LEONARDO ZUMERKORN PIPEK

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina

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  • article 3 Citação(ões) na Scopus
    Laparoscopically excised retroperitoneal presacral Schwannoma: atypical pre and postoperative manifestations - case report
    (2019) CARVALHO, Barbara Justo; MEDEIROS, Kayo Augusto de Almeida; MARTINES, Diego Ramos; NII, Fernanda; PIPEK, Leonardo Zumerkorn; MESQUITA, Gustavo Heluani Antunes de; D'ALBUQUERQUE, Luiz Augusto Carneiro; MEYER, Alberto; ANDRAUS, Wellington
    Background We are a reporting a rare case of retroperitoneal schwanomma with atypical pre and postoperative manifestations. Retroperitoneal schwannomas are rare tumors that are difficult to preoperatively diagnose. Case presentation This is a case report of a male patient, 41 years old, with symptoms of hipogastric and lower right member pain, as well as a history of a papilliferous thyroid tumor. Computerized tomography exams were inconclusive, showing a mass in the presacral region with dimensions of 4.4 x 3.9 x 3.4 cm. Removal was carried out by laparoscopic surgery, with self-limited postoperative complications. Diagnosis was carried out by anatomopathological examination, and syndromic hypotheses were discarded. Conclusions The postoperative complications of schwanomma are little reported in the literature. In the simultaneous occurrence of schwanomma and other endocrine tumors, further studies are warranted to better differentiate the cases that need investigation of syndromic causes.
  • article 4 Citação(ões) na Scopus
    Long-Term Outcomes in Severe Traumatic Brain Injury and Associated Factors: A Prospective Cohort Study
    (2022) OLIVEIRA, Daniel Vieira de; VIEIRA, Rita de Cassia Almeida; PIPEK, Leonardo Zumerkorn; SOUSA, Regina Marcia Cardoso de; SOUZA, Camila Pedroso Estevam de; SANTANA-SANTOS, Eduesley; PAIVA, Wellingson Silva
    Objective: The presence of focal lesion (FL) after a severe traumatic brain injury is an important factor in determining morbidity and mortality. Despite this relevance, few studies show the pattern of recovery of patients with severe traumatic brain injury (TBI) with FL within one year. The objective of this study was to identify the pattern of recovery, independence to perform activities of daily living (ADL), and factors associated with mortality and unfavorable outcome at six and twelve months after severe TBI with FL. Methodology: This is a prospective cohort, with data collected at admission, hospital discharge, three, six, and twelve months after TBI. RESULTS: The study included 131 adults with a mean age of 34.08 years. At twelve months, 39% of the participants died, 80% were functionally independent by the Glasgow Outcome Scale Extended, 79% by the Disability Rating Scale, 79% were independent for performing ADLs by the Katz Index, and 53.9% by the Lawton Scale. Report of alcohol intake, sedation time, length of stay in intensive care (ICU LOS), Glasgow Coma Scale, trauma severity indices, hyperglycemia, blood glucose, and infection were associated with death. At six and twelve months, tachypnea, age, ICU LOS, trauma severity indices, respiratory rate, multiple radiographic injuries, and cardiac rate were associated with dependence. Conclusions: Patients have satisfactory functional recovery up to twelve months after trauma, with an accentuated improvement in the first three months. Clinical and sociodemographic variables were associated with post-trauma outcomes. Almost all victims of severe TBI with focal lesions evolved to death or independence.
  • article 1 Citação(ões) na Scopus
    Instrument to evaluate the knowledge of patient with cirrhosis on his disease: construction and validity
    (2021) STELMACH, Mariana; MEDEIROS, Kayo Augusto de Almeida; CARVALHO, Barbara Justo; PIPEK, Leonardo Zumerkorn; MESQUITA, Gustavo Heluani Antunes de; NII, Fernanda; MARTINES, Diego Ramos; IUAMOTO, Leandro Ryuchi; D'ALBUQUERQUE, Luiz Augusto Carneiro; MEYER, Alberto; ANDRAUS, Wellington
    BackgroundThe application of measurement instruments is a strategy to evaluate the patient's knowledge about the disease. This study aims to build an instrument that evaluates the patient's knowledge about liver cirrhosis.MethodThis study includes three phases. The first one was the construction of the instrument based on a literature review. In the second phase, five experts were participated in the evaluation of the instrument, to check the validity of the content. Quantitative and qualitative analyzes were made. The tool used was the CVI (Content Validity Index) and it was used the semantic study of the questions. The third phase was the process of the restructuring the instrument.ResultsThe final version of the instrument consisted of 36 questions. The instrument was evaluated in 91.7 by the average CVI and 94.4% by the universal CVI.ConclusionsThe questions are properly structured and clear, therefore, understandable. Thus, the final instrument presented satisfactory content validity, so that, it reached the aim of this study.
  • article 46 Citação(ões) na Scopus
    Comparison of SpO(2) and heart rate values on Apple Watch and conventional commercial oximeters devices in patients with lung disease
    (2021) PIPEK, Leonardo Zumerkorn; NASCIMENTO, Rafaela Farias Vidigal; ACENCIO, Milena Marques Pagliarelli; TEIXEIRA, Lisete Ribeiro
    Lung diseases have high mortality and morbidity, with an important impact on quality of life. Hypoxemic patients are advised to use oxygen therapy to prolong their survival, but high oxygen saturation (SpO(2)) levels can also have negative effects. Pulse oximeters are the most common way to assess oxygen levels and guide medical treatment. This study aims to assess whether wearable devices can provide precise SpO(2) measurements when compared to commercial pulse oximeters. This is a cross-section study with 100 patients with chronic obstructive pulmonary disease and interstitial lung disease from an outpatient pneumology clinic. SpO(2) and heart rate data were collected with an Apple Watch Series 6 (Apple) and compared to two commercial pulse oximeters. The Bland-Altman method and interclass correlation coefficient were used to compare their values. We observed strong positive correlations between the Apple Watch device and commercial oximeters when evaluating heart rate measurements (r = 0.995, p < 0.001) and oximetry measurements (r = 0.81, p < 0.001). There was no statistical difference in the evaluation of skin color, wrist circumference, presence of wrist hair, and enamel nail for SpO(2) and heart rate measurements in Apple Watch or commercial oximeter devices (p > 0.05). Apple Watch 6 is a reliable way to obtain heart rate and SpO(2) in patients with lung diseases in a controlled environment.
  • article 0 Citação(ões) na Scopus
    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 Gadelha
    Purpose: 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.
  • article 4 Citação(ões) na Scopus
    Intussusception reveals MUTYH-associated polyposis syndrome and colorectal cancer: a case report
    (2019) MESQUITA, Gustavo Heluani Antunes de; CARVALHO, Barbara Justo; MEDEIROS, Kayo Augusto de Almeida; NII, Fernanda; MARTINES, Diego Ramos; PIPEK, Leonardo Zumerkorn; JARDIM, Yuri Justi; WAISBERG, Daniel Reis; OBARA, Marcos Takeo; SITNIK, Roberta; MEYER, Alberto; MANGUEIRA, Cristovao Luis Pitangueiras
    Background: We are reporting a rare case of MUTYH-associated polyposis, a colorectal cancer hereditary syndrome, diagnosticated after an intussusception. Colorectal cancer is an important cause of cancer related mortality that can be manifested by an intussusception, a rare occurrence in adults and almost always related to tumors. Approximately 5% of colorectal cancers can be attributed to syndromes known to cause hereditary colorectal cancer, such as MUTYH-associated polyposis, autosomal genetic syndrome associated with this disease. Case presentation: We present the case of a 44years old male, that sought medical consultation with a complaint of abdominal discomfort, that after five days changed its characteristics. The patient was sent to the emergency department were a CT-scan revealed intestinal sub-occlusion by ileocolic invagination. Right colectomy was carried out. The anatomic-pathological examination revealed a moderately differentiated mucinous adenocarcinoma and multiples sessile polyps, which led to the suspicion of a genetic syndrome. In the genetics analysis two mutations were observed in the MUTYH gene, and MUTYH-associated polyposis was diagnosticated. Conclusion: This case demonstrates the importance of meticulous analysis of the patient examinations results to identify possible discrete alterations that can lead to improved understanding of disease.
  • article 4 Citação(ões) na Scopus
    Effects of ingested nanomaterials on tissue distribution of co-ingested zinc and iron in normal and zinc-deficient mice
    (2021) GONCALVES, Johnatan P.; PIPEK, Leonardo Z.; DONAGHEY, Thomas C.; DELOID, Glen M.; DEMOKRITOU, Philip; BRAIN, Joseph D.; MOLINA, Ramon M.
    Cellulose nanofibers (CNF) reduced serum triglyceride levels in rats when co-administered with heavy cream by gavage. Do CNF and other nanomaterials (NMs) alter the tissue distribution and retention of co-administered metal ions? We evaluated whether 5 different NMs affected tissue distribution of co-ingested Zn-65(++) and Fe-59(+++) in zinc-replete versus zinc-deficient mice. Male C57BL/6J mice were fed either zinc-replete or zinc-deficient diets for 3 weeks, followed by gavage with NM suspensions in water containing both (ZnCl2)-Zn-65 and (FeCl3)-Fe-59. Urine and feces were measured for 48 h post-gavage. Mice were euthanized and samples of 22 tissues were collected and analyzed for Zn-65 and Fe-59 in a gamma counter. Our data show that zinc deficiency alters the tissue distribution of Zn-65 but not of Fe-59, indicating that zinc and iron homeostasis are regulated by distinct mechanisms. Among the tested NMs, soluble starch-coated chitosan nanoparticles, cellulose nanocrystals, and TiO2 reduced Zn and Fe tissue retention in zinc-deficient but not in zinc-replete animals.
  • article 3 Citação(ões) na Scopus
    Cirrhosis and hernia repair in a cohort of 6352 patients in a tertiary hospital Risk assessment and survival analysis
    (2022) PIPEK, Leonardo Zumerkorn; CORTEZ, Vitor Santos; TABA, Joao Victor; SUZUKI, Milena Oliveira; NASCIMENTO, Fernanda Sayuri do; MATTOS, Vitoria Carneiro de; MORAES, Walter Augusto; IUAMOTO, Leandro Ryuchi; HSING, Wu Tu; CARNEIRO-D'ALBUQUERQUE, Luiz Augusto; MEYER, Alberto; ANDRAUS, Wellington
    The prevalence of hernias in patient with cirrhosis can reach up to 40%. The pathophysiology of cirrhosis is closely linked to that of the umbilical hernia, but other types are also common in this population. The aim of this study is to evaluate factors that influence in the prognosis after hernia repair in patients with cirrhosis. A historical cohort of 6419 patients submitted to hernia repair was gathered. Clinical, epidemiological data and hernia characteristics were obtained. For patient with cirrhosis, data from exams, surgery and follow-up outcomes were also analyzed. Survival curves were constructed to assess the impact of clinical and surgical variables on survival. 342 of the 6352 herniated patients were cirrhotic. Patient with cirrhosis had a higher prevalence of umbilical hernia (67.5% x 24.2%, P<.001) and a lower prevalence of epigastric (1.8% x 9.0%, P<.001) and lumbar (0% x 0.18%, P=.022). There were no significant differences in relation to inguinal hernia (P=.609). Ascites was present in 70.1% of patient with cirrhosis and its prevalence was different in relation to the type of hernia (P<.001). The survival curve showed higher mortality for emergency surgery, MELD>14 and ascites (HR 12.6 [3.79-41.65], 4.5 [2.00-10.34], and 6.1 [1.15-20.70], respectively, P<.05). Hernia correction surgery in patient with cirrhosis has a high mortality, especially when performed under urgent conditions associated with more severe clinical conditions of patients, such as the presence of ascites and elevated MELD.
  • article 4 Citação(ões) na Scopus
    Seizure control in mono- and combination therapy in a cohort of patients with Idiopathic Generalized Epilepsy
    (2022) PIPEK, Leonardo Zumerkorn; PIPEK, Henrique Zumerkorn; CASTRO, Luiz Henrique Martins
    Idiopathic Generalized Epilepsy (IGE) patients may not achieve optimal seizure control with monotherapy. Our goal was to evaluate the efficacy of combination therapy in a retrospective series of IGE patients receiving different antiseizure medication (ASM) regimens. We retrospectively identified all patients with adolescence onset IGE with typical clinical and EEG features from a single epilepsy specialist clinic from 2009 to 2020. We evaluated long-term seizure control, for VPA, LEV, LTG mono and combination therapy. We studied 59 patients. VPA was more commonly used in men (84%) than in women (44%) (p < 0.05). VPA was the initial drug of choice in 39% of patients, followed by LEV (22%) and LTG (14.9%). Thirty-nine patients (66.1%) achieved complete seizure control for at least one year. Fifty patients (84.7)% had partial control, without GTC occurrence, for at least one year. VPA was superior to LTG for complete seizure control (p = 0.03), but not for minor seizure control or pseudoresistance (p > 0.05). Combination therapy was superior to LEV and LTG monotherapy for complete control (p = 0.03), without differences for minor seizures and pseudoresistance outcomes (p > 0.05). Combination therapy not including VPA was also non-inferior to VPA monotherapy in all settings. Combination therapy was superior to LTG and LEV monotherapy in IGE, and may be equally effective including or not VPA. Combination therapy including LTG, LEV, and/or VPA is an effective treatment option after monotherapy failure with one of these ASM in IGE. Dual therapy with LEV-LTG should be considered in monotheraphy failure, to avoid fetal effects of in utero VPA exposure.
  • article
    New perspectives on assessment and understanding of the patient with cranial bone defect: a morphometric and cerebral radiodensity assessment
    (2024) OLIVEIRA, Arthur Maynart Pereira; ANDRADE, Almir Ferreira De; PIPEK, Leonardo Zumerkorn; IACCARINO, Corrado; RUBIANO, Andres M.; AMORIM, Robson Luis; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson Silva
    Background Skull defects after decompressive craniectomy (DC) cause physiological changes in brain function and patients can have neurologic symptoms after the surgery. The objective of this study is to evaluate whether there are morphometric changes in the cortical surface and radiodensity of brain tissue in patients undergoing cranioplasty and whether those variables are correlated with neurological prognosis.Methods This is a prospective cohort with 30 patients who were submitted to cranioplasty and followed for 6 months. Patients underwent simple head CT before and after cranioplasty for morphometric and cerebral radiodensity assessment. A complete neurological exam with Mini-Mental State Examination (MMSE), modified Rankin Scale, and the Barthel Index was performed to assess neurological prognosis.Results There was an improvement in all symptoms of the syndrome of the trephined, specifically for headache (p = 0.004) and intolerance changing head position (p = 0.016). Muscle strength contralateral to bone defect side also improved (p = 0.02). Midline shift of intracranial structures decreased after surgery (p = 0.004). The Anterior Distance Difference (ADif) and Posterior Distance Difference (PDif) were used to assess morphometric changes and varied significantly after surgery. PDif was weakly correlated with MMSE (p = 0.03; r = -0.4) and Barthel index (p = 0.035; r = -0.39). The ratio between the radiodensities of gray matter and white matter (GWR) was used to assess cerebral radiodensity and was also correlated with MMSE (p = 0.041; r = -0.37).Conclusion Morphological anatomy and radiodensity of the cerebral cortex can be used as a tool to assess neurological prognosis after DC.