (28.6%) developed moderate or severe AKI. PIM-3 score (OR 3.052, 95% CI 1.56-5.97, p = 0.001), hypernatremia (OR 3.49, 95% CI 1.32-9.23, p = 0.012), and hyponatremia (OR 4.24, 95% CI 1.52-11.85, p = 0.006) were independently associated with the development of moderate/severe AKI.ConclusionsIn pediatric patients after liver transplantation, PIM-3 score, and abnormal serum sodium levels were correlated with AKI development.
  • article 1 Citação(ões) na Scopus
    Body Composition and Phase Angle: How to Improve Nutritional Evaluation in Juvenile Dermatomyositis Patients
    (2023) PUGLIESE, Camila; DELGADO, Artur Figueiredo; KOZU, Katia Tomie; CAMPOS, Lucia Maria de Arruda; AIKAWA, Nadia Emi; SILVA, Clovis Artur; ELIAS, Adriana Maluf
    (1) Background: This study aimed to assess body composition (BC) using bioelectrical impedance and food intake in juvenile dermatomyositis (JDM) patients. Associations between BC and physical activity, disease activity/cumulative damage and health-related quality of life parameters were also evaluated; (2) Methods: This was a cross-sectional study with 30 consecutive JDM patients (18 female and 12 male) and 24 healthy volunteers (14 female and 10 male) of both sexes followed at our pediatric rheumatology unit. The gathering of anthropometric and dietary data, and the performance of physical activity and bioelectrical impedance were undertaken in face-to-face meetings and through questionnaires. Clinical and therapeutic data were collected from medical records according to information from routine medical appointments; (3) Results: The frequency of high/very high body fat was significantly higher in controls compared with JDM patients (66.7% vs. 91.7%; p = 0.046). The median phase angle was significantly lower in patients compared with controls (5.2 & PLUSMN; 1.3 vs. 6.1 & PLUSMN; 1.0; p = 0.016). Body fat and lean mass were positively correlated with disease duration (r(s) = +0.629, p < 0.001 and r(s) = +0.716, p < 0.001, respectively) and phase angle (PhA) (r(s) = +0.400, p = 0.029 and r(s) = +0.619, p < 0.001, respectively). JDM patients with PhA & GE; 5.5 presented higher lean mass when compared with patients with PhA < 5.5 (p = 0.001); (4) Conclusions: Bioelectrical impedance can be a useful auxiliary exam in the medical and nutritional follow-up of JDM patients, because it seems to impact functional ability. These findings may assist professionals when advising JDM patients about the importance of physical activity and healthy eating in the preservation of lean mass.
  • article 68 Citação(ões) na Scopus
    Nutrition Therapy in a Pediatric Intensive Care Unit: Indications, Monitoring, and Complications
    (2011) ZAMBERLAN, Patricia; DELGADO, Artur Figueiredo; LEONE, Claudio; FEFERBAUM, Rubens; OKAY, Thelma Suely
    Background: Nutrition therapy (NT) is essential for the care of critically ill children. Inadequate feeding leads to malnutrition and may increase the patient's risk of morbidity and mortality. The aim of this study was to describe the NT used in a tertiary pediatric intensive care unit (PICU). Methods: The authors evaluated NT administered to 90 consecutive patients who were hospitalized for 7 days in the PICU of Instituto da Crianca, Hospital das Clinicas, Universidade de Sao Paulo, Brazil. NT was established according to the protocol provided by the institution's NT team. NT provided a balance of fluids and nutrients and was monitored with a weekly anthropometric nutrition assessment and an evaluation of complications. Results: NT was initiated, on average, within 72 hours of hospitalization. Most children (80%) received enteral nutrition (EN) therapy; of these, 35% were fed orally and the rest via nasogastric or postpyloric tube. There were gastrointestinal complications in patients (5%) who needed a postpyloric tube. Parenteral nutrition (PN) was used in only 10% of the cases, and the remaining 10% received mixed NT (EN + PN). The average calorie and protein intake was 82 kcal/kg and 2.7 g/kg per day. Arm circumference and triceps skinfold thickness decreased. Conclusions: The use of EN was prevalent in the tertiary PICU, and few clinical complications occurred. There was no statistically significant change in most anthropometric indicators evaluated during hospitalization, which suggests that NT probably helped patients maintain their nutrition status. (JPEN J Parenter Enteral Nutr. 2011;35:523-529)
  • article 19 Citação(ões) na Scopus
    Miocardite fulminante associada ao vírus influenza H1N1: relato de caso e revisão de literatura
    (2014) LOBO, Maria Lúcia Saraiva; TAGUCHI, Ângela; GASPAR, Heloísa Amaral; FERRANTI, Juliana Ferreira; CARVALHO, Werther Brunow de; DELGADO, Artur Figueiredo
    Caso de miocardite fulminante associada ao vírus influenza H1N1, em que foi descrita a evolução clínica do paciente e enfatizada a importância do ecocardiograma à beira do leito como auxílio no diagnóstico precoce e manejo de crianças com disfunção miocárdica grave, além de terem sido discutidos aspectos relevantes relacionados à terapêutica e ao prognóstico da miocardite fulminante. Trata-se de paciente do sexo feminino, 4 anos e 8 meses, previamente hígida, com história de quadro gripal há 2 semanas. Admitida no pronto-socorro com sinais de instabilidade hemodinâmica, necessitando de suporte ventilatório e drogas vasoativas. Exames laboratoriais, radiografia de tórax e ecocardiograma sugestivos de miocardite. Pesquisa positiva para H1N1 em secreção de nasofaringe. Evoluiu com choque cardiogênico refratário a despeito das medidas clínicas, indo a óbito em 48 horas após admissão na unidade de terapia intensiva. O vírus influenza H1N1 é agente etiológico associado a quadros de miocardite aguda, porém poucos são os casos relatados de miocardite fulminante pelo vírus H1N1. A identificação de sinais e sintomas sugestivos de evolução fulminante deve ser imediata e o ecocardiograma à beira do leito é uma ferramenta útil para detecção precoce de disfunção miocárdica e orientação terapêutica. O uso de terapia imunossupressora, em casos de miocardite fulminante de etiologia viral, é controverso, bem como o de terapia antiviral, de tal forma que o tratamento baseia-se em suporte hemodinâmico e ventilatório. O uso de suporte hemodinâmico, por meio de oxigenação por membrana extracorpórea, aparece como terapia promissora.
  • article 4 Citação(ões) na Scopus
    Acute petrified myocardium associated with meningococcal sepsis in childhood-onset systemic lupus erythematous: a fatal case
    (2019) SANTOS, Ana Carolina Etrusco Zaroni; LUGLIO, Michele; DELGADO, Artur Figueiredo; SCHUWARTZ, Constance Dell Santo Vieira; MARQUES, Heloisa Helena Sousa; VALOES, Clarissa Carvalho de Miranda; DOMINGUEZ, Maria Andreina Cabrera; CARVALHO, Werther Brunow de; SILVA, Clovis Artur; DUARTE-NETO, Amaro Nunes
    Acute petrified myocardium associated with septic shock, diagnosed by autopsy has rarely been described. A 15-year-old adolescent male was diagnosed with childhood-onset systemic lupus erythematosus. One year later, he was hospitalized with fever, myalgia, headache, arthritis, vomiting, dyspnea and was diagnosed with sepsis secondary to bronchopneumonia and meningitis. Blood culture identified Neisseria meningitidis serogroup Y. Despite antibiotics and intensive therapeutic measures, he died after 29 days of hospitalization. The autopsy revealed necrotic cardiomyocytes with dystrophic calcification and interstitial fibrosis.
  • article 14 Citação(ões) na Scopus
    Impact of early enteral nutrition therapy on morbimortality reduction in a Pediatric Intensive Care Unit: a systematic review
    (2013) SILVA, Fernanda Marchetto da; BERMUDES, Ana Carolina Gouvea; MANESCHY, Ivie Reis; ZANATTA, Graziela de Araujo Costa; FEFERBAUM, Rubens; CARVALHO, Werther Brunow de; TANNURI, Uenis; DELGADO, Artur Figueiredo
    Objective: To assess the impact of early introduction of enteral nutrition therapy in reducing morbidity and mortality in pediatric intensive care unit. Methods: Search in the literature of the last 10 years, in English and the target population of individuals aged 1 month to 18 years admitted to pediatric intensive care units in the databases PubMed, Lilacs and Embase using the keywords: Critical Care, Nutritional Support and Nutrition Disorders or Malnutrition. Results: Despite advances in the quality of clinical care, the prevalence of malnutrition in hospitalized children remains unchanged in the last 20 years (15-30%) and has implications for the time of admission, course of illness and morbidity. Malnutrition is common and is often poorly recognized and therefore, untreated. Nutritional therapy is an essential part in the treatment of pediatric patients who have severely ill hypercatabolic state protein, which can be minimized with an effective nutritional treatment plan. In this study, we reviewed publications which have shown that there is still a paucity of randomized and controlled studies with good statistical treatment in relation to enteral nutritional therapy with outcomes related to morbidity and mortality. The current guidelines for nutritional therapy in these patients are largely based on expert opinion and data extrapolated from adult studies and studies in healthy children. Conclusion: The scientific evidence on the use of enteral nutrition therapy in improving the development of critically ill pediatric patients is still scarce and further studies are needed focusing on it, and better guidelines must be formulated.