THIAGO JUNQUEIRA AVELINO DA SILVA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/66, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/66, Hospital das Clínicas, Faculdade de Medicina - Líder
19 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 19
- Clinical and laboratory characteristics associated with referral of hospitalized elderly to palliative care(2018) ARCANJO, Suelen Pereira; SAPORETTI, Luis Alberto; CURIATI, Jose Antonio Esper; JACOB-FILHO, Wilson; AVELINO-SILVA, Thiago JunqueiraObjective: To investigate clinical and laboratory characteristics associated with referral of acutely ill older adults to exclusive palliative care. Methods: A retrospective cohort study based on 572 admissions of acutely ill patients aged 60 years or over to a university hospital located in Sao Paulo, Brazil, from 2009 to 2013. The primary outcome was the clinical indication for exclusive palliative care. Comprehensive geriatric assessments were used to measure target predictors, such as sociodemographic, clinical, cognitive, functional and laboratory data. Stepwise logistic regression was used to identify independent predictors of palliative care. Results: Exclusive palliative care was indicated in 152 (27%) cases. In the palliative care group, in-hospital mortality and 12 month cumulative mortality amounted to 50% and 66%, respectively. Major conditions prompting referral to palliative care were advanced dementia (45%), cancer (38%), congestive heart failure (25%), stage IV and V renal dysfunction (24%), chronic obstructive pulmonary disease (8%) and cirrhosis (4%). Major complications observed in the palliative care group included delirium (p<0.001), infections (p<0.001) and pressure ulcers (p<0.001). Following multivariate analysis, male sex (OR=2.12; 95% CI: 1.32-3.40), cancer (OR=7.36; 95% CI: 4.26-13.03), advanced dementia (OR=12.6; 95% CI: 7.5-21.2), and albumin levels (OR=0.25; 95% CI: 0.17-0.38) were identified as independent predictors of referral to exclusive palliative care. Conclusion: Advanced dementia and cancer were the major clinical conditions associated with referral of hospitalized older adults to exclusive palliative care. High short-term mortality suggests prognosis should be better assessed and discussed with patients and families in primary care settings.
- Comprehensive geriatric assessment predicts mortality and adverse outcomes in hospitalized older adults(2014) AVELINO-SILVA, Thiago J.; FARFEL, Jose M.; CURIATI, Jose A. E.; AMARAL, Jose R. G.; CAMPORA, Flavia; JACOB-FILHO, WilsonBackground: Comprehensive Geriatric Assessment (CGA) provides detailed information on clinical, functional and cognitive aspects of older patients and is especially useful for assessing frail individuals. Although a large proportion of hospitalized older adults demonstrate a high level of complexity, CGA was not developed specifically for this setting. Our aim was to evaluate the application of a CGA model for the clinical characterization and prognostic prediction of hospitalized older adults. Methods: This was a prospective observational study including 746 patients aged 60 years and over who were admitted to a geriatric ward of a university hospital between January 2009 and December 2011, in Sao Paulo, Brazil. The proposed CGA was applied to evaluate all patients at admission. The primary outcome was in-hospital death, and the secondary outcomes were delirium, nosocomial infections, functional decline and length of stay. Multivariate binary logistic regression was performed to assess independent factors associated with these outcomes, including socio-demographic, clinical, functional, cognitive, and laboratory variables. Impairment in ten CGA components was particularly investigated: polypharmacy, activities of daily living (ADL) dependency, instrumental activities of daily living (IADL) dependency, depression, dementia, delirium, urinary incontinence, falls, malnutrition, and poor social support. Results: The studied patients were mostly women (67.4%), and the mean age was 80.5 +/- 7.9 years. Multivariate logistic regression analysis revealed the following independent factors associated with in-hospital death: IADL dependency (OR= 4.02; CI= 1.52-10.58; p= .005); ADL dependency (OR= 2.39; CI= 1.25-4.56; p= .008); malnutrition (OR= 2.80; CI= 1.63-4.83; p< .001); poor social support (OR= 5.42; CI= 2.93-11.36; p< .001); acute kidney injury (OR= 3.05; CI= 1.78-5.27; p< .001); and the presence of pressure ulcers (OR= 2.29; CI= 1.04-5.07; p= .041). ADL dependency was independently associated with both delirium incidence and nosocomial infections (respectively: OR= 3.78; CI= 2.30-6.20; p< .001 and OR= 2.30; CI= 1.49-3.49; p< .001). The number of impaired CGA components was also found to be associated with in-hospital death (p< .001), delirium incidence (p< .001) and nosocomial infections (p= .005). Additionally, IADL dependency, malnutrition and history of falls predicted longer hospitalizations. There were no significant changes in overall functional status during the hospital stay. Conclusions: CGA identified patients at higher risk of in-hospital death and adverse outcomes, of which those with functional dependence, malnutrition and poor social support were foremost.
- Safety profile of the adjuvanted recombinant zoster vaccine: Pooled analysis of two large randomised phase 3 trials(2019) LOPEZ-FAUQUED, Marta; CAMPORA, Laura; DELANNOIS, Frederique; IDRISSI, Mohamed El; OOSTVOGELS, Lidia; LOOZE, Ferdinandus J. De; DIEZ-DOMINGO, Javier; HEINEMAN, Thomas C.; LAL, Himal; MCELHANEY, Janet E.; MCNEIL, Shelly A.; YEO, Wilfred; TAVARES-DA-SILVA, Fernanda; AHONEN, Anitta; AVELINO-SILVA, Thiago Junquera; BARBA-GOMEZ, Jose Fernando; BERGLUND, Johan; CUIXART, Carlos Brotons; CASO, Covadonga; CHLIBEK, Roman; CHOI, Won Suk; CUNNINGHAM, Anthony L.; DESOLE, Maria Guiseppina; EIZENBERG, Peter; ESEN, Meral; ESPIE, Emmanuelle; GERVAIS, Pierre; GHESQUIERE, Wayne; GODEAUX, Olivier; GORFINKEL, Iris; HUI, David Shu Cheong; HWANG, Shinn-Jang; KORHONEN, Tiina; KOVAC, Martina; LEDENT, Edouard; LEUNG, Edward; LEVIN, Myron J.; PEREZ, Silvia Narejos; NETO, Jose Luiz; PAUKSENS, Karlis; PODER, Airi; PINTA, Maria Luisa Rodriguez de la; ROMBO, Lars; SCHWARZ, Tino F.; SMETANA, Jan; STANISCIA, Tommaso; TINOCO, Juan Carlos; TOMA, Azhar; VASTIAU, Ilse; VESIKARI, Timo; VOLPI, Antonio; WATANABE, Daisuke; WECKX, Lily Yin; ZAHAF, ToufikBackground: The ZOE-50 (NCT01165177) and ZOE-70 (NCT01165229) phase 3 clinical trials showed that the adjuvanted recombinant zoster vaccine (RZV) was >= 90% efficacious in preventing herpes zoster in adults. Here we present a comprehensive overview of the safety data from these studies. Methods: Adults aged >= 50 (ZOE-50) and >= 70 (ZOE-70) years were randomly vaccinated with RZV or placebo. Safety analyses were performed on the pooled total vaccinated cohort, consisting of participants receiving at least one dose of RZV or placebo. Solicited and unsolicited adverse events (AEs) were collected for 7 and 30 days after each vaccination, respectively. Serious AEs (SAEs) were collected from the first vaccination until 12 months post-last dose. Fatal AEs, vaccination-related SAEs, and potential immune-mediated diseases (pIMDs) were collected during the entire study period. Results: Safety was evaluated in 14,645 RZV and 14,660 placebo recipients. More RZV than placebo recipients reported unsolicited AEs (50.5% versus 32.0%); the difference was driven by transient injection site and solicited systemic reactions that were generally seen in the first week post-vaccination. The occurrence of overall SAEs (RZV: 10.1%; Placebo: 10.4%), fatal AEs (RZV: 4.3%; Placebo: 4.6%), and pIMDs (RZV: 1.2%; Placebo: 1.4%) was balanced between groups. The occurrence of possible exacerbations of pIMDs was rare and similar between groups. Overall, except for the expected local and systemic symptoms, the safety results were comparable between the RZV and Placebo groups irrespective of participant age, gender, or race. Conclusions: No safety concerns arose, supporting the favorable benefit-risk profile of RZV. (C) 2019 GlaxoSmithKline Biologicals SA.
- Transforming the invisible into the visible: disparities in the access to health in LGBT plus older people(2023) CRENITTE, Milton Roberto Furst; MELO, Leonardo Rabelo de; JACOB-FILHO, Wilson; AVELINO-SILVA, Thiago JunqueiraObjectives: To compare variables of access to healthcare between the LGBT+ population aged 50 and over and those non-LGBT+.Methods: A cross-sectional study was carried out in Brazil through a confidential online questionnaire. The use of the health system was characterized by the number of preventive tests performed and measured by the PCATool-Brasil scale (a 10-point scale in which higher scores were associated with better assistance in healthcare). The association between being LGBT+ and access to health was analyzed in Poisson regression models.Results: 6693 participants (1332 LGBT+ and 5361 non-LGBT+) with a median age of 60 years were included. In the univariate analysis, it was observed not only lower scores on the PCATool scale (5.13 against 5.82, p < 0.001), but a greater proportion of individuals among those classified with the worst quintile of access to healthcare (< 4 points), 31% against 18% (p < 0.001). Being LGBT+ was an independent factor associated with worse access to health (PR = 2.5, 95% CI 2.04-3.06). The rate of screening cancer, for breast, colon, and cervical cancer was also found to be lower in the LGBT+ population. Conclusion: Healthcare access and health service experiences were worse in the LGBT+ group than in their non-LGBT peers. Inclusive and effective healthcare public policies are essential to promote healthy aging for all.
- Diagnostic discrepancies between emergency department admissions and hospital discharges among older adults: secondary analysis on a population-based survey(2020) AVELINO-SILVA, Thiago Junqueira; STEINMAN, Michael AlanBACKGROUND: Older adults frequently experience nonspecific clinical features. However, there is limited evidence on how often admission diagnoses for hospitalized older patients are incorrect, potentially leading to treatment delays. OBJECTIVES: To determine the consistency between hospital admission and discharge diagnoses, and identify factors associated with diagnostic discrepancies in older adults. DESIGN AND SETTING: Population-based cohort study in the United States. We included adults aged >= 18 years who were admitted from emergency departments (EDs) to hospitals, identified using the 2005-2010 National Hospital Ambulatory Medical Survey, a nationally representative survey. METHODS:Three admission diagnoses and the principal discharge diagnosis were captured and classified as discrepant if they involved considerably different conditions within the same organ system, or different organ systems altogether. RESULTS: Each year, 12 million adults were hospitalized following ED visits in the United States; 45% were aged >= 65 years. These patients' mean age was 79 years and 58% were women. Diagnostic discrepancies between admission and discharge were more common among adults >= 65 years (12.5 versus 83%; P < 0.001). Certain admission diagnoses had particularly high rates of diagnostic discrepancies: 26-27% of patients presenting with mental disorders or with endocrine and metabolic diseases had substantial diagnostic discrepancies between admission and discharge. Substantial diagnostic discrepancy was independently associated with longer hospitalization and higher in-hospital mortality. CONCLUSION: One out of eight older adults hospitalized from EDs was discharged with a principal diagnosis differing considerably from the admission diagnosis. Given that missed or delayed diagnoses are a critical safety problem, clinicians should be vigilant and frequently cogitate alternative diagnostic possibilities.
- Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients (vol 20, 324, 2022)(2023) FIGUEIREDO, Flavio de Azevedo; RAMOS, Lucas Emanuel Ferreira; SILVA, Rafael Tavares; PONCE, Daniela; CARVALHO, Rafael Lima Rodrigues de; SCHWARZBOLD, Alexandre Vargas; MAURILIO, Amanda de Oliveira; SCOTTON, Ana Luiza Bahia Alves; GARBINI, Andresa Fontoura; FARACE, Barbara Lopes; GARCIA, Barbara Machado; SILVA, Carla Thais Candida Alves da; CIMINI, Christiane Correa Rodrigues; CARVALHO, Cintia Alcantara de; DIAS, Cristiane dos Santos; SILVEIRA, Daniel Vitorio; MANENTI, Euler Roberto Fernandes; CENCI, Evelin Paola de Almeida; ANSCHAU, Fernando; ARANHA, Fernando Graca; AGUIAR, Filipe Carrilho de; BARTOLAZZI, Frederico; VIETTA, Giovanna Grunewald; NASCIMENTO, Guilherme Fagundes; NOAL, Helena Carolina; DUANI, Helena; VIANNA, Heloisa Reniers; GUIMARAES, Henrique Cerqueira; ALVARENGA, Joice Coutinho de; CHATKIN, Jose Miguel; MORAIS, Julia Drumond Parreiras de; MACHADO-RUGOLO, Juliana; RUSCHEL, Karen Brasil; MARTINS, Karina Paula Medeiros Prado; MENEZES, Luanna Silva Monteiro; COUTO, Luciana Siuves Ferreira; CASTRO, Luis Cesar de; NASI, Luiz Antonio; CABRAL, Maderson Alvares de Souza; FLORIANI, Maiara Anschau; SOUZA, Maira Dias; SOUZA-SILVA, Maira Viana Rego; CARNEIRO, Marcelo; GODOY, Mariana Frizzo de; BICALHO, Maria Aparecida Camargos; LIMA, Maria Clara Pontello Barbosa; ALIBERTI, Marlon Juliano Romero; NOGUEIRA, Matheus Carvalho Alves; MARTINS, Matheus Fernandes Lopes; GUIMARAES-JUNIOR, Milton Henriques; SAMPAIO, Natalia da Cunha Severino; OLIVEIRA, Neimy Ramos de; ZIEGELMANN, Patricia Klarmann; ANDRADE, Pedro Guido Soares; ASSAF, Pedro Ledic; MARTELLI, Petronio Jose de Lima; DELFINO-PEREIRA, Polianna; MARTINS, Raphael Castro; MENEZES, Rochele Mosmann; FRANCISCO, Saionara Cristina; ARAUJO, Silvia Ferreira; OLIVEIRA, Talita Fischer; OLIVEIRA, Thainara Conceicao de; SALES, Thais Lorenna Souza; AVELINO-SILVA, Thiago Junqueira; RAMIRES, Yuri Carlotto; PIRES, Magda Carvalho; MARCOLINO, Milena Soriano
- Prediction of intensive care admission and hospital mortality in COVID-19 patients using demographics and baseline laboratory data(2023) AVELINO-SILVA, Vivian I.; AVELINO-SILVA, Thiago J.; ALIBERTI, Marlon J. R.; FERREIRA, Juliana C.; COBELLO JUNIOR, Vilson; SILVA, Katia R.; POMPEU, Jose E.; ANTONANGELO, Leila; MAGRI, Marcello M.; BARROS FILHO, Tarcisio E. P.; SOUZA, Heraldo P.; KALLAS, Esper G.Introduction: Optimized allocation of medical resources to patients with COVID-19 has been a critical concern since the onset of the pandemic.Methods: In this retrospective cohort study, the authors used data from a Brazilian tertiary university hospital to explore predictors of Intensive Care Unit (ICU) admission and hospital mortality in patients admitted for COVID19. Our primary aim was to create and validate prediction scores for use in hospitals and emergency departments to aid clinical decisions and resource allocation. Results: The study cohort included 3,022 participants, of whom 2,485 were admitted to the ICU; 1968 survived, and 1054 died in the hospital. From the complete cohort, 1,496 patients were randomly assigned to the derivation sample and 1,526 to the validation sample. The final scores included age, comorbidities, and baseline laboratory data. The areas under the receiver operating characteristic curves were very similar for the derivation and validation samples. Scores for ICU admission had a 75% accuracy in the validation sample, whereas scores for death had a 77% accuracy in the validation sample. The authors found that including baseline flu-like symptoms in the scores added no significant benefit to their accuracy. Furthermore, our scores were more accurate than the previously published NEWS-2 and 4C Mortality Scores.Discussion and conclusions: The authors developed and validated prognostic scores that use readily available clinical and laboratory information to predict ICU admission and mortality in COVID-19. These scores can become valuable tools to support clinical decisions and improve the allocation of limited health resources.
- Muscle strength and muscle mass as predictors of hospital length of stay in patients with moderate to severe COVID-19: a prospective observational study(2021) GIL, Saulo; JACOB FILHO, Wilson; SHINJO, Samuel Katsuyuki; FERRIOLLI, Eduardo; BUSSE, Alexandre Leopold; AVELINO-SILVA, Thiago Junqueira; LONGOBARDI, Igor; OLIVEIRA JUNIOR, Gersiel Nascimento de; SWINTON, Paul; GUALANO, Bruno; ROSCHEL, HamiltonBackground Strength and muscle mass are predictors of relevant clinical outcomes in critically ill patients, but in hospitalized patients with COVID-19, it remains to be determined. In this prospective observational study, we investigated whether muscle strength or muscle mass are predictive of hospital length of stay (LOS) in patients with moderate to severe COVID-19 patients. Methods We evaluated prospectively 196 patients at hospital admission for muscle mass and strength. Ten patients did not test positive for SARS-CoV-2 during hospitalization and were excluded from the analyses. Results The sample comprised patients of both sexes (50% male) with a mean age (SD) of 59 (+/- 15) years, body mass index of 29.5 (+/- 6.9) kg/m(2). The prevalence of current smoking patients was 24.7%, and more prevalent coexisting conditions were hypertension (67.7%), obesity (40.9%), and type 2 diabetes (36.0%). Mean (SD) LOS was 8.6 days (7.7); 17.0% of the patients required intensive care; 3.8% used invasive mechanical ventilation; and 6.6% died during the hospitalization period. The crude hazard ratio (HR) for LOS was greatest for handgrip strength comparing the strongest versus other patients (1.47 [95% CI: 1.07-2.03; P = 0.019]). Evidence of an association between increased handgrip strength and shorter hospital stay was also identified when handgrip strength was standardized according to the sex-specific mean and standard deviation (1.23 [95% CI: 1.06-1.43; P = 0.007]). Mean LOS was shorter for the strongest patients (7.5 +/- 6.1 days) versus others (9.2 +/- 8.4 days). Evidence of associations were also present for vastus lateralis cross-sectional area. The crude HR identified shorter hospital stay for patients with greater sex-specific standardized values (1.20 [95% CI: 1.03-1.39; P = 0.016]). Evidence was also obtained associating longer hospital stays for patients with the lowest values for vastus lateralis cross-sectional area (0.63 [95% CI: 0.46-0.88; P = 0.006). Mean LOS for the patients with the lowest muscle cross-sectional area was longer (10.8 +/- 8.8 days) versus others (7.7 +/- 7.2 days). The magnitude of associations for handgrip strength and vastus lateralis cross-sectional area remained consistent and statistically significant after adjusting for other covariates. Conclusions Muscle strength and mass assessed upon hospital admission are predictors of LOS in patients with moderate to severe COVID-19, which stresses the value of muscle health in prognosis of this disease.
- COVID-19 outcomes in people living with HIV: Peering through the waves(2023) SALES, Thais Lorenna Souza; SOUZA-SILVA, Maira Viana Rego; DELFINO-PEREIRA, Polianna; NEVES, Joao Victor Baroni; SACIOTO, Manuela Furtado; ASSIS, Vivian Costa Morais de; DUANI, Helena; OLIVEIRA, Neimy Ramos de; SAMPAIO, Natalia da Cunha Severino; RAMOS, Lucas Emanuel Ferreira; SCHWARZBOLD, Alexandre Vargas; JORGE, Alzira de Oliveira; SCOTTON, Ana Luiza Bahia Alves; CASTRO, Bruno Mateus de; SILVA, Carla Thais Candida Alves da; RAMOS, Carolina Marques; ANSCHAU, Fernando; BOTONI, Fernando Antonio; GRIZENDE, Genna Maira Santos; NASCIMENTO, Guilherme Fagundes; RUSCHEL, Karen Brasil; MENEZES, Luanna Silva Monteiro; CASTRO, Luis Cesar de; NASI, Luiz Antonio; CARNEIRO, Marcelo; GODOY, Mariana Frizzo de; NOGUEIRA, Matheus Carvalho Alves; JR, Milton Henriques Guimaraes; ZIEGELMANN, Patricia Klarmann; ALMEIDA, Rafaela Charao de; FRANCISCO, Saionara Cristina; NETO, Sidney Teodoro Silveira; ARAUJO, Silvia Ferreira; AVELINO-SILVA, Thiago Junqueira; ALIBERTI, Marlon Juliano Romero; PIRES, Magda Carvalho; SILVA, Eduardo Sergio da; MARCOLINO, Milena SorianoObjective: To evaluate clinical characteristics and outcomes of COVID-19 patients infected with HIV, and to compare with a paired sample without HIV infection. Methods: This is a substudy of a Brazilian multicentric cohort that comprised two periods (2020 and 2021). Data was obtained through the retrospective review of medical records. Primary outcomes were admission to the intensive care unit, invasive mechanical ventilation, and death. Patients with HIV and controls were matched for age, sex, number of comorbidities, and hospital of origin using the technique of propensity score matching (up to 4:1). They were compared using the Chi-Square or Fisher's Exact tests for categorical variables and the Wilcoxon for numerical variables. Results: Throughout the study, 17,101 COVID-19 patients were hospitalized, and 130 (0.76%) of those were infected with HIV. The median age was 54 (IQR: 43.0;64.0) years in 2020 and 53 (IQR: 46.0;63.5) years in 2021, with a predominance of females in both periods. People Living with HIV (PLHIV) and their controls showed similar prevalence for admission to the ICU and invasive mechanical ventilation requirement in the two periods, with no significant differences. In 2020, in-hospital mortality was higher in the PLHIV compared to the controls (27.9% vs. 17.7%; p = 0.049), but there was no difference in mortality between groups in 2021 (25.0% vs. 25.1%; p > 0.999). Conclusions: Our results reiterate that PLHIV were at higher risk of COVID-19 mortality in the early stages of the pandemic, however, this finding did not sustain in 2021, when the mortality rate is similar to the control group.
- ACE2 Expression and Risk Factors for COVID-19 Severity in Patients with Advanced Age(2020) TAVARES, Caio de Assis Moura; AVELINO-SILVA, Thiago Junqueira; BENARD, Gil; CARDOZO, Francisco Akira Malta; FERNANDES, Juliana Ruiz; GIRARDI, Adriana Castello Costa; JACOB FILHO, Wilson