WERTHER BRUNOW DE CARVALHO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Pediatria, Faculdade de Medicina - Docente
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina - Líder
16 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 16
- Miocardite fulminante associada ao vírus influenza H1N1: relato de caso e revisão de literatura(2014) LOBO, Maria Lúcia Saraiva; TAGUCHI, Ângela; GASPAR, Heloísa Amaral; FERRANTI, Juliana Ferreira; CARVALHO, Werther Brunow de; DELGADO, Artur FigueiredoCaso de miocardite fulminante associada ao vírus influenza H1N1, em que foi descrita a evolução clínica do paciente e enfatizada a importância do ecocardiograma à beira do leito como auxílio no diagnóstico precoce e manejo de crianças com disfunção miocárdica grave, além de terem sido discutidos aspectos relevantes relacionados à terapêutica e ao prognóstico da miocardite fulminante. Trata-se de paciente do sexo feminino, 4 anos e 8 meses, previamente hígida, com história de quadro gripal há 2 semanas. Admitida no pronto-socorro com sinais de instabilidade hemodinâmica, necessitando de suporte ventilatório e drogas vasoativas. Exames laboratoriais, radiografia de tórax e ecocardiograma sugestivos de miocardite. Pesquisa positiva para H1N1 em secreção de nasofaringe. Evoluiu com choque cardiogênico refratário a despeito das medidas clínicas, indo a óbito em 48 horas após admissão na unidade de terapia intensiva. O vírus influenza H1N1 é agente etiológico associado a quadros de miocardite aguda, porém poucos são os casos relatados de miocardite fulminante pelo vírus H1N1. A identificação de sinais e sintomas sugestivos de evolução fulminante deve ser imediata e o ecocardiograma à beira do leito é uma ferramenta útil para detecção precoce de disfunção miocárdica e orientação terapêutica. O uso de terapia imunossupressora, em casos de miocardite fulminante de etiologia viral, é controverso, bem como o de terapia antiviral, de tal forma que o tratamento baseia-se em suporte hemodinâmico e ventilatório. O uso de suporte hemodinâmico, por meio de oxigenação por membrana extracorpórea, aparece como terapia promissora.
- Functional capacity after pediatric liver transplantation: A pilot study(2014) SILVA, Rosangela Maria da; CARVALHO, Werther Brunow de; JOHNSTON, Cintia; CASTRO, Mariela Borba de; FERREIRA, Israel Manta; PATTI, Camilla L.; AZEVEDO, Ramiro Anthero de; GONZALEZ, Adriano Miziara; LINHARES, Marcelo Moura; SALZEDAS-NETTO, Alcides AugustoThe prospective cross-sectional study investigated the 6MWT performance in pediatric group of liver transplant recipients (6-17 yr, median post-transplantation time of 22 months) and compared to the normal values obtained in healthy children as well as evaluated the reproducibility of the 6MWT. We analyzed the relationship between walked distance and the 6MWw, distance walked x body weight) with the anthropometric, clinical, and pulmonary functions. In post-transplanted group, the average walked distance was significantly shorter compared with control (687 +/- 80 m vs. 511 +/- 72 m, p < 0.001). The calculated ICC coefficient confirmed the reproducibility among tests. The Pearson correlation revealed that only walked distance in the 6MWT was moderately correlated with tidal volume. Conversely, the 6MWw was significantly correlated with age, weight, height, BMI, FVC, PEF rate, and volume expiratory. According to multiple regression analysis, age, VE and FVC factors explained 80% of the variance in the 6MWw. In conclusion, the pediatric liver transplant recipients' performance in the 6MWT is significantly lower than the values for healthy children of the same age. Notably, the 6MWw may provide relevant information, constituting an additional parameter in the determination of functional capacity.
- Value of clinical pulmonary infection score in critically ill children as a surrogate for diagnosis of ventilator-associated pneumonia(2014) SILVA, Paulo Sergio Lucas da; AGUIAR, Vania Euzebio de; CARVALHO, Werther Brunow de; FONSECA, Marcelo Cunio MachadoRationale: Although the modified clinical pulmonary infection score (mCPIS) has been endorsed by national organizations, only a very few pediatric studies have assessed it for the diagnosis of ventilator-associated pneumonia (VAP). Methods: Seventy children were prospectively included if they fulfilled the diagnosis criteria for VAP referenced by the Centers for Disease Control and Prevention. The primary outcome was performance of mCPIS calculated on day 1 to accurately identify VAP as defined by microbiological data. Results: The data showed that an mCPIS of 6 or higher had a sensitivity of 94%, specificity of 50%, positive predictive value of 64%, negative predictive value of 90%, a positive likelihood ratio of 1.88, and a negative likelihood ratio of 0.11. The area under the receiver operating characteristic curve was 0.70. A positive posttest result increased the disease probability by 15.4%, whereas a negative test result reduced the probability by 38.6%. Patients with an mCPIS of 6 or higher had longer length of mechanical ventilation and pediatric intensive care unit stay compared with patients with an mCPIS lower than 6. Conclusion: The mCPIS had a clinically acceptable performance, and it can be a helpful screening tool for VAP diagnosis. An mCPIS lower than 6 was highly able in distinguishing patients without VAP. Despite its high sensitivity and negative predictive value of this score, further studies are required to assess the use of mCPIS in guiding therapeutic decisions.
- Focused cardiac ultrasound: a training course for pediatric intensivists and emergency physicians(2014) GASPAR, Heloisa A.; MORHY, Samira S.; LIANZA, Alessandro C.; CARVALHO, Werther B. de; ANDRADE, Jose L.; PRADO, Rogerio R. do; SCHVARTSMAN, Claudio; DELGADO, Artur F.Background: Focused echocardiographic examinations performed by intensivists and emergency room physicians can be a valuable tool for diagnosing and managing the hemodynamic status of critically ill children. The aim of this study was to evaluate the learning curve achieved using a theoretical and practical training program designed to enable pediatric intensivists and emergency physicians to conduct targeted echocardiograms. Methods: Theoretical and practical training sessions were conducted with 16 pediatric intensivist/ emergency room physicians. The program included qualitative analyses of the left ventricular (LV) and right ventricular (RV) functions, evaluation of pericardial effusion/ cardiac tamponade and valvular regurgitation and measurements of the distensibility index of the inferior vena cava (dIVC), ejection fraction (EF) and cardiac index (CI). The practical training sessions were conducted in the intensive care unit; each student performed 24 echocardiograms. The students in training were evaluated in a practical manner, and the results were compared with the corresponding examinations performed by experienced echocardiographers. The evaluations occurred after 8, 16 and 24 practical examinations. Results: The concordance rates between the students and echocardiographers in the subjective analysis of the LV function were 81.3% at the first evaluation, 96.9% at the second evaluation and 100% at the third evaluation (p < 0.001). For the dIVC, we observed a concordance of 46.7% at the first evaluation, 90.3% at the second evaluation and 87.5% at the third evaluation (p = 0.004). The means of the differences between the students' and echocardiographers' measurements of the EF and CI were 7% and 0.56 L/min/m(2), respectively, after the third stage of training. Conclusions: The proposed training was demonstrated to be sufficient for enabling pediatric physicians to analyze subjective LV function and to measure dIVC, EF and CI. This training course should facilitate the design of other echocardiography training courses that could be implemented in medical residency programs to improve these physicians' technical skills and the care of critically ill patients.
- Bedside Echocardiography for Pediatric Hemodynamic Monitoring: What Is the Impact in the Outcome?(2014) GASPAR, Heloisa Amaral; TUMA, Patricia Leao; CARVALHO, Werther Brunow; DELGADO, Artur Figueredo
conferenceObject Ventilatory Practices And Adjunctive Therapies In Children With Ards: A Prospective Observational Study(2014) BARREIRA, E. R.; SHIEH, H. H.; SUZUKI, A. S.; DEGASPARE, N. V.; CAVALHEIRO, P. O.; MUNOZ, G. O. C.; MARTINES, J. A. D. S.; LANE, C.; CARVALHO, W. B.; GILIO, A. E.; PRECIOSO, A. R.- ARDS definitions in children: one step forward(2014) FIORETTO, Jose R.; CARVALHO, Werther B. de
- Profile of Hemodynamic Changes in Preterm Neonates: The Light in the End of Tunnel(2014) VIEIRA, Renata A.; CECCON, Maria Esther J. R.; REDONDO, Ana Carolina Costa; CARVALHO, Werther B. de
- TLR-2 and TLR-4 expression in monocytes of newborns with late-onset sepsis(2014) REDONDO, Ana C. C.; CECCON, Maria E. J. R.; SILVEIRA-LESSA, Ana L.; QUINELLO, Camila; PALMEIRA, Patricia; CARVALHO, Werther B.; CARNEIRO-SAMPAIO, MagdaObjective: To analyze toll-like receptor (TLR)-2 and TLR-4 expression in monocytes of newborns with late-onset sepsis. Methods: This prospective study included 27 full-term newborns aged 8 to 29 days, with clinical and laboratory diagnosis of late-onset sepsis. Ten newborns (37%) had positive cultures. Cytokines were measured by cytometric bead array in peripheral blood, while TLR-2, TLR-4 expression, and median fluorescence intensity (MFI) were determined by immunophenotyping peripheral whole blood monocytes, and were analyzed with a BD FACSDiva flow cytometer (Becton, Dickinson and Company, USA). A comparison was performed with healthy adults. Results: Microorganisms were identified in 37% of these septic newborns, and all of them had high levels of pro-inflammatory cytokines (IL-8, IL-6, IL-1 beta) and anti-inflammatory cytokine (IL-10) corroborating the inflammatory/septic process. In monocytes, the frequency of TLR-4 expression was higher in infected newborns (p = 0.01). Conclusion: This study investigated the innate immune response in septic newborns. Septic newborns that relied almost exclusively on the innate immune system showed little in vivo response at nnonocyte activation, suggesting impaired immune response and increased susceptibility to infection.
- Fatal acute liver failure in a child due to acquired rubella infection(2014) FIGUEIREDO, Cristina Adelaide; OLIVEIRA, Maria Isabel de; TARANDACHI, Priscila Rodrigues; CARVALHO, Werther Brunow de; KANAMURA, Cristina Takami; SCATENA, Renata dos Santos