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
7 resultados
Resultados de Busca
Agora exibindo 1 - 7 de 7
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 Treatment of Carbapenem resistant Enterobacteriaceae with reduced susceptibility to polymyxin among kidney transplant recipients experience during an outbreak period(2016) FREIRE, Maristela; PAULA, Flavio J. De; AZEVEDO, Luiz Sergio; LAZARO, Ana Carolina; ROSSI, Flavia; DAVID-NETO, Elias; NAHAS, Willian; PIERROTTI, Ligia C.- Risk Factors for Mortality among Kidney Transplant Recipients with Pneumocystis Jirovecii Infection(2018) MORTARI, Naima; FREIRE, Maristela; AZEVEDO, Luis Sergio; PAULA, Flavio Jota De; CAIAFFA-FILHO, Helio; NAHAS, William; DAVID-NETO, Elias; PIERROTTI, Ligia C.
- Amikacin Prophylaxis and Risk Factors for Surgical Site Infection After Kidney Transplantation(2015) FREIRE, Maristela P.; ANTONOPOULOS, Ioannis M.; PIOVESAN, Affonso Celso; MOURA, Maria L.; PAULA, Flavio Jota de; SPADAO, Fernanda; GUIMARAES, Thais; DAVID-NETO, Elias; NAHAS, William C.; PIERROTTI, Ligia C.Background. Antibiotic prophylaxis plays a major role in preventing surgical site infections (SSIs). This study aimed to evaluate antibiotic prophylaxis in kidney transplantation and identify risk factors for SSIs. Methods. We evaluated all kidney transplantation recipients from January 2009 and December 2012. We excluded patients who died within the first 72 hr after transplantation, were undergoing simultaneous transplantation of another organ, or were below 12 years of age. The main outcome measure was SSI during the first 60 days after transplantation. Results. A total of 819 kidney transplants recipients were evaluated, 65% of whom received a deceased-donor kidney. The antibiotics used as prophylaxis included cephalosporin, in 576 (70%) cases, and amikacin, in 233 (28%). We identified SSIs in 106 cases (13%), the causative agent being identified in 72 (68%). Among the isolated bacteria, infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae predominated. Multivariate analysis revealed that the risk factors for post-kidney transplantation SSIs were deceased donor, thin ureters at kidney transplantation, antithymocyte globulin induction therapy, blood transfusion at the transplantation procedure, high body mass index, and diabetes mellitus. The only factor associated with a reduction in the incidence of SSIs was amikacin use as antibiotic prophylaxis. Factors associated with reduced graft survival were: intraoperative blood transfusions, reoperation, human leukocyte antigen mismatch, use of nonstandard immunosuppression therapy, deceased donor, post-kidney transplantation SSIs, and delayed graft function. Conclusion. Amikacin prophylaxis is a useful strategy for preventing SSIs.
conferenceObject Which Induction Therapy Should Be Used in Kidney Transplants with Prolonged Cold Ischemia Time?(2012) ARAUJO, M. J. C. L. N.; ONUSIC, V. L.; BATTAINI, L. C.; BARBOSA, E. A.; BOJIKIAN, R. T.; DAVID, D. R.; ANTONOPOULOS, I. M.; PAULA, F. Jota de; NAHAS, W. C.; NETO, E. D.; LEMOS, F. B. C.; CASTRO, M. C. Ribeiro de- Coronary Artery Disease Assessment and Intervention in Renal Transplant Patients: Analysis from the KiHeart Cohort(2016) LIMA, Jose J. G. De; GOWDAK, Luis Henrique W.; PAULA, Flavio J. de; MUELA, Henrique Cotchi S.; DAVID-NETO, Elias; BORTOLOTTO, Luiz A.Background. The value of coronary artery disease (CAD) assessment and coronary intervention in the prognosis of patients who undergo renal transplantation is controversial. We investigated whether pretransplant identification of patients with CAD is helpful for defining prognosis and whether preemptive coronary intervention reduces the incidence of cardiovascular events and death after engraftment. Methods. We analyzed the impact of coronary assessment by clinical stratification and coronary angiography and of coronary intervention on prognosis in 535 chronic kidney disease patients on the transplantation waiting list who underwent renal transplantation. Results. Patients with 70% or greater narrowing experienced more coronary events than patients with less significant lesions (P = 0.01) and subjects at low risk (P = 0.001). Coronary assessment did not discriminate between the risk of death in patients with or without significant CAD, and the independent predictors of death were age (hazards ratio, 1.04; 95% confidence interval, 1.01-1.06, P = 0.001) and diabetes (hazards ratio, 1.63; 95% confidence interval, 1.11-2.39, P = 0.01). No difference occurred in events and mortality between patients treated medically or by intervention, but the severity of CAD was higher in the latter. Conclusions. Coronary assessment identified patients at increased risk of posttransplant coronary events and was also useful to define a low-risk population that may be safely transplanted without in-depth cardiovascular evaluation. However, it did not differentiate between the risk of death in patients with and those without significant CAD. Survival was similar in patients undergoing either medical or interventional treatment for CAD.
- A Double-Blinded, Prospective Study to Define Antigenemia and Quantitative Real-Time Polymerase Chain Reaction Cutoffs to Start Preemptive Therapy in Low-Risk, Seropositive, Renal Transplanted Recipients(2014) DAVID-NETO, Elias; TRIBONI, Ana H. K.; PAULA, Flavio J.; BOAS, Lucy S. Vilas; MACHADO, Clarisse M.; AGENA, Fabiana; LATIF, Acram Z. A.; ALENCAR, Cecilia S.; PIERROTTI, Ligia C.; NAHAS, William C.; CAIAFFA-FILHO, Helio H.; PANNUTI, Claudio S.Background. Cytomegalovirus (CMV) disease occurs in 16% to 20% of low-risk, CMV-positive renal transplant recipients. The cutoffs for quantitative real-time polymerase chain reaction (qPCR) or phosphoprotein (pp65) antigenemia (pp65emia) for starting preemptive therapy have not been well established. Methods. We measured qPCR and pp65emia weekly from day 7 to day 120 after transplantation, in anti-CMV immunoglobulin GYpositive donor and recipient pairs. Patients and physicians were blinded to the test results. Suspicion of CMV disease led to the order of new tests. In asymptomatic viremic patients, the highest pp65emia and qPCR values were used, whereas we considered the last value before diagnosis in those with CMV disease. Results. We collected a total of 1,481 blood samples from 102 adult patients. Seventeen patients developed CMV disease, 54 presented at least one episode of viremia that cleared spontaneously, and 31 never presented viremia. Five patients developed CMV disease after the end of the study period. The median (95% confidence interval) pp65emia and qPCR values were higher before CMV disease than during asymptomatic viremia (6 [9-82] vs. 3 [1-14] cells/10(6) cells; P<0.001 and 3,080 [1,263-15,605] vs. 258 [258-1,679] copies/mL; P=0.008, respectively). The receiver operating characteristic curve showed that pp65emia 4 cells/10(6) cells or greater showed a sensitivity and specificity to predict CMV disease of 69% and 81%, respectively (area, 0.769; P=0.001), with a positive predictive value of 37% and a negative predictive value of 93%. For qPCR 2,000 copies/mL or higher, the positive predictive value and negative predictive value were 57% and 91%, respectively (receiver operating characteristic area, 0.782; P=0.000). Conclusion. With these cutoffs, both methods are appropriate for detecting CMV disease.