LEONARDO ZUMERKORN PIPEK
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
10 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 10
- Long-term outcomes of ruptured saccular intracranial aneurysm clipping versus coiling: systematic review and meta-analysis of randomized controlled trials(2022) RABELO, Nicollas Nunes; TELLES, Joao Paulo Mota; PIPEK, Leonardo Zumerkorn; MAKAREM, Louise; BOECHAT, Antonio Luis; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaIntroduction Previous meta-analyses comparing microsurgery and coiling that include BRAT may be inaccurate to compare the outcomes of ruptured saccular aneurysms. This study aims to evaluate 10-year efficiency, safety, and advantages of coiling compared with clipping in patients with spontaneous saccular aneurismal SAH as a primary outcome. Also analyzed secondary outcomes: no-occlusion, mortality, rebleeding, and retreatment. Methods A systematic search of the literature on microsurgical clipping versus coiling was done to identify RCTs with at least 10 years of follow-up published between 2000 and 2021. The primary outcome was favorable functional outcome, defined as a modified Rankin scale (mRS) score <= 2. Secondary outcomes were no-occlusion, mortality, rebleeding, and retreatment. Quality of the included trials was analyzed using the Risk of Bias 2.0 (RoB 2.0) tool. A random-effects meta-analysis was performed. Results Two studies reported 10-year follow-up results, and the meta-analysis did not demonstrate significant differences between groups (OR 0.9, 95%CI 0.66-1.24, I-2 = 21%). No differences were observed compared clipping and coiling regarding occlusion rates (OR 5.3, 95%CI 0.8-36.3, I-2 = 89%). Mortality rates did not show significant differences between treatment modalities (OR 0.97, 95%CI 0.77-1.21, I-2 = 0%). Rebleeding rates were also similar between groups (OR 1.63, 95%CI 0.25-10.7, h= 37%); however, significantly higher retreatment rates were associated with coiling (OR 10.6, 95%CI 2.1-52.5, I-2 = 80%). Overall, risk of bias was low. Conclusion There are no long-term differences regarding no-occlusion, mortality, and rebleeding rates between coiling and clipping. Higher retreatment rates were associated with coiling.
- Homocysteine is associated with higher risks of ischemic stroke: A systematic review and meta-analysis(2022) RABELO, Nicollas Nunes; TELLES, Joao Paulo Mota; PIPEK, Leonardo Zumerkorn; NASCIMENTO, Rafaela Farias Vidigal; GUSMAO, Rodrigo Coimbra de; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaBackground High levels of homocysteine (Hct) have been associated with great risks of ischemic stroke. However, some controversy still exists. We performed a systematic review and meta-analysis to compare the levels of Hct between patients with ischemic stroke and controls. Methods We performed a systematic literature search for articles reporting Hct levels of patients with occurrence of ischemic stroke. We employed a random-effects inverse-variance weighted meta-analytical approach in order to pool standardized mean differences, with estimation of tau(2) through the DerSimonian-Laird method. Results The initial search yielded 1361 studies. After careful analysis of abstracts and full texts, the meta-analysis included data from 38 studies, which involved almost 16 000 stroke events. However, only 13 studies reported means and standard deviations for cases and controls, and therefore were used in the meta-analysis. Those studies presented data from 5002 patients with stroke and 4945 controls. Standardized mean difference was 1.67 (95% CI 1.00-2.25, P < 0.01), indicating that Hct levels were significantly larger in patients with ischemic stroke compared to controls. Between-study heterogeneity was very large (I-2 = 99%), particularly because three studies showed significantly large mean differences. Conclusion This meta-analysis shows that patients with ischemic stroke have higher levels of Hct compared to controls. Whether this is a modifiable risk factor remains to be assessed through larger prospective cohorts.
- Could outcomes of intracranial aneurysms be better predict using serum creatinine and glomerular filtration rate?(2022) RABELO, Nicollas Nunes; PIPEK, Leonardo Zumerkorn; NASCIMENTO, Rafaela Farias Vidigal; TELLES, Joao Paulo Mota; BARBATO, Natalia Camargo; COELHO, Antonio Carlos Samaia da Silva; BARBOSA, Guilherme Bitencourt; YOSHIKAWA, Marcia Harumy; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaPurpose: To analyze the role of serum creatinine levels as a biomarker of intracranial aneurysm outcomes. Methods: This is a prospective analysis of outcomes of patients with intracranial aneurysm. One hundred forty-seven patients with serum creatinine at admission and 6 months follow up were included. Linear and logistic regressions were used to analyze the data. Modified Rankin scale (mRS) was used to assess outcome. Results: Creatinine level was not directly related to aneurysm outcome nor aneurysm rupture (p > 0.05). However, patients with a glomerular filtration rate (GFR) lower than 72.50 mL.min(-1) had an odds ratio (OR) of 3.049 (p = 0.006) for worse outcome. Similarly, aneurysm rupture had an OR of 2.957 (p = 0.014) for worse outcomes. Stepwise selection model selected 4 variables for outcomes prediction: serum creatinine, sex, hypertension and treatment. Hypertensive patients had, on average, an increase in 0.588 in mRS (p = 0.022), while treatment with microsurgery had a decrease in 0.555 (p = 0.038). Conclusion: Patients with higher GFR had better outcomes after 6 months. Patients with higher GFR had better outcomes after 6 months. Creatinine presented an indirect role in GFR values and should be included in models for outcome prediction.
- Prospective Analysis of Cerebral Edema Admission and Clinical Outcome in Ruptured Intracranial Aneurysm(2023) OBERMAN, Dan Zimelewicz; RABELO, Nicollas Nunes; PIPEK, Leonardo Zumerkorn; TELLES, Joao Paulo Mota; BARBAT, Natalia Camargo; COELHO, Antonio Carlos Samaia da S. I. L. V. A.; YOSHIKAWA, Marcia Harumy; BARBOSA, Guilherme Bittencourt; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaAIM: To evaluate the association between global cerebral edema (GCE) after subarachnoid hemorrhage (SAH) and its impact on functional outcome evaluated by the modified Rankin scale (mRS). MATERIAL and METHODS: This is a prospective cohort study with patients who were admitted to the hospital due to SAH. During the period from January 2018 to November 2019, 107 patients with intracranial aneurysms were enrolled. Using univariate and multivariate analysis, we sought to identify predictors and evaluated the impact of GCE on outcome after 6 months using the mRS. RESULTS: GCE was present in 54 (50.5%) patients, of which 27 (25.2%) were mild, 20 (18.7%) moderate and 7 (6.5%) were severe. Univariate analysis identified high Hunt-Hess and Glasgow coma scale on clinical admission as predictors factors of GCE (p<0.05), and higher modified Fisher scale as a radiological predictor of Glasgow coma scale (p<0.05). Thirty-three (30.8%) patients were deceased at 6 months. Death or severe disability were predicted by higher age, poor clinical scale on admission and severe GCE (p<0.05). CONCLUSION: GCE on admission is independently associated with poor clinical outcomes at discharge, and six months after SAH. Given its strong association with poor clinical grade on admission, GCE should be considered a straightforward and radiological important marker of early brain injury, with ominous implications.
- Analysis of Serum Cholesterol, Statins and Atherosclerotic Plaque in Ruptured and Unruptured Intracranial Aneurysm(2022) PIPEK, Leonardo Zumerkorn; RABELO, Nicollas Nunes; PIPEK, Henrique Zumerkorn; TELLES, Joao Paulo Mota; BARBAT, Natalia Camargo; COELHO, Antonio Carlos Samaia da Silva; YOSHIKAWA, Marcia Harumy; BARBOSA, Guilherme Bitencourt; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaIntroduction Intracranial aneurysm (IA) is a major healthcare concern. The use of statin to reduce serum cholesterol has shown evidence to reduce cardiovascular risk in various diseases, but the impact on IA has not been described. This study aims to determine whether statin use, and serum cholesterol levels interfere with outcomes after IA event. Methods A cohort of patients with IA was analyzed. Patients social and demographics data were collected. Modified Rankin scale (mRS) score after 6 months of follow-up was the endpoint. The data regarding statins use, presence or not of atherosclerotic plaque in radiological images and serum cholesterol of 35 patients were included in our study. Linear regression models were used to determine the influence of those 6 variables in the clinical outcome. Results The prevalence of atherosclerotic plaque, high cholesterol and use of statins was 34.3%, 48.5%, and 14.2%, respectively. Statins and serum cholesterol did not impact the overall outcome, measured by mRS after 6 months ( p > 0.05), but did show different tendencies when separated by IA rupture status. Serum cholesterol shows an important association with rupture of aneurysm ( p = 0.0382). High cholesterol and use of statins show a tendency for worse outcome with ruptured aneurysm, and the opposite is true for unruptured aneurysm. The presence of atherosclerotic plaques was not related with worse outcomes. Conclusions Multiple and opposite mechanisms might be involved in the pathophysiology of IA. Ruptured aneurysms are associated with higher levels of serum cholesterol. Serum cholesterol and statins use were not correlated with worse outcomes, but further studies are important to clarify these relationships.
- Aneurysmal Subarachnoid Hemorrhage: Is the Time Until Intervention Related to Minor Disabilities in 6 Months?(2023) TEBELSKIS, Yuri; RABELO, Nicollas Nunes; PIPEK, Leonardo Zumerkorn; TELLES, Joao Paulo Mota; BARBOSA, Guilherme Bitencourt; BARBAT, Natalia Camargo; COELHO, Antonio Carlos Samaia da Silva; YOSHIKAWA, Marcia Harumy; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaBackground Aneurysmal subarachnoid hemorrhages (aSAHs) account for 5% of all strokes, an appalling number when it comes to the second most common cause of death worldwide. The basis of the treatment is clinical support and either endovascular or surgical intervention. The purpose of the present study is to analyze if the time from the onset of the thunderclap headache until treatment intervention is related to the degree of disability after 6 months.Methods In the present prospective observational study, data were collected from all patients ( n = 223) admitted to the hospital with a diagnosis of aSAH. Patients whose data were missing or who missed the follow-up after 6 months were excluded. Then, the number of days from the thunderclap headache until the surgical intervention (Delta T) was obtained. The degree of disability was evaluated using standardized scales, Rankin Scale (RS) and Glasgow Outcome Scale (GOS), at the time of discharge as well as 6 months later. Then, the RS and GOS were correlated with Delta T.Results An average of 6.8 days was found from the onset of symptoms to the intervention, the average age was 54 years old, 73% were women and 55% were smokers. The mean Glasgow Coma Scale on admission was 13. The mean score on the Hunt and Hess scale was 2.1. From the radiological point of view, the mean size of the aneurysm was 6 mm, and the modified Fisher Scale was 3.1. Of the total number of patients at the end of the study ( n = 78), 50 underwent microsurgical treatment (63%). Rankin scale at discharge was 1.9 and GOS was 4.5, with no statistically significant change at 6 months. Analyzing the data distribution using linear regression, no statistically significant correlation was found between the time until treatment and disability using RS and GOS ( p > 0.05). The same results were found even analyzing age subgroups (<= 45 years old, 45 to 55 years old, 55 to 70 years old, and > 70 years old with a p -value > 0.05).Conclusions The present study suggests that there is no linear correlation between Delta T and disability at 6 months for the population studied. However, more studies are needed to assess whether these findings may be present in other populations, especially with a shorter time from symptoms to intervention, since the greatest risk of rebleeding occurs in the first 3 days after the event.
- Long-term outcomes of ruptured saccular intracranial aneurysm clipping versus coiling: systematic review and eta-analysis of randomized controlled trials (Apr, 10.1007/s10072-022-06039-2, 2022)(2022) RABELO, Nicollas Nunes; TELLES, Joao Paulo Mota; PIPEK, Leonardo Zumerkorn; MAKAREM, Louise; BOECHAT, Antonio Luis; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval Gadelha
- Microsurgery versus embolization: different risk factors for short- and long- term outcomes of patients with ruptured aneurysms(2022) YOSHIKAWA, Marcia Harumy; RABELO, Nicollas Nunes; TELLES, Joao Paulo Mota; BARBOSA, Guilherme Bitencourt; BARBATO, Natalia Camargo; COELHO, Antonio Carlos Samaia da Silva; PIPEK, Leonardo Zumerkorn; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaPurpose: To evaluate the risk factors for poor outcomes after surgical and endovascular treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods: Patients with ??? 18-years of age and aSAH were included, while patients who died within 12 h of admission or lost follow-up were excluded. All participants underwent standardized clinical and radiological assessment on admission and were reassessed at discharge and at 6-months follow-up using the Glasgow Outcome Scale (GOS). Results: Death at discharge was associated with female gender, anterior communication artery (ACoA) aneurysm location and presence of atherosclerotic plaque in the surgical group, and with age in the endovascular group. Both groups had clinical condition on follow-up associated with mFisher score on admission and hypertension. GOS on follow-up was also associated with presence of atherosclerotic plaque and multiple aneurysms in surgical group, and with age in endovascular group. Conclusion: Subjects treated surgically are prone to unfavorable outcomes if atherosclerotic plaques and multiple aneurysms are present. In patients with endovascular treatment, age was the main predictor of clinical outcome.
- Role of temporary arterial occlusion in subarachnoid hemorrhage outcomes: a prospective cohort study(2023) YOSHIKAWA, Marcia Harumy; RABELO, Nicollas Nunes; TELLES, Joao Paulo Mota; PIPEK, Leonardo Zumerkorn; BARBOSA, Guilherme Bitencourt; BARBATO, Natalia Camargo; COELHO, Antonio Carlos Samaia da Silva; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaPurpose: Temporary arterial occlusion (TAO) is a widespread practice in the surgical treatment of intracranial aneurysms. This study aimed to investigate TAO's role during ruptured aneurysm clipping as an independent prognostic factor on short-and long-term outcomes. Methods: This prospective cohort included 180 patients with ruptured intracranial aneurysms and an indication of microsurgical treatment. Patients who died in the first 12 hours after admission were excluded. Results: TAO was associated with intraoperative rupture (IOR) (odds ratio - OR = 10.54; 95% confidence interval - 95%CI 4.72-23.55; p < 0.001) and surgical complications (OR = 2.14; 95%CI 1.11-4.07; p = 0.01). The group with TAO and IOR had no significant difference in clinical (p = 0.06) and surgical (p = 0.94) complications compared to the group that had TAO, but no IOR. Among the 111 patients followed six months after treatment, IOR, number of occlusions, and total time of occlusion were not associated with Glasgow Outcome Scale (GOS) in the follow-up (respectively, p = 0.18, p = 0.30, and p = 0.73). Among patients who underwent TAO, IOR was also not associated with GOS in the follow-up (p = 0.29). Conclusion: TAO was associated with IOR and surgical complications, being the latter independent of IOR occurrence. In long-term analysis, neither TAO nor IOR were associated with poor clinical outcomes.
- Influence of Serum Ferritin and B12 Levels in the Functional Outcomes of Patients with Ruptured and Unruptured Intracranial Aneurysms(2023) RABELO, Nicollas Nunes; COELHO, Antonio Carlos Samaia da Silva; PIPEK, Leonardo Zumerkorn; TELLES, Joao Paulo Mota; BARBATO, Natalia Camargo; YOSHIKAWA, Marcia Harumy; BARBOSA, Guilherme Bitencourt; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaIntroduction Pathological processes in the arterial wall that result in vessel dilation are the cause of intracranial aneurysms (IAs), and the risk factors for their formation and progression are not well established. Ferritin is associated with inflammation and angiogenesis; it has protective antioxidative activity, and controls cell differentiation. Vitamin B12 is related to neurological and hematological disorders; it can be used as differential diagnosis tool, and acts in the control of homocysteinemia, a predictor of worse prognosis. The present article aims to assess the correlation between serum ferritin and B12 levels and the patient's functional outcome.Materials and Methods In the present cohort study, we assessed the serum levels of ferritin and B12, as well as the scores on the modified Rankin and Glasgow Outcome Scales at 6 months, of 2 groups, one with 19 and the other with 49 individuals, out of 401 patients treated for IA at Universidade de Sao Paulo from 2018 to 2019. We performed a statistical analysis, using logistic regression, to determine the aforementioned correlation.Results In the univariable analysis, the serum levels of ferritin showed no significant impact on the functional outcome (odds ratio [OR]: 0.96 for every 100 pg/mL increase; 95% confidence interval [95%CI]: 0.761-1.210; p = 0.732); neither did the serum levels of B12 (OR: 0.998 for every 100 pg/mL increase; 95%CI: 0.826-1.206; p = 0.987). Moreover, no significant impact on the functional outcome was observed in the multivariable analysis regarding the serum levels of B12, age, hypertension, and aneurysm rupture (OR: 1.086 for every 100 pg/mL increase; 95%CI: 0.847-1.392; p = 0.513).Conclusion We were not able to confirm a statistical correlation regarding the serum levels of ferritin and B12, and functional outcome of IA patients. These variables might be linked to other determinants of the pathophysiology of IAs, like inflammation and homocysteinemia.