CARLOS ROBERTO RIBEIRO DE CARVALHO
Projetos de Pesquisa
Unidades Organizacionais
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
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina - Líder
11 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 11
- Respiratory arousal threshold among patients with isolated sleep apnea and with comorbid insomnia (COMISA)(2023) YANAGIMORI, Marcela; FERNANDES, Mariana D.; GARCIA, Michelle L.; SCUDELLER, Paula G.; CARVALHO, Carlos R. R.; EDWARDS, Bradley; LORENZI-FILHO, Geraldo; GENTA, Pedro R.Insomnia and obstructive sleep apnea (OSA) are common sleep disorders and frequently coexist (COMISA). Arousals from sleep may be a common link explaining the frequent comorbidity of both disorders. Respiratory arousal threshold (AT) is a physiologic measurement of the level of respiratory effort to trigger an arousal from sleep. The impact of COMISA on AT is not known. We hypothesized that a low AT is more common among COMISA than among patients with OSA without insomnia. Participants referred for OSA diagnosis underwent a type 3 sleep study and answered the insomnia severity index (ISI) questionnaire and the Epworth sleepiness scale. Participants with an ISI score >= 15 were defined as having insomnia. Sleep apnea was defined as an apnea hypopnea index (AHI) >= 15 events/h. Low AT was determined using a previously validated score based on 3 polysomnography variables (AHI, nadir SpO(2) and the frequency of hypopneas). OSA-only (n = 51) and COMISA (n = 52) participants had similar age (61[52-68] vs 60[53-65] years), body-mass index (31.3[27.7-36.2] vs 32.2[29.5-38.3] kg/m(2)) and OSA severity (40.2[27.5-60] vs 37.55[27.9-65.2] events/h): all p = NS. OSA-only group had significantly more males than the COMISA group (58% vs 33%, p = 0.013. The proportion of participants with a low AT among OSA-only and COMISA groups was similar (29 vs 33%, p = NS). The similar proportion of low AT among COMISA and patients with OSA suggests that the respiratory arousal threshold may not be related to the increased arousability of insomnia.
- Tele-Intensive Care Unit Program in Brazil: Implementation and Expansion(2023) SCUDELLER, Paula Gobi; LAMAS, Celina de Almeida; ALVARENGA, Aline Morgan; GARCIA, Michelle Louvaes; AMARAL, Talita Freitas; OLIVEIRA, Martina Rodrigues de; MACEDO, Bruno Rocha de; TESTA, Carolina Burgarelli; BAPTISTA, Fernanda Spadotto; FRANCISCO, Rossana Pulcineli Vieira; CARVALHO, Carlos Roberto Ribeiro de; Tele ICU HCFMUSP Study GroupIn this scientific report, we aimed to describe the implementation and expansion of a Tele-Intensive Care Unit (Tele-ICU) program in Brazil, highlighting the pillars of success, improvements, and perspectives. Tele-ICU program emerged during the COVID-19 pandemic at the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), focusing on clinical case discussions and training of health practitioners in public hospitals of the state of Sao Paulo in Brazil, to support health care professionals for treating COVID-19 patients. The success of implementing this initiative endorsed the project expansion to other five hospitals from different macroregions of the country, leading to the Tele-ICU-Brazil. These projects assisted 40 hospitals, allowing more than 11,500 teleinterconsultations (exchange of medical information between health care professionals using a licensed online platform) and training more than 14,800 health care professionals, reducing mortality and length of hospitalized patients. A segment in telehealth for the obstetrics health care was implemented after detecting these were a susceptible group of patients to COVID-19 severity. As a perspective, this segment will be expanded to 27 hospitals in the country. The Tele-ICU projects reported here were the largest digital health ICU programs ever established in Brazilian National Health System until know. Their results were unprecedented and proved to be crucial for supporting health care professionals nationwide during the COVID-19 pandemic and guide future initiatives in digital health in Brazil's National Health System.
- Risk Factors for the Impairment of Ambulation in Older People Hospitalized with COVID-19: A Retrospective Cohort Study(2023) SILVA, E. C. G. E.; SCHMITT, A. C. B.; GODOY, C. G. de; OLIVEIRA, D. B. de; TANAKA, C.; TOUFEN, C. Jr.; CARVALHO, C. R. R. de; CARVALHO, C. R. F.; FU, C.; HILL, K. D.; POMPEU, J. E.(1) Background: Some older people hospitalized with COVID-19 have experienced reduced ambulation capacity. However, the prevalence of the impairment of ambulation capacity still needs to be established. Objective: To estimate the prevalence of, and identify the risk factors associated with, the impairment of ambulation capacity at the point of hospital discharge for older people with COVID-19. (2) Methods: A retrospective cohort study. Included are those with an age > 60 years, of either sex, hospitalized due to COVID-19. Clinical data was collected from patients’ medical records. Ambulation capacity prior to COVID-19 infection was assessed through the patients’ reports from their relatives. Multiple logistic regressions were performed to identify the risk factors associated with the impairment of ambulation at hospital discharge. (3) Results: Data for 429 older people hospitalized with COVID-19 were randomly collected from the medical records. Among the 56.4% who were discharged, 57.9% had reduced ambulation capacity. Factors associated with reduced ambulation capacity at discharge were a hospital stay longer than 20 days (Odds Ratio (OR): 3.5) and dependent ambulation capacity prior to COVID-19 (Odds Ratio (OR): 11.3). (4) Conclusion: More than half of the older people who survived following hospitalization due to COVID-19 had reduced ambulation capacity at hospital discharge. Impaired ambulation prior to the infection and a longer hospital stay were risks factors for reduced ambulation capacity.
- Long-term respiratory follow-up of ICU hospitalized COVID-19 patients: Prospective cohort study(2023) CARVALHO, Carlos Roberto Ribeiro; LAMAS, Celina Almeida; CHATE, Rodrigo Caruso; SALGE, Joao Marcos; SAWAMURA, Marcio Valente Yamada; ALBUQUERQUE, Andre L. P. de; JR, Carlos Toufen; LIMA, Daniel Mario; GARCIA, Michelle Louvaes; SCUDELLER, Paula Gobi; NOMURA, Cesar Higa; GUTIERREZ, Marco Antonio; BALDI, Bruno GuedesBackgroundCoronavirus disease (COVID-19) survivors exhibit multisystemic alterations after hospitalization. Little is known about long-term imaging and pulmonary function of hospitalized patients intensive care unit (ICU) who survive COVID-19. We aimed to investigate long-term consequences of COVID-19 on the respiratory system of patients discharged from hospital ICU and identify risk factors associated with chest computed tomography (CT) lesion severity. MethodsA prospective cohort study of COVID-19 patients admitted to a tertiary hospital ICU in Brazil (March-August/2020), and followed-up six-twelve months after hospital admission. Initial assessment included: modified Medical Research Council dyspnea scale, SpO(2) evaluation, forced vital capacity, and chest X-Ray. Patients with alterations in at least one of these examinations were eligible for CT and pulmonary function tests (PFTs) approximately 16 months after hospital admission. Primary outcome: CT lesion severity (fibrotic-like or non-fibrotic-like). Baseline clinical variables were used to build a machine learning model (ML) to predict the severity of CT lesion. ResultsIn total, 326 patients (72%) were eligible for CT and PFTs. COVID-19 CT lesions were identified in 81.8% of patients, and half of them showed mild restrictive lung impairment and impaired lung diffusion capacity. Patients with COVID-19 CT findings were stratified into two categories of lesion severity: non-fibrotic-like (50.8%-ground-glass opacities/reticulations) and fibrotic-like (49.2%-traction bronchiectasis/architectural distortion). No association between CT feature severity and altered lung diffusion or functional restrictive/obstructive patterns was found. The ML detected that male sex, ICU and invasive mechanic ventilation (IMV) period, tracheostomy and vasoactive drug need during hospitalization were predictors of CT lesion severity(sensitivity,0.78 +/- 0.02;specificity,0.79 +/- 0.01;F1-score,0.78 +/- 0.02;positive predictive rate,0.78 +/- 0.02; accuracy,0.78 +/- 0.02; and area under the curve,0.83 +/- 0.01). ConclusionICU hospitalization due to COVID-19 led to respiratory system alterations six-twelve months after hospital admission. Male sex and critical disease acute phase, characterized by a longer ICU and IMV period, and need for tracheostomy and vasoactive drugs, were risk factors for severe CT lesions six-twelve months after hospital admission.
- Functional impact on adults and older people after hospitalization by Covid-19(2023) OCHIAI, Gabriela Sayuri; GODOY, Caroline Gil de; SILVA, Erika Christina Gouveia E; OLIVEIRA, Danielle Brancolini de; SILVA, Elizabeth Mendes da; VIANA, Bianca de Oliveira Candido; SILVA, Juliana Magalhaes da; SOUZA, Roberta Oliveira Bueno de; SANTOS, Michelle Didone dos; CAMPOS, Camila Machado de; SCHMITT, Ana Carolina Basso; CARVALHO, Celso Ricardo Fernandes de; FU, Carolina; TANAKA, Clarice; TOUFEN JR., Carlos; CARVALHO, Carlos Roberto Ribeiro de; POMPEU, Jose EduardoBackground and Objectives Hospitalization by Covid-19 can cause persistent functional consequences after hospital discharge due to direct and indirect effects of SARS-COV-2 in several organs and systems of the body added to post-intensive care syndrome and prolonged bed rest. These impacts can lead to dependency in activities of daily living, mainly in older people due to aging process and functional decline. This study aimed to compare the effects of hospitalization by Covid-19 on functional capacity of adults and older people and to identify its associated factors. Methods Cross-sectional observational study of 159 survivors of hospitalization by Covid-19 after 1 month from discharge at Hospital das Clinicas of the University of Sao Paulo, divided into groups: adults (aged < 60 years) and older people (aged >= 60 years). Those who did not accept to participate, without availability or without ability to understand the questionnaires were excluded. Functional capacity was assessed by the Barthel Index and patients were classified according to their scores. Data analysis was performed in JASP Statistics program and the sample was compared between the age groups. Wilcoxon test was applied to compare before and after periods, Mann-Whitney test was used for between groups comparison. We adopted alpha = 0.05. Results The total Barthel Index median score was lower 1 month after hospital discharge than in the pre-Covid-19 period. Older people had worse functional status than adults before and also showed greater impairment after hospital discharge. Both groups showed lower Barthel Index classification than before, and older people presented more functional dependence than adults in both periods. Age, sarcopenia and frailty were associated factors. Discussion Hospitalization by Covid-19 impacts functional capacity after 1 month from discharge, especially in older people. Age, sarcopenia and frailty are associated factors. These results suggest need for care and rehabilitation of Covid-19 survivors.
- Telemedicine as a tool in the smoking cessation clinic-154 cases in 2 years in the largest city in Latin America.(2023) NERY, Telma Cassia Santos; MARTINS, Stella R.; FREITAS, Jefferson Benedito Pires; ROIO, Lavinia Clara Del; ALMEIDA, Gustavo Correa De; MIZUTANI, Rafael Futoshi; CARVALHO, Carlos Roberto Ribeiro
- User Experience Regarding Digital Primary Health Care in Santarem, Amazon: Evaluation of Patient Satisfaction and Doctor's Feedback(2023) BIN, Kaio Jia; ALVES, Patricia Gabriela Santana; COSTA, Raquel; EIRAS, Paula Cruz; ARAUJO, Luciano Nader de; PEREIRA, Antonio Jose Rodrigues; CARVALHO, Carlos; MALIK, Ana MariaBackground: With the arrival of the pandemic, telemedicine has been widely used to provide medical care and can be used to assist patients in regions far from urban centers that are difficult to access, such as riverside communities in the Brazilian Amazon region. A telemedicine project connecting Sao Paulo, a mega-metropolis, to Paysandu, a riverside district in the Amazon, was built to serve the local population where access to the nearest medical care is 6 hours away by speedboat. Objective: This study aims to assess the feedback from patients and doctors regarding the use of telemedicine in outpatient care at Paysandu, a riverside district in the Amazon. Methods: This is a single-center study following the guidelines ""Evaluating digital health products"" from Public Health England, with local adaptations for the project and the Brazilian reality, that was conducted between Sao Paulo and Santarem in Brazil. A survey was carried out with patients who were treated by a doctor in the city of Sao Paulo, about 2500 km from the local basic health unit, between September 27 to December 15, 2021. At the end of each teleconsultation, the attending physician answered an administrative survey form, and the patient answered a satisfaction survey. Results: A total of 111 patients completed the satisfaction survey from a total of 220 consultations carried out during the period (95% CI margin error 0.22%). According to the survey, more than 95% of patients were satisfied with the service, 87.4% (n=97) had previous experience with videoconferencing, and 76.6% (n=85) reported that their demand was fully solved. Additionally, according to the hired doctor's feedback, the average duration of the consultations was between 15 and 20 minutes. Of the 220 teleconsultations performed, 90.9% (n=200) of the demands were solved with support from the local health team, and 99.1% Conclusions: This teleconsultation project between Sao Paulo and Paysandu showed that it is possible to offer medical care from more developed locations to communities far from urban centers, as is the case with Paysandu District. Beyond the feasibility of the infrastructure, acceptance and satisfaction among patients were high. This health care supply model has proven to be functional and should be expanded nationally or perhaps internationally to regions lacking medical assistance. Escalation of the project does not seem too difficult once infrastructure issues are solved.
- A novel wireless oxygen gas sensor based on silver film loaded on a patch antenna(2023) NASCIMENTO, Joao Paulo Costa do; CARMO, Felipe Felix do; SALES, Antonio Jefferson Mangueira; MAIA, Saulo Macedo; FRUTUOSO, Romulo Lopes; CAVALCANTE, Tarique da Silveira; CAVALCANTE, Cleidson; VIEIRA, Julio Daniel Siqueira; CARVALHO, Carlos Roberto Ribeiro de; SOMBRA, Antonio Sergio BezerraIn this work, a patch antenna loaded with sensitive silver film was employed for the detection of oxygen gas at high concentrations. SEM micrographs demonstrate that the morphology of the Ag film presents an elevated degree of porosity, confirming that the film is suitable for adsorbing O2 gas molecules on its surface. Numerical simulation performed was validated, and the values of the far-field parameters showed that the investigated device works efficiently as an antenna. During the tests carried out, it was observed that the device responds sensitively to the presence of oxygen gas demonstrating shifts of the antenna resonant frequency to higher values as a function of the O2 concentration. The antenna sensitivity was calculated, presenting a value of 0.14 MHz/ O2% for the frequency at 5.968 GHz, 0.23 MHz/O2% for frequency at 8.246 GHz, and 0.15 MHz/O2% for the frequency at 10.039 GHz. Results obtained indicate that the patch antenna tested could be used as a sensor of oxygen gas in environments with elevated concentrations of this gas, such as oxygen concentrators and other medical equipment. Because the device analyzed is an antenna, it would be possible transmitting the sensing information to another device which would make it a potential candidate for application in healthcare monitoring.
- Breathing Under Pressure: An exploratory analysis of differences in respiratory muscle activity and work of breathing during exercise in COPD and ILD(2023) FERREIRA, Jeferson George; IAMONTI, Vinicius Carlos; PEREIRA, Mayra Caleffi; PLETSCH-ASSUNCAO, Renata; MACCHIONE, Marcelo Ceneviva; SANTANA, Pauliane Vieira; CARDENAS, Leticia Zumpano; CARUSO, Pedro; CARVALHO, Carlos Roberto Ribeiro; ALBUQUERQUE, Andre Luis Pereira
- Post-acute sequelae of SARS-CoV-2 associates with physical inactivity in a cohort of COVID-19 survivors(2023) GIL, Saulo; GUALANO, Bruno; ARAUJO, Adriana Ladeira de; OLIVEIRA JUNIOR, Gersiel Nascimento de; DAMIANO, Rodolfo Furlan; PINNA, Fabio; IMAMURA, Marta; ROCHA, Vanderson; KALLAS, Esper; BATISTELLA, Linamara Rizzo; V, Orestes Forlenza; CARVALHO, Carlos R. R. de; BUSATTO, Geraldo Filho; ROSCHEL, HamiltonThe aim of this study was to determine whether Post-acute Sequelae of SARS-CoV-2 Infection (PASC) are associated with physical inactivity in COVID-19 survivors. This is a cohort study of COVID-19 survivors discharged from a tertiary hospital in Sao Paulo, Brazil. Patients admitted as inpatients due to laboratory-confirmed COVID-19 between March and August 2020 were consecutively invited for a follow-up in-person visit 6 to 11 months after hospitalization. Ten symptoms of PASC were assessed using standardized scales. Physical activity was assessed by questionnaire and participants were classified according to WHO Guidelines. 614 patients were analyzed (age: 56 +/- 13 years; 53% male). Frequency of physical inactivity in patients exhibiting none, at least 1, 1-4, and 5 or more symptoms of PASC was 51%, 62%, 58%, and 71%, respectively. Adjusted models showed that patients with one or more persistent PASC symptoms have greater odds of being physically inactive than those without any persistent symptoms (OR: 1.57 [95% CI 1.04-2.39], P=0.032). Dyspnea (OR: 2.22 [1.50-3.33], P<0.001), fatigue (OR: 2.01 [1.40-2.90], P<0.001), insomnia (OR: 1.69 [1.16-2.49], P=0.007), post-traumatic stress (OR: 1.53 [1.05-2.23], P=0.028), and severe muscle/joint pain (OR: 1.53 [95% CI 1.08-2.17], P=0.011) were associated with greater odds of being physically inactive. This study suggests that PASC is associated with physical inactivity, which itself may be considered as a persistent symptom among COVID-19 survivors. This may help in the early identification of patients who could benefit from additional interventions tailored to combat inactivity (even after treatment of PASC), with potential beneficial impacts on overall morbidity/mortality and health systems worldwide.