FLAVIO JOTA DE PAULA
Índice h a partir de 2011
13
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
69 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 69
conferenceObject CORONARY ASSESSMENT IN YOUNG PATIENTS ON HEMODIALYSIS(2020) LIMA, Jose De; GOWDAK, Luis Henrique W.; PAULA, Flavio J. de; DAVID NETO, Elias; BORTOLOTTO, Luiz A.conferenceObject Desensitization Using Only IVIG: Is That an Option for Highly-Sensitized Patients Waiting for Kidneys from Cadaveric Donors?(2019) PAIXAO, J. O.; ULISSES, L. R.; SOUZA, P. S.; BEZERRA, G.; AGENA, F.; RODRGUES, H. P.; PANAJOTOPOULOS, N.; PAULA, F. J.; DAVID-NETO, E.; CASTRO, M. R.- Institutional protocol adherence in the incidence of recurrent urinary tract infection after kidney transplantation(2020) FREIRE, Maristela P.; MARTINHO, Lorena; V, Clara Mendes; SPADAO, Fernanda; PAULA, Flavio Jota De; NAHAS, William C.; DAVID-NETO, Elias; PIERROTTI, Ligia C.Objectives: Recurrent urinary tract infections (rUTIs) occur frequently after kidney transplantation (KT), however their optimal management remains undefined. This study aimed to identify risk factors for rUTI and to validate a protocol for UTI and rUTI treatment after KT. Methods: This retrospective cohort study involved patients undergoing KT between January 2013 and July 2016. Patients were followed-up from day of KT until graft loss, death or end of follow-up (31 December 2018). We analysed all episodes of symptomatic UTI. The main outcome measure was rUTI after KT. Analysis was done per episode in a multilevel approach; patient features were considered in the distal level and UTI features in the proximal level. Univariate and multivariate analyses were performed by Cox regression. A propensity score was used to adjust the risk of patients with carbapenem-resistant Enterobacteriaceae. Results: During the study period, 787 patients underwent KT, of whom 152 (19.3%) developed 356 UTI episodes. The most common micro-organisms wereEscherichia coli (165/356; 46.3%) and Klebsiella pneumoniae (101/356; 28.4%). Multidrug-resistant micro-organisms were isolated in 161 UTIs (45.2%). Risk factors for rUTI were diabetic nephropathy as the cause of end-stage renal disease (P = 0.02), UTI in first 180 days after KT (P = 0.04), anatomic alteration of the urinary tract at UTI diagnosis (P = 0.004) and length of time to effective therapy (P = 0.002); UTI treatment duration according to institutional protocol (P = 0.04) was the only protective factor identified. Conclusion: Appropriate therapy duration has an impact on rUTI prevention after KT. (C) 2020 The Authors.
- Outcomes and Mortality in Renal Transplant Recipients Admitted to the Intensive Care Unit(2015) MARQUES, I. D. B.; CAIRES, R. A.; MACHADO, D. J. B.; GOLDENSTEIN, P. T.; RODRIGUES, C. E.; PEGAS, J. C. R.; PAULA, F. J. de; DAVID-NETO, E.; COSTA, M. G.Introduction. In the intensive care unit (ICU), mortality is considered higher among renal transplant recipients than among nontransplantation patients. However, data regarding severe complications after kidney transplantation are scarce. Materials and Methods. In this study, we evaluated all consecutive renal transplant recipients admitted to our ICU between July 2012 and July 2013 (n = 70), comparing their outcomes with those of a control group of nontransplantation patients admitted during the same period (n = 153). Among the transplant recipients, we compared survivors and nonsurvivors to identify predictors of ICU mortality. Results. The mean age of the transplant recipients was 52 13 years. Of the 70 transplant recipients, 18 (25%) required mechanical ventilation, 28 (40%) required inotropic support, and 27 (39%) required hemodialysis, all of which are factors that worsen the prognosis significantly. Twenty-two (31%) of the transplant recipients died in the ICU and 17 (24%) died within 30 days after ICU discharge, rates similar to those observed for the control group. Conclusions. We observed similar mortality between recipient and control groups, albeit the mortality was higher in the clinical group. In the multivariate model, the need for mechanical ventilation and the need for hemodialysis were independently associated with mortality.
- Pneumocystis jirovecii pneumonia with an atypical granulomatous response after kidney transplantation(2014) RAMALHO, J.; MARQUES, I. D. Bacelar; AGUIRRE, A. R.; PIERROTTI, L. C.; PAULA, F. J. de; NAHAS, W. C.; DAVID-NETO, E.Pneumocystis jirovecii pneumonia (PCP) continues to be a leading cause of morbidity and mortality in kidney transplant recipients. Granulomatous PCP is an unusual histological presentation that has been described in a variety of immunosuppressive conditions. Previous studies have demonstrated an association between granulomatous disorders and hypercalcemia, the purported mechanism of which is extrarenal production of 1,25-dihydroxyvitamin D by activated macrophages. Here, we report a case of granulomatous formation in a kidney transplant recipient with PCP who presented with hypercalcemia and suppressed parathyroid hormone, both of which resolved after successful treatment of the pneumonia. In immunocompromised patients, pulmonary infection associated with hypercalcemia should raise the suspicion of PCP and other granulomatous disorders.
conferenceObject Desensitization Using Only Polyvalent Immunoglobulins (IVIG) for Kidney Transplantation with Living Donors (LD)(2019) ULISSES, L. R.; PAIXAO, J. O.; SOUZA, P. S.; BEZERRA, G.; RODRIGUES, H.; PANAJATOPOULOS, N.; PAULA, F. J. De; DAVID-NETO, E.; CASTRO, M. C. R.conferenceObject Plasma Cell Infiltration: General Overview of Clinical and Pathological Correlations in Renal Transplantation(2015) NIHEI, C.; LEMOS, F.; DAVID, D.; SOUZA, P.; PAULA, F. de; NAHAS, W.; DAVID-NETO, E.- Prioritization Due to Dialysis Access Failure Impacts on Patient Survival after Kidney Transplantation(2013) REUSING JR., J.; SOUZA, P.; GALANTE, N.; AGENA, F.; PAULA, F. de; NAHAS, W.; DAVID-NETO, E.Dialysis vascular access failure, recipient of a non-renal solid organ transplantation and previous kidney donation are current indications of priority allocation (PA) for kidney transplant (KT) at our centre. Mortality among PA patients under dialysis is high and risk factors for long-term patient outcomes after transplantation remain largely elusive. In this study we analyzed a cohort of patients that received KT from Jan/2007 to Dec/2011. Long-term patient survival was compared between PA and non PA recipients transplanted in this period of time and clinical relevant data were analyzed. Data were recorded as of Aug/2012. Results: 948 KT were performed at our institution and 93 (9.8%) were included in our PA program. Most PA patients (n=86) had access failure. The mean follow up time was 32 (0 – 69) months. 5-year patient survival was lower in PA patients (76vs 86%, p=0.001). Twenty (21.5%) PA patients died and all deaths occurred in those with access failure, being 70% of them in the first 3 months. Causes of death were infection in 10 patients, bleeding complications (n=6), uremia (n=1), mesenteric ischemia (n=1) and unspecified shock (n=2). Considering this high mortality rate in the first 3 months after transplantation, we compared patients who died in this period of time (group A) vs. those who survived more than 3 months (group B). Age, gender, previous kidney transplants, sensitization, number of HLA mismatches, pre-transplant DSA, pre-transplant diabetes, induction therapy, DGF, rejection, use of heparin, IVIg and time from inscription in the PA program to transplantation were not statistically different between groups. Among 47 patients who were screened for thrombophilia, 83.3% from group A were positive vs. 31.7% from group B (p=0.01). Infection after transplantation and hemorrhagic complications were more frequent in group A. Groups were not different regarding causes of death. PA patients have a lower survival and this excessive death rate occur in the first three months after transplantation mainly due to infections and bleeding. Thrombophilia is very frequent in PA patients with HR....... for death.
conferenceObject Cardiac scintigraphy fails to identify patients with single-vessel coronary artery disease and end-stage renal disease: potential impact on cardiovascular morbidity(2012) GOWDAK, Luis Henrique W.; PAULA, Flavio J. de; CESAR, Luiz Antonio M.; LIMA, Jose Jayme G. deIntroduction: Patients (pt) with end-stage renal disease (ESRD) are at increased risk for CAD and major adverse cardiovascular events. Cardiac scintigraphy is regarded as a non-invasive, useful screening tool for risk stratification and to exclude significant CAD in the general population; invasive coronary angiography is usually performed following a positive result in the non-invasive assessment. Objectives: To determine the accuracy of such approach in pt with ESRD being considered as renal transplant candidates. Methods: 482 pt with ESRD (56 ±9 years; 69% men) underwent cardiac scintigraphy (99mTc MIBI-SPECT with dipyridamole) and coronary angiography, regardless of symptoms. Myocardial perfusion scans were categorized as normal or abnormal (fixed and/or transient perfusion defects); significant CAD was defined by luminal stenosis ≥70%. The sensitivity (Sen), specificity (Spe), positive (PPV) and negative (NPV) predictive values were calculated for pt with 1-, 2- or 3-vessel CAD. Kaplan-Meier curves were constructed for the probability of survival free of fatal/non-fatal MACE during a 5-year follow-up based on the results of angiography. Results: 240 pt (50%) had perfusion defects; 237 pt (49%) had significant CAD, of which 89 (38%), 70 (29%), and 78 (33%) had 1-, 2-, and 3-vessel disease, respectively. Figure 1 shows that pt with any degree of significant CAD had a worse-long term prognosis than pt with no CAD. Figure 2 shows that abnormal myocardial scans were more likely to be found in pt with 2- (69%) or 3-vessel CAD (76%), whereas in pt with no CAD, 64% of them had a normal perfusion scan (P<0.0001). However, in pt with 1-vessel CAD, the occurrence of normal and abnormal scans was almost identical (48 vs. 52%). A myocardial perfusion defect yielded a Sen=52%, 69% and 76%, a Spe=28%, 37% and 41%, a PPV=30%, 31% and 39%, and a NPV = 49%, 74% and 77% for the diagnosis of 1-, 2- and 3-vessel CAD, respectively. Conclusion: In pt with ESRD: 1) the prevalence of significant CAD is high, and this imposes a worse long-term prognosis independently of the number of affected vessels; 2) myocardial perfusion assessment by SPECT has a low sensitivity to detect 1-vessel CAD; 3) as a consequence, many pt with 1-vessel CAD could be mistakenly deemed to be free of CAD and, therefore, not treated accordingly, although their long-term prognosis seemed to be no different of that from pt with 2- or 3-vessel disease.- Pamidronate for the treatment of osteoporosis secondary to chronic cholestatic liver disease in Wistar rats(2012) PEREIRA, F. A.; MATTAR, R.; FACINCANI, I.; DEFINO, H. L. A.; RAMALHO, L. N. Z.; JORGETTI, V.; VOLPON, J. B.; PAULA, F. J. A. deOsteoporosis is a major complication of chronic cholestatic liver disease (CCLD). We evaluated the efficacy of using disodium pamidronate (1.0 mg/kg body weight) for the prevention (Pr) or treatment (Tr) of cholestasis-induced osteoporosis in male Wistar rats: sham-operated (Sham = 12); bile duct-ligated (Bi = 15); bile duct-ligated animals previously treated with pamidronate before and 1 month after surgery (Pr = 9); bile duct-ligated animals treated with pamidronate 1 month after surgery (Tr = 9). Rats were sacrificed 8 weeks after surgery. Immunohistochemical expression of IGF-I and GH receptor was determined in the proximal growth plate cartilage of the left tibia. Histomorphometric analysis was performed in the right tibia and the right femur was used for biomechanical analysis. Bone material volume over tissue volume (BV/TV) was significantly affected by CCLD (Sham = 18.1 +/- 3.2 vs Bi = 10.6 +/- 2.2%) and pamidronate successfully increased bone volume. However, pamidronate administered in a preventive regimen presented no additional benefit on bone volume compared to secondary treatment (BV/TV: Pr = 39.4 +/- 12.0; Tr = 41.2 +/- 12.7%). Moreover, the force on the momentum of fracture was significantly reduced in Pr rats (Sham = 116.6 +/- 23.0; Bi = 94.6 +/- 33.8; Pr = 82.9 +/- 22.8; Tr = 92.5 +/- 29.5 N; P < 0.05, Sham vs Pr). Thus, CCLD had a significant impact on bone histomorphometric parameters and pamidronate was highly effective in increasing bone mass in CCLD; however, preventive therapy with pamidronate has no advantage regarding bone fragility.