EVELINDA MARRAMON TRINDADE
Índice h a partir de 2011
11
Projetos de Pesquisa
Unidades Organizacionais
PAHC, Hospital das Clínicas, Faculdade de Medicina
4 resultados
Resultados de Busca
Agora exibindo 1 - 4 de 4
- Improving preoperative risk-of-death prediction in surgery congenital heart defects using artificial intelligence model: A pilot study(2020) CHANG JUNIOR, Joao; BINUESA, Fabio; CANEO, Luiz Fernando; TURQUETTO, Aida Luiza Ribeiro; ARITA, Elisandra Cristina Trevisan Calvo; BARBOSA, Aline Cristina; FERNANDES, Alfredo Manoel da Silva; TRINDADE, Evelinda Marramon; JATENE, Fabio Biscegli; DOSSOU, Paul-Eric; JATENE, Marcelo BiscegliBackground Congenital heart disease accounts for almost a third of all major congenital anomalies. Congenital heart defects have a significant impact on morbidity, mortality and health costs for children and adults. Research regarding the risk of pre-surgical mortality is scarce. Objectives Our goal is to generate a predictive model calculator adapted to the regional reality focused on individual mortality prediction among patients with congenital heart disease undergoing cardiac surgery. Methods Two thousand two hundred forty CHD consecutive patients' data from InCor's heart surgery program was used to develop and validate the preoperative risk-of-death prediction model of congenital patients undergoing heart surgery. There were six artificial intelligence models most cited in medical references used in this study: Multilayer Perceptron (MLP), Random Forest (RF), Extra Trees (ET), Stochastic Gradient Boosting (SGB), Ada Boost Classification (ABC) and Bag Decision Trees (BDT). Results The top performing areas under the curve were achieved using Random Forest (0.902). Most influential predictors included previous admission to ICU, diagnostic group, patient's height, hypoplastic left heart syndrome, body mass, arterial oxygen saturation, and pulmonary atresia. These combined predictor variables represent 67.8% of importance for the risk of mortality in the Random Forest algorithm. Conclusions The representativeness of ""hospital death"" is greater in patients up to 66 cm in height and body mass index below 13.0 for InCor's patients. The proportion of ""hospital death"" declines with the increased arterial oxygen saturation index. Patients with prior hospitalization before surgery had higher ""hospital death"" rates than who did not required such intervention. The diagnoses groups having the higher fatal outcomes probability are aligned with the international literature. A web application is presented where researchers and providers can calculate predicted mortality based on the CgntSCORE on any web browser or smartphone.
- Evaluation of Surgical Treatment of Congenital Heart Disease in Patients Aged Above 16 Years(2012) CANEO, Luiz Fernando; JATENE, Marcelo B.; RISO, Arlindo A.; TANAMATI, Carla; PENHA, Juliano; MOREIRA, Luiz Felipe; ATIK, Edmar; TRINDADE, Evelinda; STOLF, Noedir A. G.Background: The increasing number of children with evolving congenital heart diseases demands greater preparation of professionals and institutions that handle them. Objective: To describe the profile of patients aged over 16 years with congenital heart disease, who have undergone surgery, and analyze the risk factors that predict hospital mortality. Methods: One thousand five hundred twenty patients (mean age 27 +/- 13 years) were operated between January 1986 and December 2010. We performed a descriptive analysis of the epidemiological profile of the study population and analyzed risk factors for hospital mortality, considering the complexity score, the year in which surgery was performed, the procedure performed or not performed by the pediatric surgeon and reoperation. Results: There was a significant increase in the number of cases from the year 2000. The average complexity score was 5.4 and the septal defects represented 45% of cases. Overall mortality was 7.7% and most procedures (973 or 61.9%) with greater complexity were performed by pediatric surgeons. Complexity (OR 1.5), reoperation (OR 2.17) and pediatric surgeon (OR 0.28) were independent risk factors influencing mortality. Multivariate analysis showed that the year in which the surgery was performed (OR 1.03), the complexity (OR 1.44) and the pediatric surgeon (OR 0.28) influenced the result. Conclusion: There is an increasing number of patients aged 16 years which, despite the large number of simple cases, the most complex ones were referred to pediatric surgeons, who had lower mortality, especially in recent years. (Arq Bras Cardiol 2012;98(5):390-397)
- Aerobic exercise and inspiratory muscle training increase functional capacity in patients with univentricular physiology after Fontan operation: A randomized controlled trial(2021) TURQUETTO, Aida Luiza Ribeiro; SANTOS, Marcelo Rodrigues dos; AGOSTINHO, Daniela Regina; SAYEGH, Ana Luiza Carrari; SOUZA, Francis Ribeiro de; AMATO, Luciana Patrick; BARNABE, Milena Schiezari Ru; OLIVEIRA, Patricia Alves de; LIBERATO, Gabriela; BINOTTO, Maria Angelica; NEGRAO, Carlos Eduardo; CANEO, Luiz Fernando; TRINDADE, Evelinda; JATENE, Fabio Biscegli; JATENE, Marcelo BiscegliBackground: The effect of exercise training and its mechanisms on the functional capacity improvement in Fontan patients (FP) are virtually unknown. This trial evaluated four-month aerobic exercise training and inspiratory muscle training on functional capacity, pulmonary function, and autonomic control in patients after Fontan operation. Methods: A randomized controlled clinical trial with 42 FP aged 12 to 30 years and, at least, five years of Fontan completion. Twenty-seven were referred to a four-months supervised and personalized aerobic exercise training (AET) or an inspiratory muscle training (IMT). A group of non-exercise (NET) was used as control. The effects of the exercise training in peak VO2; pulmonary volumes and capacities, maximal inspiratory pressure (MIP); muscle sympathetic nerve activity (MSNA); forearm blood flow (FBF); handgrip strength and cross-sectional area of the thigh were analyzed. Results: The AET decreased MSNA (p = 0.042), increased FBF (p 0.012) and handgrip strength (p = 0.017). No significant changes in autonomic control were found in IMT and NET groups. Both AET and IMT increased peak VO2, but the increase was higher in the AET group compared to IMT (23% vs. 9%). No difference was found in the NET group. IMT group showed a 58% increase in MIP (p = 0.008) in forced vital capacity (p = 0.011) and forced expiratory volume in the first second (p = 0.011). No difference in pulmonary function was found in the AET group. Conclusions: Both aerobic exercise and inspiratory musde training improved functional capacity. The AET group developed autonomic control, and handgrip strength, and the IMT increased inspiratory muscle strength and spirometry.
- Efeito econômico do uso da oxigenação extracorpórea para suporte de pacientes adultos com insuficiência respiratória grave no Brasil: uma análise hipotética(2014) PARK, Marcelo; MENDES, Pedro Vitale; ZAMPIERI, Fernando Godinho; AZEVEDO, Luciano Cesar Pontes; COSTA, Eduardo Leite Vieira; ANTONIALI, Fernando; RIBEIRO, Gustavo Calado de Aguiar; CANEO, Luiz Fernando; CRUZ NETO, Luiz Monteiro da; CARVALHO, Carlos Roberto Ribeiro; TRINDADE, Evelinda MarramonObjetivo: Analisar o custo-utilidade do uso da oxigenação extracorpórea para pacientes com síndrome da angústia respiratória aguda grave no Brasil. Métodos: Com bancos de dados de estudos previamente publicados, foi construída uma árvore encadeada de decisões. Os custos foram extraídos da média de 3 meses do preço pago pelo Sistema Único de Saúde em 2011. Com 10 milhões de pacientes simulados com desfechos e custos predeterminados, uma análise da relação de incremento de custo e de anos de vida ganhos ajustados pela qualidade (custo-utilidade) foi realizada com sobrevida de 40 e 60% dos pacientes que usaram oxigenação extracorpórea. Resultados: A árvore de decisões resultou em 16 desfechos com técnicas diferentes de suporte à vida. Com a sobrevida de 40/60%, respectivamente, o incremento de custos foi de R$ -301,00/-14,00, com o preço pago de R$ -30.913,00/-1.752,00 por ano de vida ganho ajustado pela qualidade para 6 meses e de R$ -2.386,00/-90,00 por ano de vida ganho ajustado pela qualidade até o fim de vida, quando se analisaram todos os pacientes com síndrome da angústia respiratória aguda grave. Analisando somente os pacientes com hipoxemia grave (relação da pressão parcial de oxigênio no sangue sobre a fração inspirada de oxigênio <100mmHg), o incremento de custos foi de R$ -5.714,00/272,00, com preço por ano de vida ganho ajustado pela qualidade em 6 meses de R$ -9.521,00/293,00, e com o custo de R$ -280,00/7,00 por ano de vida ganho ajustado pela qualidade. Conclusão: A relação de custo-utilidade do uso da oxigenação extracorpórea no Brasil foi potencialmente aceitável neste estudo hipotético.