CARLOS ROBERTO RIBEIRO DE CARVALHO

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Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina - Líder

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Agora exibindo 1 - 10 de 25
  • conferenceObject
    Respiratory Arousal Threshold Among Patients with Isolated Sleep Apnea and with Comorbid Insomnia (COMISA)
    (2022) YANAGIMORI, M.; FERNANDES, M. D.; GARCIA, M. L.; SCUDELLER, P. G.; CARVALHO, C. R.; LORENZI-FILHO, G.; GENTA, P.
  • article 0 Citação(ões) na Scopus
  • bookPart
    Teleconsulting for severe respiratory cases
    (2022) CARVALHO, Carlos Roberto de
  • article 0 Citação(ões) na Scopus
    Something not so new for lymphangioleiomyomatosis: is VEGF-D a glass half empty or half full?
    (2022) AMARAL, Alexandre Franco; CARVALHO, Carlos Roberto Ribeiro; BALDI, Bruno Guedes
  • bookPart
    Teleconsultoria para casos respiratórios graves
    (2022) CARVALHO, Carlos Roberto de
  • article 0 Citação(ões) na Scopus
    Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital (vol 76, e3511, 2021)
    (2022) FINK, Thais T.; MARQUES, Heloisa H. S.; GUALANO, Bruno; LINDOSO, Livia; BAIN, Vera; ASTLEY, Camilla; MARTINS, Fernanda; MATHEUS, Denise; MATSUO, Olivia M.; SUGUITA, Priscila; TRINDADE, Vitor; PAULA, Camila S. Y.; FARHAT, Sylvia C. L.; PALMEIRA, Patricia; LEAL, Gabriela N.; SUZUKI, Lisa; ODONE FILHO, Vicente; CARNEIRO-SAMPAIO, Magda; DUARTE, Alberto Jose S.; ANTONANGELO, Leila; BATISTTELLA, Linamara R.; POLANCZYK, Guilherme V.; PEREIRA, Rosa Maria R.; CARVALHO, Carlos Roberto R.; BUCHPIGUEL, Carlos A.; LATRONICO, Ana Claudia; SEELAENDER, Marilia; SILVA, Clovis Artur; PEREIRA, Maria Fernanda B.
  • article 15 Citação(ões) na Scopus
    Clinical, sociodemographic and environmental factors impact post-COVID-19 syndrome
    (2022) FERREIRA, Juliana Carvalho; MOREIRA, Tiana C. Lopes; ARAUJO, Adriana Ladeira de; IMAMURA, Marta; DAMIANO, Rodolfo F.; GARCIA, Michelle L.; SAWAMURA, Marcio V. Y.; PINNA, Fabio R.; GUEDES, Bruno F.; GONCALVES, Fabio A. Rodrigues; MANCINI, Marcio; BURDMANN, Emmanuel A.; SILVA FILHO, Demostenes Ferreira da; POLIZEL, Jefferson Lordello; BENTO, Ricardo F.; ROCHA, Vanderson; NITRINI, Ricardo; SOUZA, Heraldo Possolo de; LEVIN, Anna S.; KALLAS, Esper G.; FORLENZA, Orestes V.; BUSATTO, Geraldo F.; BATISTELLA, Linamara R.; CARVALHO, Carlos R. Ribeiro de; MAUAD, Thais; GOUVEIA, Nelson
    Background Sociodemographic and environmental factors are associat-ed with incidence, severity, and mortality of COVID-19. However, little is known about the role of such factors in persisting symptoms among re-covering patients. We designed a cohort study of hospitalized COVID-19 survivors to describe persistent symptoms and identify factors associated with post-COVID-19 syndrome. Methods We included patients hospitalized between March to August 2020 who were alive six months after hospitalization. We collected indi-vidual and clinical characteristics during hospitalization and at follow-up assessed ten symptoms with standardized scales, 19 yes/no symptoms, a functional status and a quality-of-life scale and performed four clinical tests. We examined individual exposure to greenspace and air pollution and considered neighbourhood acute accent s population density and socioeconomic conditions as contextual factors in multilevel regression analysis. Results We included 749 patients with a median follow-up of 200 (IQR = 185-235) days, and 618 (83%) had at least one of the ten symptoms measured with scales. Pain (41%), fatigue (38%) and posttraumatic stress disorder (35%) were the most frequent. COVID-19 severity, comorbidities, BMI, female sex, younger age, and low socioeconomic position were associ-ated with different symptoms. Exposure to ambient air pollution was asso-ciated with higher dyspnoea and fatigue scores and lower functional status. Conclusions We identified a high frequency of persistent symptoms among COVID-19 survivors that were associated with clinical, sociodemographic, and environmental variables. These findings indicate that most patients re-covering from COVID-19 will need post-discharge care, and an additional burden to health care systems, especially in LMICs, should be expected.
  • article 11 Citação(ões) na Scopus
    Post-acute sequelae of SARS-CoV-2 infection: relationship of central nervous system manifestations with physical disability and systemic inflammation
    (2022) BUSATTO, Geraldo F.; ARAUJO, Adriana Ladeira de; CASTALDELLI-MAIA, Joao Mauricio; DAMIANO, Rodolfo Furlan; IMAMURA, Marta; GUEDES, Bruno F.; PINNA, Fabio de Rezende; SAWAMURA, Marcio Valente Yamada; MANCINI, Marcio C.; SILVA, Katia R. da; GARCIA, Michelle L.; SUMITA, Nairo; BRUNONI, Andre Russowsky; DUARTE, Alberto J. da Silva; BURDMANN, Emmanuel A.; KALLAS, Esper G.; CERRI, Giovanni G.; NITRINI, Ricardo; BENTO, Ricardo F.; ROCHA, Vanderson Geraldo; SOUZA, Heraldo Possolo de; MIGUEL, Euripedes C.; CARVALHO, Carlos R. R. de; FORLENZA, Orestes V.; BATISTELLA, Linamara Rizzo
    Background Despite the multitude of clinical manifestations of post-acute sequelae of SARS-CoV-2 infection (PASC), studies applying statistical methods to directly investigate patterns of symptom co-occurrence and their biological correlates are scarce. Methods We assessed 30 symptoms pertaining to different organ systems in 749 adults (age = 55 +/- 14 years; 47% female) during in-person visits conducted at 6-11 months after hospitalization due to coronavirus disease 2019 (COVID-19), including six psychiatric and cognitive manifestations. Symptom co-occurrence was initially investigated using exploratory factor analysis (EFA), and latent variable modeling was then conducted using Item Response Theory (IRT). We investigated associations of latent variable severity with objective indices of persistent physical disability, pulmonary and kidney dysfunction, and C-reactive protein and D-dimer blood levels, measured at the same follow-up assessment. Results The EFA extracted one factor, explaining 64.8% of variance; loadings were positive for all symptoms, and above 0.35 for 16 of them. The latent trait generated using IRT placed fatigue, psychiatric, and cognitive manifestations as the most discriminative symptoms (coefficients > 1.5, p < 0.001). Latent trait severity was associated with decreased body weight and poorer physical performance (coefficients > 0.240; p <= 0.003), and elevated blood levels of C-reactive protein (coefficient = 0.378; 95% CI 0.215-0.541; p < 0.001) and D-dimer (coefficient = 0.412; 95% CI 0.123-0.702; p = 0.005). Results were similar after excluding subjects with pro-inflammatory comorbidities. Conclusions Different symptoms that persist for several months after moderate or severe COVID-19 may unite within one latent trait of PASC. This trait is dominated by fatigue and psychiatric symptoms, and is associated with objective signs of physical disability and persistent systemic inflammation.
  • article 3 Citação(ões) na Scopus
    Desfechos clínicos e características da mecânica pulmonar entre a síndrome do desconforto respiratório agudo associada à COVID-19 e a não associada à COVID-19: uma análise de escore de propensão de dois importantes ensaios randomizados
    (2022) TOMAZINI, Bruno Martins; COSTA, Eduardo Leite Vieira; BESEN, Bruno Adler Maccagnan Pinheiro; ZAMPIERI, Fernando Godinho; CARVALHO, Carlos Roberto Ribeiro de; CASER, Eliana Bernardete; SOUZA-DANTAS, Vicente Cés de; BOSCHI, Emerson; FUMIS, Renata Rego Lins; ALENCAR FILHO, Meton Soares de; MAIA, Israel Silva; OLIVEIRA FILHO, Wilson de; VEIGA, Viviane Cordeiro; AVEZUM, Alvaro; LOPES, Renato Delascio; MACHADO, Flávia Ribeiro; BERWANGER, Otávio; ROSA, Regis Goulart; CAVALCANTI, Alexandre Biasi; AZEVEDO, Luciano César Pontes de
    ABSTRACT Objective: To compare the lung mechanics and outcomes between COVID-19-associated acute respiratory distress syndrome and non-COVID-19-associated acute respiratory distress syndrome. Methods: We combined data from two randomized trials in acute respiratory distress syndrome, one including only COVID-19 patients and the other including only patients without COVID-19, to determine whether COVID-19-associated acute respiratory distress syndrome is associated with higher 28-day mortality than non-COVID-19 acute respiratory distress syndrome and to examine the differences in lung mechanics between these two types of acute respiratory distress syndrome. Results: A total of 299 patients with COVID-19-associated acute respiratory distress syndrome and 1,010 patients with non-COVID-19-associated acute respiratory distress syndrome were included in the main analysis. The results showed that non-COVID-19 patients used higher positive end-expiratory pressure (12.5cmH2O; SD 3.2 versus 11.7cmH2O SD 2.8; p < 0.001), were ventilated with lower tidal volumes (5.8mL/kg; SD 1.0 versus 6.5mL/kg; SD 1.2; p < 0.001) and had lower static respiratory compliance adjusted for ideal body weight (0.5mL/cmH2O/kg; SD 0.3 versus 0.6mL/cmH2O/kg; SD 0.3; p = 0.01). There was no difference between groups in 28-day mortality (52.3% versus 58.9%; p = 0.52) or mechanical ventilation duration in the first 28 days among survivors (13 [IQR 5 - 22] versus 12 [IQR 6 - 26], p = 0.46). Conclusion: This analysis showed that patients with non-COVID-19-associated acute respiratory distress syndrome have different lung mechanics but similar outcomes to COVID-19-associated acute respiratory distress syndrome patients. After propensity score matching, there was no difference in lung mechanics or outcomes between groups.
  • article 3 Citação(ões) na Scopus
    Mortality over time among COVID-19 patients hospitalized during the first surge of the pandemic: A large cohort study
    (2022) MARCILIO, Izabel; LAZAR NETO, Felippe; CORTEZ, Andre Lazzeri; MIETHKE-MORAIS, Anna; NOVAES, Hillegonda Maria Dutilh; SOUSA, Heraldo Possolo de; CARVALHO, Carlos Roberto Ribeiro de; LEVIN, Anna Sara Shafferman; FERREIRA, Juliana Carvalho; GOUVEIA, Nelson
    BackgroundCapacity strain negatively impacts patient outcome, and the effects of patient surge are a continuous threat during the COVID-19 pandemic. Evaluating changes in mortality over time enables evidence-based resource planning, thus improving patient outcome. Our aim was to describe baseline risk factors associated with mortality among COVID-19 hospitalized patients and to compare mortality rates over time. MethodsWe conducted a retrospective cohort study in the largest referral hospital for COVID-19 patients in Sao Paulo, Brazil. We investigated risk factors associated with mortality during hospitalization. Independent variables included age group, sex, the Charlson Comorbidity Index, admission period according to the stage of the first wave of the epidemic (early, peak, and late), and intubation. ResultsWe included 2949 consecutive COVID-19 patients. 1895 of them were admitted to the ICU, and 1473 required mechanical ventilation. Median length of stay in the ICU was 10 (IQR 5-17) days. Overall mortality rate was 35%, and the adjusted odds ratios for mortality increased with age, male sex, higher Charlson Comorbidity index, need for mechanical ventilation, and being admitted to the hospital during the wave peak of the epidemic. Being admitted to the hospital during the wave peak was associated with a 33% higher risk of mortality. ConclusionsIn-hospital mortality was independently affected by the epidemic period. The recognition of modifiable operational variables associated with patient outcome highlights the importance of a preparedness plan and institutional protocols that include evidence-based practices and allocation of resources.