RODRIGO ANTONIO BRANDAO NETO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/51 - Laboratório de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina
LIM/51 - Laboratório de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina
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Resultados de Busca
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- Mortality and other outcomes of patients with coronavirus disease pneumonia admitted to the emergency department: A prospective observational Brazilian study(2021) BRANDAO NETO, Rodrigo A.; MARCHINI, Julio F.; MARINO, Lucas O.; ALENCAR, Julio C. G.; LAZAR NETO, Felippe; RIBEIRO, Sabrina; SALVETTI, Fernando V.; RAHHAL, Hassan; GOMEZ, Luz Marina Gomez; BUENO, Caue G.; FARIA, Carine C.; CUNHA, Victor P. da; PADRAO, Eduardo; VELASCO, Irineu T.; SOUZA, Heraldo Possolo deBackground The first cases of coronavirus disease (COVID-19) in Brazil were diagnosed in February 2020. Our Emergency Department (ED) was designated as a COVID-19 exclusive service. We report our first 500 confirmed COVID-19 pneumonia patients. Methods From 14 March to 16 May 2020, we enrolled all patients admitted to our ED that had a diagnosis of COVID-19 pneumonia. Infection was confirmed via nasopharyngeal swabs or tracheal aspirate PCR. The outcomes included hospital discharge, invasive mechanical ventilation, and in-hospital death, among others. Results From 2219 patients received in the ED, we included 506 with confirmed COVID-19 pneumonia. We found that 333 patients were discharged home (65.9%), 153 died (30.2%), and 20 (3.9%) remained in the hospital. A total of 300 patients (59.3%) required ICU admission, and 227 (44.9%) needed invasive ventilation. The multivariate analysis found age, number of comorbidities, extension of ground glass opacities on chest CT and troponin with a direct relationship with all-cause mortality, whereas dysgeusia, use of angiotensin converting enzyme inhibitor or angiotensin-ii receptor blocker and number of lymphocytes with an inverse relationship with all-cause mortality Conclusions This was a sample of severe patients with COVID-19, with 59.2% admitted to the ICU and 41.5% requiring mechanical ventilator support. We were able to ascertain the outcome in majority (96%) of patients. While the overall mortality was 30.2%, mortality for intubated patients was 55.9%. Multivariate analysis agreed with data found in other studies although the use of angiotensin converting enzyme inhibitor or angiotensin-ii receptor blocker as a protective factor could be promising but would need further studies.
- Lung ultrasound score predicts outcomes in COVID-19 patients admitted to the emergency department(2021) ALENCAR, Julio Cesar Garcia de; MARCHINI, Julio Flavio Meirelles; MARINO, Lucas Oliveira; RIBEIRO, Sabrina Correa da Costa; BUENO, Caue Gasparotto; CUNHA, Victor Paro da; LAZAR NETO, Felippe; BRANDAO NETO, Rodrigo Antonio; SOUZA, Heraldo PossoloBackground During the COVID-19 pandemic, creating tools to assess disease severity is one of the most important aspects of reducing the burden on emergency departments. Lung ultrasound has a high accuracy for the diagnosis of pulmonary diseases; however, there are few prospective studies demonstrating that lung ultrasound can predict outcomes in COVID-19 patients. We hypothesized that lung ultrasound score (LUS) at hospital admission could predict outcomes of COVID-19 patients. This is a prospective cohort study conducted from 14 March through 6 May 2020 in the emergency department (ED) of an urban, academic, level I trauma center. Patients aged 18 years and older and admitted to the ED with confirmed COVID-19 were considered eligible. Emergency physicians performed lung ultrasounds and calculated LUS, which was tested for correlation with outcomes. This protocol was approved by the local Ethics Committee number 3.990.817 (CAAE: 30417520.0.0000.0068). Results The primary endpoint was death from any cause. The secondary endpoints were ICU admission and endotracheal intubation for respiratory failure. Among 180 patients with confirmed COVID-19 who were enrolled (mean age, 60 years; 105 male), the average LUS was 18.7 +/- 6.8. LUS correlated with findings from chest CT and could predict the estimated extent of parenchymal involvement (mean LUS with < 50% involvement on chest CT, 15 +/- 6.7 vs. 21 +/- 6.0 with > 50% involvement, p < 0.001), death (AUC 0.72, OR 1.13, 95% CI 1.07 to 1.21; p < 0.001), endotracheal intubation (AUC 0.76, OR 1.17, 95% CI 1.09 to 1.26; p < 0.001), and ICU admission (AUC: 0.71, OR 1.14, 95% CI 1.07 to 1.21; p < 0.001). Conclusions In COVID-19 patients admitted in ED, LUS was a good predictor of death, ICU admission, and endotracheal intubation.
- Assessment scores in H1N1 infection(2011) BRANDAO-NETO, Rodrigo Antonio; GOULART, Alessandra Carvalho; SANTANA, Alfredo Nicodemos Cruz; SCALABRINI-NETO, Augusto; VELASCO, Irineu Tadeu
- Erythema induratum of Bazin associated with Addison's disease: first description(2012) BRANDAO NETO, Rodrigo Antonio; CARVALHO, Jozelio Freire deCONTEXT: Erythema induratum of Bazin (EIB) is considered to be a tuberculid reaction and consists of recurrent painful nodules. The differential diagnosis includes diseases like nodular vasculitis, perniosis, polyarteritis nodosa and erythema nodosum. CASE REPORT: We report the case of a woman with EIB who developed Addison's disease during treatment with anti-tuberculosis drugs with good response to glucocorticoid replacement. The diagnosis was obtained through the clinical picture, positive tuberculin test and positive BCG (bacillus Calmette-Guerin) test on the histological sample. Anti-tuberculosis drugs and glucocorticoid replacement led to disappearance of the signs and symptoms. CONCLUSIONS: This is the first description of an association between EIB and Addison's disease. It should be borne in mind that tuberculosis is an important etiological factor for Addison's disease.
article 0 Citação(ões) na Scopus Assessment scores in H1N1 infection Response(2011) BRANDAO-NETO, Rodrigo Antonio; GOULART, Alessandra Carvalho; SANTANA, Alfredo Nicodemos Cruz; SCALABRINI-NETO, Augusto; VELASCO, Irineu Tadeu- First-attempt intubation success and complications in patients with COVID-19 undergoing emergency intubation(2020) ALENCAR, Julio Cesar Garcia de; MARQUES, Bruno; MARCHINI, Julio Flavio Meirelles; MARINO, Lucas Oliveira; RIBEIRO, Sabrina Correa da Costa; BUENO, Caue Gasparotto; CUNHA, Victor Paro da; LAZAR NETO, Felippe; VALENTE, Fernando Salvetti; RAHHAL, Hassan; PEREIRA, Juliana Batista Rodrigues; PADRAO, Eduardo Messias Hirano; WANDERLEY, Annelise Passos Bispos; COSTA, Millena Gomes Pinheiro; BRANDAO NETO, Rodrigo Antonio; SOUZA, Heraldo PossoloObjectivesTo evaluate the first-attempt success rates and complications of endotracheal intubation of coronavirus disease 2019 (COVID-19) patients by emergency physicians. MethodsThis prospective observational study was conducted from March 24, 2020 through May 28, 2020 at the emergency department (ED) of an urban, academic trauma center. We enrolled patients consecutively admitted to the ED with suspected or confirmed COVID-19 submitted to endotracheal intubation. No patients were excluded. The primary outcome was first-attempt intubation success, defined as successful endotracheal tube placement with the first device passed (endotracheal tube) during the first laryngoscope insertion confirmed with capnography. Secondary outcomes included the following complications: hypotension, hypoxemia, aspiration, and esophageal intubation. ResultsA total of 112 patients with confirmed or suspected COVID-19 were enrolled. Median age was 61 years and 61 patients (54%) were men. The primary outcome, first-attempt intubation success, was achieved in 82% of patients. Among the 20 patients who were not intubated on the first attempt, 75% were intubated on the second attempt and 20% on the third attempt; cricothyrotomy was performed in 1 patient. Forty-eight (42%) patients were hypotensive and required norepinephrine immediately post-intubation. Fifty-eight (52%) experienced peri-intubation hypoxemia, and 2 patients (2%) had cardiac arrest. There were no cases of failed intubation resulting in death up to 24 hours after the procedure. ConclusionEmergency physicians achieve high success rates when intubating COVID19 patients, although complications are frequent. However, these findings should be considered provisional until their generalizability is assessed in their institutions and setting.
- Lower peripheral blood Toll-like receptor 3 expression is associated with an unfavorable outcome in severe COVID-19 patients(2021) MENEZES, Maria Clara Saad; VEIGA, Alicia Dudy Muller; LIMA, Thais Martins de; ARIGA, Suely Kunimi Kubo; BARBEIRO, Hermes Vieira; MOREIRA, Claudia de Lucena; PINTO, Agnes Araujo Sardinha; BRANDAO, Rodrigo Antonio; MARCHINI, Julio Flavio; ALENCAR, Julio Cesar; MARINO, Lucas Oliveira; GOMEZ, Luz Marina; CAMARA, Niels Olsen Saraiva; SOUZA, Heraldo P.The role of innate immunity in COVID-19 is not completely understood. Therefore, this study explored the impact of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection on the expression of Pattern Recognition Receptors (PRRs) in peripheral blood cells and their correlated cytokines. Seventy-nine patients with severe COVID-19 on admission, according to World Health Organization (WHO) classification, were divided into two groups: patients who needed mechanical ventilation and/or deceased (SEVERE, n=50) and patients who used supplementary oxygen but not mechanical ventilation and survived (MILD, n=29); a control group (CONTROL, n=17) was also enrolled. In the peripheral blood, gene expression (mRNA) of Toll-like receptors (TLRs) 3, 4, 7, 8, and 9, retinoic-acid inducible gene I (RIGI), NOD-like receptor family pyrin domain containing 3 (NLRP3), interferon alpha (IFN-alpha), interferon beta (IFN-beta), interferon gamma (IFN-gamma), interferon lambda (IFN-lambda), pro-interleukin(IL)-1 beta (pro-IL-1 beta), and IL-18 was determined on admission, between 5-9 days, and between 10-15 days. Circulating cytokines in plasma were also measured. When compared to the COVID-19 MILD group, the COVID-19 SEVERE group had lower expression of TLR3 and overexpression of TLR4.