Instituto Central - HC/ICHC

URI Permanente desta comunidade

Inaugurado a 19 de abril de 1944, o Instituto Central (ICHC) é o hospital base do Sistema Faculdade de Medicina da Universidade de São Paulo - Hospital das Clínicas (FMUSP-HC). Ocupa posição de destaque como instituição de assistência, ensino e pesquisa, sendo um avançado centro de excelência e referência no desenvolvimento de tecnologia voltada para a saúde.

O atendimento é realizado por equipes multidisciplinares compostas por profissionais das mais diversas áreas como enfermagem, fisioterapia, nutrição, serviço social, fonoaudiologia e farmácia. É composto pelo Instituto Central e Prédio dos Ambulatórios, concentrando a grande maioria das especialidades médicas do Sistema HC: Clínica Cirúrgica (Geral, Aparelho Digestivo, Fígado, Cabeça e Pescoço, Torácica, Vascular), Clínica Médica (Hematologia, Endocrinologia, Pneumologia, Nefrologia, Alergia e Imunologia, Reumatologia, Gastroenterologia, Geriatria), Neurologia Clínica e Cirúrgica, Urologia, Ginecologia, Obstetrícia, Dermatologia, Plástica e Queimaduras, Oftalmologia, Otorrinolaringologia, Endoscopia, Moléstias Infecciosas e Parasitarias entre outras. Além das clínicas médicas e cirúrgicas, conta com o pronto-socorro central, que atende diariamente a emergências de alta complexidade e pessoas vindas das diferentes partes da capital, interior e outros estados, disponibilizando tratamento a pacientes ambulatoriais e áreas de apoio diagnóstico e terapêutico. Comporta a Divisão de Nutrição e Dietética: que é a primeira unidade de nutrição em hospital público do Brasil a receber a certificação NBR ISO 9001.

O Instituto Central também oferece serviços diferenciados, como o da Farmácia do ICHC, no Prédio dos Ambulatórios do ICHC (PAMB), na qual são fabricados os medicamentos que não despertam interesse comercial e, por essa razão, não existem no mercado, e também são preparadas diluições e dosagens diferentes das disponíveis no mercado, segundo a necessidade do paciente, ou composições diferentes das tradicionais.

Site oficial: https://www.hc.fm.usp.br/index.php?option=com_content&view=article&id=102:instituto-central&catid=27&Itemid=226

Índice h

Scopus: 174

Navegar

Coleções desta Comunidade

Agora exibindo 1 - 3 de 3

Submissões Recentes

article
Update of the Brazilian consensus recommendations on Duchenne muscular dystrophy
(2023) ARAUJO, Alexandra Prufer de Queiroz Campos; SAUTE, Jonas Alex Morales; FORTES, Clarisse Pereira Dias Drumond; JR, Marcondes Cavalcante Franca; PEREIRA, Jaqueline Almeida; ALBUQUERQUE, Marco Antonio Veloso de; CARVALHO, Alzira Alves de Siqueira; CAVALCANTI, Eduardo Boiteux Uchoa; COVALESKI, Anna Paula Paranhos Miranda; FAGONDES, Simone Chaves; GURGEL-GIANNETTI, Juliana; GONCALVES, Marcus Vinicius Magno; MARTINEZ, Alberto Rolim Muro; NEVES, Flavio Reis; NUCCI, Anamarli; NUCERA, Ana Paula Cassetta dos Santos; PESSOA, Andre Luis Santos; REBEL, Marcos Ferreira; SANTOS, Flavia Nardes dos; SCOLA, Rosana Herminia; SOBREIRA, Claudia Ferreira da Rosa
In the last few decades, there have been considerable improvements in the diagnosis and care of Duchenne muscular dystrophy (DMD), the most common childhood muscular dystrophy. International guidelines have been published and recently reviewed. A group of Brazilian experts has developed a standard of care based on a literature review with evidence-based graded recommendations in a two-part publication. Implementing best practice management has helped change the natural history of this chronic progressive disorder, in which the life expectancy for children of the male sex in the past used to be very limited. Since the previous publication, diagnosis, steroid treatment, rehabilitation, and systemic care have gained more significant insights with new original work in certain fields. Furthermore, the development of new drugs is ongoing, and some interventions have been approved for use in certain countries. Therefore, we have identified the need to review the previous care recommendations for Brazilian patients with DMD. Our objective was to create an evidence-based document that is an update on our previous consensus on those topics.
article 0 Citação(ões) na Scopus
Improving perioperative care in low-resource settings with goal-directed therapy: a narrative review
(2024) LOBO, Suzana Margareth; SILVA, Joao Manoel da; MALBOUISSON, Luiz Marcelo
Perioperative Goal-Directed Therapy (PGDT) has significantly showed to decrease complications and risk of death in high-risk patients according to numerous meta-analyses. The main goal of PGDT is to individualize the therapy with fluids, inotropes, and vasopressors, during and after surgery, according to patients' needs in order to prevent organic dysfunction development. In this opinion paper we aimed to focus a discussion on possible alternatives to invasive hemodynamic monitoring in low resource settings. (c) 2023 Sociedade Brasileira de Anestesiologia.
article 3 Citação(ões) na Scopus
Hybrid laparoscopic versus fully robot-assisted minimally invasive esophagectomy: an international propensity-score matched analysis of perioperative outcome
(2023) JUNG, Jin-On; GROOT, Eline M. de; KINGMA, B. Feike; BABIC, Benjamin; RUURDA, Jelle P.; GRIMMINGER, Peter P.; HOELZEN, Jens P.; CHAO, Yin-Kai; HAVEMAN, Jan W.; DET, Marc J. van; ROUANET, Philippe; BENEDIX, Frank; LI, Hecheng; SARKARIA, Inderpal; HENEGOUWEN, Mark van Berge I.; BOXEL, Gijs I. van; CHIU, Philip; EGBERTS, Jan-Hendrik; SALLUM, Rubens; IMMANUEL, Arul; TURNER, Paul; LOW, Donald E.; HUBKA, Michal; PEREZ, Daniel; STRIGNANO, Paolo; BIEBL, Matthias; CHAUDRY, M. Asif; BRUNS, Christiane J.; HILLEGERSBERG, Richard van; FUCHS, Hans F.
BackgroundCurrently, little is known regarding the optimal technique for the abdominal phase of RAMIE. The aim of this study was to investigate the outcome of robot-assisted minimally invasive esophagectomy (RAMIE) in both the abdominal and thoracic phase (full RAMIE) compared to laparoscopy during the abdominal phase (hybrid laparoscopic RAMIE).MethodsThis retrospective propensity-score matched analysis of the International Upper Gastrointestinal International Robotic Association (UGIRA) database included 807 RAMIE procedures with intrathoracic anastomosis between 2017 and 2021 from 23 centers.ResultsAfter propensity-score matching, 296 hybrid laparoscopic RAMIE patients were compared to 296 full RAMIE patients. Both groups were equal regarding intraoperative blood loss (median 200 ml versus 197 ml, p = 0.6967), operational time (mean 430.3 min versus 417.7 min, p = 0.1032), conversion rate during abdominal phase (2.4% versus 1.7%, p = 0.560), radical resection (R0) rate (95.6% versus 96.3%, p = 0.8526) and total lymph node yield (mean 30.4 versus 29.5, p = 0.3834). The hybrid laparoscopic RAMIE group showed higher rates of anastomotic leakage (28.0% versus 16.6%, p = 0.001) and Clavien Dindo grade 3a or higher (45.3% versus 26.0%, p < 0.001). The length of stay on intensive care unit (median 3 days versus 2 days, p = 0.0005) and in-hospital (median 15 days versus 12 days, p < 0.0001) were longer for the hybrid laparoscopic RAMIE group.ConclusionsHybrid laparoscopic RAMIE and full RAMIE were oncologically equivalent with a potential decrease of postoperative complications and shorter (intensive care) stay after full RAMIE.
article 0 Citação(ões) na Scopus
Pharmacokinetics and Therapeutic Target Attainment of Meropenem in Pediatric Post-Liver Transplant Patients: Extended vs Intermittent Infusion
(2023) MORALES JUNIOR, Ronaldo; JUODINIS, Vanessa D'amaro; TELLES, Joao Paulo; ROMANO, Paschoalina; DUARTE, Nilo Jose Coelho; SOUZA, Daniela Carla De; SANTOS, Silvia Regina Cavani Jorge
Purpose. The aim of this study is to characterize the concentration-time profile, pharmacokinetics parameters, and therapeutic target attainment of meropenem in pediatric post-liver transplant patients according to the duration of infusion. Methods. This is a prospective cohort of pediatric transplant recipients with preserved renal function receiving meropenem 40 mg/kg every 8 hours. The patients were stratified into 2 groups based on infusion duration: G1 (15 minutes of intermittent infusion) and G1 (3 hours of extended infusion). Two blood samples per child were collected during the same interval within 48 hours of starting the antimicrobial. Meropenem concentrations were determined by high-performance liquid chromatography with tandem mass spectrometry. Pharmacokinetic parameters were assessed using a noncompartmental analysis. The therapeutic target was defined as 100% of the time above the minimum inhibitory concentration.Findings. Fourteen patients with 28 measured meropenem concentrations were included. Lower values of volume of distribution and meropenem clearance compared with other critically ill pediatric populations were found. All patients achieved the therapeutic target against gram-negative pathogens with a minimum inhibitory concentration of <= 8 mg/L. Patients receiving a 15-minute infusion had higher values of peak and trough concentrations, resulting in unnecessary increased total drug exposure when compared to patients receiving a 3-hour infusion (P < .05).Conclusions. Meropenem at 120 mg/kg/d attained the therapeutic target against sensitive microorganisms in pediatric liver transplant recipients. The extended infusion should be preferred for patient safety. Because of the pharmacokinetic changes resulting from liver transplantation, individualized meropenem dosing regimens may be necessary.
article 3 Citação(ões) na Scopus
Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer
(2023) TOBIAS-MACHADO, Marcos; ORNELLAS, Antonio A.; HIDAKA, Alexandre K.; MEDINA, Luis G.; MATTOS, Pablo A. L.; BESIO, Ruben S.; ABREU, Diego; CASTRO, Pedro R.; NISHIMOTO, Ricardo H.; ASTIGUETA, Juan; DOURADO, Aurus; MACHADO, Roberto D.; MAGNABOSCO, Wesley J.; CORONA-MONTES, Victor; VILLOLDO, Gustavo M.; ZAMPOLLI, Hamilton C.; TAHA, Anis; AUAD, Pericles R.; FARIA, Eliney F.; ARANTES, Paulo B. O.; TAVARES, Alessandro; NASCIMENTO, Francisco S. M. S.; BRAZAO JR., Eder S.; ROCHA, Mauricio M.; COSTA, Walter H.; PANICO, Vinicius; REIS, Leonardo O.; ALMEIDA-CARRERA, Roberto J.; SILVA, Rafael C.; ZEQUI, Stenio C.; CALIXTO, Jose R. R.; SOTELO, Rene
Objective: To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). Materials and Methods: Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. Results: From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. Conclusion: VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of nonbulky lymph nodes in penile cancer.
article 0 Citação(ões) na Scopus
Accuracy of the 10 μg desmopressin test for differential diagnosis of Cushing syndrome: a systematic review and meta-analysis
(2024) GIAMPIETRO, Rodrigo Rosa; CABRAL, Marcos Vinicius Gama; PEREIRA, Elizandra Gomes; MACHADO, Marcio Carlos; VILAR, Lucio; NUNES-NOGUEIRA, Vania dos Santos
We evaluated the accuracy of the 10 mu g desmopressin test in differentiating Cushing disease (CD) from non-neoplastic hypercortisolism (NNH) and ectopic ACTH syndrome (EAS). A systematic review of studies on diagnostic test accuracy in patients with CD, NNH, or EAS subjected to the desmopressin test obtained from LILACS, PubMed, EMBASE, and CENTRAL databases was performed. Two reviewers independently selected the studies, assessed the risk of bias, and extracted the data. Hierarchical and bivariate models on Stata software were used for meta-analytical summaries. The certainty of evidence was measured using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation Working Group) approach. In total, 14 studies were included: 3 studies on differentiated CD versus NNH and 11 studies on differentiated CD versus EAS. Considering Delta ACTH in 8 studies involving 429 patients, the pooled sensitivity for distinguishing CD from EAS was 0.85 (95% confidence interval [CI]: 0.80-0.89, I2 = 17.6%) and specificity was 0.64 (95% CI: 0.49-0.76, I2 = 9.46%). Regarding Delta cortisol in 6 studies involving 233 participants, the sensitivity for distinguishing CD from EAS was 0.81 (95% CI: 0.74-0.87, I2 = 7.98%) and specificity was 0.80 (95% CI: 0.61-0.91, I2 = 12.89%). The sensitivity and specificity of the combination of Delta ACTH > 35% and Delta cortisol > 20% in 5 studies involving 511 participants were 0.88 (95% CI: 0.79-0.93, I2 = 35%) and 0.74 (95% CI: 0.55-0.87, I2 = 27%), respectively. The pooled sensitivity for distinguishing CD from NNH in 3 studies involving 170 participants was 0.88 (95% CI: 0.79-0.93) and the specificity was 0.94 (95% CI: 0.86-0.97). Based on the desmopressin test for differentiating CD from EAS, considering Delta ACTH, Delta cortisol, or both percent increments, 15%, 19%, or 20% of patients with CD, respectively, would be incorrectly classified as having EAS. For CD versus NNH, 11% of patients with CD would be falsely diagnosed as having NNH, whereas 7% of patients with NNH would be falsely diagnosed as having CD. However, in all hierarchical plots, the prediction intervals were considerably wider than the confidence intervals. This indicates low confidence in the estimated accuracy, and the true accuracy is likely to be different. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=85634, identifier CRD42018085634; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=68317, identifier CRD42017068317.
article 0 Citação(ões) na Scopus
To be or not to B27 positive: implications for the phenotypes of axial spondyloarthritis outcomes. Data from a large multiracial cohort from the Brazilian Registry of Spondyloarthritis
(2024) RESENDE, Gustavo Gomes; SAAD, Carla Goncalves Schahin; MARQUES, Claudia Diniz Lopes; RIBEIRO, Sandra Lucia Euzebio; GAVI, Maria Bernadete Renoldi de Oliveira; YAZBEK, Michel Alexandre; MARINHO, Adriana de Oliveira; MENIN, Rita de Cassia; OCHTROP, Manuella Lima Gomes; SOARES, Andressa Miozzo; CAVALCANTI, Nara Gualberto; CARNEIRO, Jamille Nascimento; CASTRO, Glaucio Ricardo Werner de; FERNANDES, Jose Mauro Carneiro; SOUZA, Elziane; ALVARENGA, Corina Quental de Menezes; VIEIRA, Rejane Maria Rodrigues de Abreu; MACHADO, Natalia Pereira; XIMENES, Antonio Carlos; GAZZETA, Morgana Ohira; ALBUQUERQUE, Cleandro Pires de; SKARE, Thelma Larocca; KEISERMAN, Mauro Waldemar; KOHEM, Charles Lubianca; BENACON, Gabriel Sarkis; ROCHA, Vitor Florencio Santos; LAGE, Ricardo da Cruz; MALHEIRO, Olivio Brito; GOLEBIOVSKI, Rywka Tenenbaum Medeiros; OLIVEIRA, Thauana Luiza; DUQUE, Ruben Horst; LONDE, Ana Carolina; PINHEIRO, Marcelo de Medeiros; SAMPAIO-BARROS, Percival Degrava
Background There is a remarkable variability in the frequency of HLA-B27 positivity in patients with spondyloarthritis (SpA), which may be associated with different clinical presentations worldwide. However, there is a lack of data considering ethnicity and sex on the evaluation of the main clinical and prognostic outcomes in mixed-race populations. The aim of this study was to evaluate the frequency of HLA-B27 and its correlation with disease parameters in a large population of patients from the Brazilian Registry of Spondyloarthritis (RBE).Methods The RBE is a multicenter, observational, prospective cohort that enrolled patients with SpA from 46 centers representing all five geographic regions of Brazil. The inclusion criteria were as follow: (1) diagnosis of axSpA by an expert rheumatologist; (2) age >= 18 years; (3) classification according to ASAS axial. The following data were collected via a standardized protocol: demographic data, disease parameters and treatment historical.Results A total of 1096 patients were included, with 73.4% HLA-B27 positivity and a mean age of 44.4 (+/- 13.2) years. Positive HLA-B27 was significantly associated with male sex, earlier age at disease onset and diagnosis, uveitis, and family history of SpA. Conversely, negative HLA-B27 was associated with psoriasis, higher peripheral involvement and disease activity, worse quality of life and mobility.Conclusions Our data showed that HLA-B27 positivity was associated with a classic axSpA pattern quite similar to that of Caucasian axSpA patients around the world. Furthermore, its absence was associated with peripheral manifestations and worse outcomes, suggesting a relevant phenotypic difference in a highly miscegenated population.
article 0 Citação(ões) na Scopus
COVID-19 Vaccination in Patients with Inborn Errors of Immunity Reduces Hospitalization and Critical Care Needs Related to COVID-19: a USIDNET Report
(2024) MCDONNELL, John; COUSINS, Kimberley; YOUNGER, M. Elizabeth M.; LANE, Adam; ABOLHASSANI, Hassan; ABRAHAM, Roshini S.; AL-TAMEMI, Salem; ALDAVE-BECERRA, Juan Carlos; AL-FARIS, Eman Hesham; ALFARO-MURILLO, Alberto; ALKHATER, Suzan A.; ALSAATI, Nouf; DOSS, Alexa Michelle Altman; ANDERSON, Melissa; ANGAROLA, Ernestina; ARIUE, Barbara; ARNOLD, Danielle E.; ASSA'AD, Amal H.; AYTEKIN, Caner; BANK, Meaghan; BERGERSON, Jenna R. E.; BLEESING, Jack; BOESING, John; BOUSO, Carolina; BRODSZKI, Nicholas; CABANILLAS, Diana; CADY, Carol; CALLAHAN, Meghan A.; CAORSI, Roberta; CARBONE, Javier; CARRABBA, Maria; CASTAGNOLI, Riccardo; CATANZARO, Jason R.; CHAN, Samantha; CHANDRA, Sharat; CHAPDELAINE, Hugo; CHAVOSHZADEH, Zahra; CHONG, Hey Jin; CONNORS, Lori; CONSONNI, Filippo; CORREA-JIMENEZ, Oscar; CUNNINGHAM-RUNDLES, Charlotte; D'ASTOUS-GAUTHIER, Katherine; DELMONTE, Ottavia Maria; DEMIRDAG, Yesim Yilmaz; DESHPANDE, Deepti R.; DIAZ-CABRERA, Natalie M.; DIMITRIADES, Victoria R.; EL-OWAIDY, Rasha; ELGHAZALI, Gehad; AL-HAMMADI, Suleiman; FABIO, Giovanna; FAURE, Astrid Schellnast; FENG, Jin; FERNANDEZ, James M.; FILL, Lauren; FRANCO, Guacira R.; FRENCK, Robert W.; FULEIHAN, Ramsay L.; GIARDINO, Giuliana; GALANT-SWAFFORD, Jessica; GAMBINERI, Eleonora; GARABEDIAN, Elizabeth K.; GEERLINKS, Ashley V.; GOUDOURIS, Ekaterini; GRECCO, Octavio; PAN-HAMMARSTROM, Qiang; KHANI, Hedieh Haji Khodaverdi; HAMMARSTROM, Lennart; HARTOG, Nicholas L.; HEIMALL, Jennifer; HERNANDEZ-MOLINA, Gabriela; HORNER, Caroline C.; HOSTOFFER, Robert W.; HRISTOVA, Nataliya; HSIAO, Kuang-Chih; IVANKOVICH-ESCOTO, Gabriela; JABER, Faris; JALIL, Maaz; JAMEE, Mahnaz; JEAN, Tiffany; JEONG, Stephanie; JHAVERI, Devi; JORDAN, Michael B.; JOSHI, Avni Y.; KALKAT, Amanpreet; KANAREK, Henry J.; KELLNER, Erinn S.; KHOJAH, Amer; KHOURY, Ruby; KOKRON, Cristina M.; KUMAR, Ashish; LECERF, Kelsey; LEHMAN, Heather K.; LEIDING, Jennifer W.; LESMANA, Harry; LIM, Xin Rong; LOPES, Joao Pedro; LOPEZ, Ana Laura; TARQUINI, Lucia; LUNDGREN, Ingrid S.; MAGNUSSON, Julieann; MARINHO, Ana Karolina B. B.; MARSEGLIA, Gian Luigi; MARTONE, Giulia M.; MECHTLER, Annamaria G.; MENDONCA, Leonardo; MILNER, Joshua D.; MUSTILLO, Peter J.; NADERI, Asal Gharib; NAVIGLIO, Samuele; NELL, Jeremy; NIEBUR, Hana B.; NOTARANGELO, Luigi; OLEASTRO, Matias; ORTEGA-LOPEZ, Maria Claudia; PATEL, Neil R.; PETROVIC, Gordana; PIGNATA, Claudio; PORRAS, Oscar; PRINCE, Benjamin T.; PUCK, Jennifer M.; QAMAR, Nashmia; RABUSIN, Marco; RAJE, Nikita; REGAIRAZ, Lorena; RISMA, Kimberly A.; RISTAGNO, Elizabeth H.; ROUTES, John; ROXO-JUNIOR, Persio; SALEMI, Negin; SCALCHUNES, Christopher; SCHUVAL, Susan J.; SENEVIRATNE, Suranjith L.; SHANKAR, Ashwin; SHERKAT, Roya; SHIN, Junghee Jenny; SIDDIQI, Abeer; SIGNA, Sara; SOBH, Ali; LIMA, Fabiana Mascarenhas Souza; STENEHJEM, Kristen K.; TAM, Jonathan S.; TANG, Monica; BARROS, Myrthes Toledo; VERBSKY, James; VERGADI, Eleni; VOELKER, Dayne H.; VOLPI, Stefano; WALL, Luke A.; WANG, Christine; WILLIAMS, Kelli W.; WU, Eveline Y.; WU, Shan Shan; ZHOU, Jessie J.; COOK, Alexandria; SULLIVAN, Kathleen E.; MARSH, Rebecca
Background The CDC and ACIP recommend COVID-19 vaccination for patients with inborn errors of immunity (IEI). Not much is known about vaccine safety in IEI, and whether vaccination attenuates infection severity in IEI. Objective To estimate COVID-19 vaccination safety and examine effect on outcomes in patients with IEI. Methods We built a secure registry database in conjunction with the US Immunodeficiency Network to examine vaccination frequency and indicators of safety and effectiveness in IEI patients. The registry opened on January 1, 2022, and closed on August 19, 2022. Results Physicians entered data on 1245 patients from 24 countries. The most common diagnoses were antibody deficiencies (63.7%). At least one COVID-19 vaccine was administered to 806 patients (64.7%), and 216 patients received vaccination prior to the development of COVID-19. The most common vaccines administered were mRNA-based (84.0%). Seventeen patients were reported to seek outpatient clinic or emergency room care for a vaccine-related complication, and one patient was hospitalized for symptomatic anemia. Eight hundred twenty-three patients (66.1%) experienced COVID-19 infection. Of these, 156 patients required hospitalization (19.0%), 47 required ICU care (5.7%), and 28 died (3.4%). Rates of hospitalization (9.3% versus 24.4%, p < 0.001), ICU admission (2.8% versus 7.6%, p = 0.013), and death (2.3% versus 4.3%, p = 0.202) in patients who had COVID-19 were lower in patients who received vaccination prior to infection. In adjusted logistic regression analysis, not having at least one COVID-19 vaccine significantly increased the odds of hospitalization and ICU admission. Conclusion Vaccination for COVID-19 in the IEI population appears safe and attenuates COVID-19 severity.
article 0 Citação(ões) na Scopus
Machine learning algorithms using national registry data to predict loss to follow-up during tuberculosis treatment
(2024) RODRIGUES, Moreno M. S.; BARRETO-DUARTE, Beatriz; VINHAES, Caian L.; ARAUJO-PEREIRA, Mariana; FUKUTANI, Eduardo R.; BERGAMASCHI, Keityane Bone; KRISTKI, Afranio; CORDEIRO-SANTOS, Marcelo; ROLLA, Valeria C.; STERLING, Timothy R.; QUEIROZ, Artur T. L.; ANDRADE, Bruno B.
Background Identifying patients at increased risk of loss to follow-up (LTFU) is key to developing strategies to optimize the clinical management of tuberculosis (TB). The use of national registry data in prediction models may be a useful tool to inform healthcare workers about risk of LTFU. Here we developed a score to predict the risk of LTFU during anti-TB treatment (ATT) in a nationwide cohort of cases using clinical data reported to the Brazilian Notifiable Disease Information System (SINAN). Methods We performed a retrospective study of all TB cases reported to SINAN between 2015 and 2022; excluding children (< 18 years-old), vulnerable groups or drug-resistant TB. For the score, data before treatment initiation were used. We trained and internally validated three different prediction scoring systems, based on Logistic Regression, Random Forest, and Light Gradient Boosting. Before applying our models we splitted our data into training (similar to 80% data) and test (similar to 20%) sets, and then compared the model metrics using the test data set. Results Of the 243,726 cases included, 41,373 experienced LTFU whereas 202,353 were successfully treated. The groups were different with regards to several clinical and sociodemographic characteristics. The directly observed treatment (DOT) was unbalanced between the groups with lower prevalence in those who were LTFU. Three models were developed to predict LTFU using 8 features (prior TB, drug use, age, sex, HIV infection and schooling level) with different score composition approaches. Those prediction scoring systems exhibited an area under the curve (AUC) ranging between 0.71 and 0.72. The Light Gradient Boosting technique resulted in the best prediction performance, weighting specificity and sensitivity. A user-friendly web calculator app was developed (https://tbprediction.herokuapp.com/) to facilitate implementation. Conclusions Our nationwide risk score predicts the risk of LTFU during ATT in Brazilian adults prior to treatment commencement utilizing schooling level, sex, age, prior TB status, and substance use (drug, alcohol, and/or tobacco). This is a potential tool to assist in decision-making strategies to guide resource allocation, DOT indications, and improve TB treatment adherence.
article 4 Citação(ões) na Scopus
The trajectory of very old critically ill patients
(2024) GUIDET, Bertrand; VALLET, Helene; FLAATTEN, Hans; JOYNT, Gavin; BAGSHAW, Sean M.; LEAVER, Susannah K.; BEIL, Michael; DU, Bin; FORTE, Daniel N.; ANGUS, Derek C.; SVIRI, Sigal; LANGE, Dylan de; HERRIDGE, Margaret S.; JUNG, Christian
The demographic shift, together with financial constraint, justify a re-evaluation of the trajectory of care of very old critically ill patients (VIP), defined as older than 80 years. We must avoid over- as well as under-utilisation of critical care interventions in this patient group and ensure the inclusion of health care professionals, the patient and their caregivers in the decision process. This new integrative approach mobilises expertise at each step of the process beginning prior to intensive care unit (ICU) admission and extending to long-term follow-up. In this review, several international experts have contributed to provide recommendations that can be universally applied. Our aim is to define a minimum core dataset of information to be shared and discussed prior to ICU admission and to facilitate the shared-decision-making process with the patient and their caregivers, throughout the patient journey. Documentation of uncertainty may contribute to a tailored level of care and ultimately to discussions around possible limitations of life sustaining treatments. The goal of ICU care is not only to avoid death, but more importantly to maintain an acceptable quality of life and functional autonomy after hospital discharge. Societal consideration is important to highlight, together with alternatives to ICU admission. We discuss challenges for the future and potential areas of research. In summary, this review provides a state-of-the-art current overview and aims to outline future directions to address the challenges in the treatment of VIP.