SERGIO SAMIR ARAP
Projetos de Pesquisa
Unidades Organizacionais
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina
2 resultados
Resultados de Busca
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- Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study(2022) SHRECKENGOST, C. S. Harrell; FOIANINI, J. E.; ENCINAS, K. M. Moron; GUARACHI, H. Tola; ABRIL, K.; AMIN, D.; BERKOWITZ, D.; CASTATER, C. A.; DOUGLAS, J. M.; GRANT, A. A.; KHULLAR, O. V.; LANE, A. N.; LIN, A.; NIROULA, A.; NIZAM, A.; RASHIED, A.; REITZ, A. W.; ROSER, S. M.; SPYCHALSKI, J.; ARAP, S. S.; BENTO, R. F.; CIARALO, P. P. D.; IMAMURA, R.; KOWALSKI, L. P.; MAHMOUD, A.; MARIANI, A. W.; MENEGOZZO, C. A. M.; MINAMOTO, H.; MONTENEGRO, F. L. M.; PêGO-FERNANDES, P. M.; SANTOS, J.; UTIYAMA, E. M.; SREEDHARAN, J. K.; KALCHIEM-DEKEL, O.; NGUYEN, J.; DHAMSANIA, R. K.; ALLEN, K.; MODZIK, A.; PATHAK, V.; WHITE, C.; BLAS, J.; EL-ABUR, I. Talal; TIRADO, G.; BENíTEZ, C. Yánez; WEISER, T. G.; BARRY, M.; BOECK, M.; FARRELL, M.; GREENBERG, A.; MILLER, P.; PARK, P.; CAMAZINE, M.; DILLON, D.; SMITH, R. N.OBJECTIVES: Timing of tracheostomy in patients with COVID-19 has attracted substantial attention. Initial guidelines recommended delaying or avoiding tracheostomy due to the potential for particle aerosolization and theoretical risk to providers. However, early tracheostomy could improve patient outcomes and alleviate resource shortages. This study compares outcomes in a diverse population of hospitalized COVID-19 patients who underwent tracheostomy either ""early""(within 14 d of intubation) or ""late""(more than 14 d after intubation). DESIGN: International multi-institute retrospective cohort study. SETTING: Thirteen hospitals in Bolivia, Brazil, Spain, and the United States. PATIENTS: Hospitalized patients with COVID-19 undergoing early or late tracheostomy between March 1, 2020, and March 31, 2021. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: A total of 549 patients from 13 hospitals in four countries were included in the final analysis. Multivariable regression analysis showed that early tracheostomy was associated with a 12-day decrease in time on mechanical ventilation (95% CI, -16 to -8; p < 0.001). Further, ICU and hospital lengths of stay in patients undergoing early tracheostomy were 15 days (95% CI, -23 to -9 d; p < 0.001) and 22 days (95% CI, -31 to -12 d) shorter, respectively. In contrast, early tracheostomy patients experienced lower risk-adjusted survival at 30-day post-admission (hazard ratio, 3.0; 95% CI, 1.8-5.2). Differences in 90-day post-admission survival were not identified. CONCLUSIONS: COVID-19 patients undergoing tracheostomy within 14 days of intubation have reduced ventilator dependence as well as reduced lengths of stay. However, early tracheostomy patients experienced lower 30-day survival. Future efforts should identify patients most likely to benefit from early tracheostomy while accounting for location-specific capacity. Copyright © 2022 The Authors.
- Acute and long-term kidney function after parathyroidectomy for primary hyperparathyroidism(2020) BELLI, Marcelo; MARTIN, Regina Matsunaga; BRESCIA, Marilia D'Elboux Guimaraes; NASCIMENTO JR., Climerio Pereira; MASSONI NETO, Ledo Mazzei; ARAP, Sergio Samir; FERRAZ-DE-SOUZA, Bruno; MOYSES, Rosa Maria Affonso; PEACOCK, Munro; MONTENEGRO, Fabio Luiz de MenezesBackground In kidney transplant patients, parathyroidectomy is associated with an acute decrease in renal function. Acute and chronic effects of parathyroidectomy on renal function have not been extensively studied in primary hyperparathyroidism (PHPT). Methods This retrospective cohort study included 494 patients undergoing parathyroidectomy for PHPT. Acute renal changes were evaluated daily until day 4 post-parathyroidectomy and were stratified according to acute kidney injury (AKI) criteria. Biochemical assessment included serum creatinine, total and ionized calcium, parathyroid hormone (PTH), and 25-hydroxyvitamin D (25OHD). The estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. We compared preoperative and postoperative renal function up to 5 years of follow-up. Results A total of 391 (79.1%) patients were female, and 422 (85.4%) were non-African American. The median age was 58 years old. The median (first and third quartiles) preoperative serum creatinine, PTH and total calcium levels were 0.81 mg/dL (0.68-1.01), 154.5 pg/mL (106-238.5), and 10.9 mg/dL (10.3-11.5), respectively. The median (first and third quartiles) preoperative eGFR was 86 mL/min/1.73 m(2) (65-101.3). After surgery, the median acute decrease in the eGFR was 21 mL/min/1.73 m(2) (p<0.0001). Acutely, 41.1% of patients developed stage 1 AKI, 5.9% developed stage 2 AKI, and 1.8% developed stage 3 AKI. The acute eGFR decrease (%) was correlated with age and PTH, calcium and preoperative creatinine levels in univariate analysis. Multivariate analysis showed that the acute change was related to age and preoperative values of ionized calcium, phosphorus and creatinine. The change at 12 months was related to sex, preoperative creatinine and 25OHD. Permanent reduction in the eGFR occurred in 60.7% of patients after an acute episode. Conclusion There was significant acute impairment in renal function after parathyroidectomy for PHPT, and almost half of the patients met the criteria for AKI. Significant eGFR recovery was observed during the first month after surgery, but a small permanent reduction may occur. Patients treated for PHPT seemed to present with prominent renal dysfunction compared to patients who underwent thyroidectomy.