MARIA AUGUSTA BENTO CICARONI GIBELLI

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Autor: GIBELLI, Maria Augusta Bento Cicaroni × Assunto: Medicine, General & Internal ×

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  • article 61 Citação(ões) na Scopus
    Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome
    (2020) PEREIRA, Maria Fernanda Badue; LITVINOV, Nadia; FARHAT, Sylvia Costa Lima; EISENCRAFT, Adriana Pasmanik; GIBELLI, Maria Augusta Bento Cicaroni; CARVALHO, Werther Brunow de; FERNANDES, Vinicius Rodrigues; FINK, Thais de Toledo; FRAMIL, Juliana Valeria de Souza; GALLETI, Karine Vusberg; FANTE, Alice Lima; FONSECA, Maria Fernanda Mota; WATANABE, Andreia; PAULA, Camila Sanson Yoshino de; PALANDRI, Giovanna Gavros; LEAL, Gabriela Nunes; DINIZ, Maria de Fatima Rodrigues; PINHO, Joao Renato Rebello; SILVA, Clovis Artur; MARQUES, Heloisa Helena de Sousa
    OBJECTIVES: To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). METHODS: This cross-sectional study included 471 samples collected from 371 patients (age<18 years) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The study group comprised 66/371 (18%) laboratory-confirmed pediatric COVID-19 patients: 61 (92.5%) patients tested positive on real-time reverse transcription-polymerase chain reaction tests for SARS-CoV-2, and 5 (7.5%) patients tested positive on serological tests. MIS-C was diagnosed according to the criteria of the Center for Disease Control. RESULTS: MIS-C was diagnosed in 6/66 (9%) patients. The frequencies of diarrhea, vomiting, and/or abdominal pain (67% vs. 22%, p=0.034); pediatric SARS (67% vs. 13%, p=0.008); hypoxemia (83% vs. 23%, p=0.006); and arterial hypotension (50% vs. 3%, p=0.004) were significantly higher in patients with MIS-C than in those without MIS-C. The frequencies of C-reactive protein levels >50 mg/L (83% vs. 25%, p=0.008) and D-dimer levels >1000 ng/mL (100% vs. 40%, p=0.007) and the median D-dimer, troponin T, and ferritin levels (p < 0.05) were significantly higher in patients with MIS-C. The frequencies of pediatric intensive care unit admission (100% vs. 60%, p=0.003), mechanical ventilation (83% vs. 7%, p < 0.001), vasoactive agent use (83% vs. 3%, p <0.001), shock (83% vs. 5%, p<0.001), cardiac abnormalities (100% vs. 2%, p <0.001), and death (67% vs. 3%, p < 0.001) were also significantly higher in patients with MIS-C. Similarly, the frequencies of oxygen therapy (100% vs. 33%, p=0.003), intravenous immunoglobulin therapy (67% vs. 2%, p < 0.001), aspirin therapy (50% vs. 0%, p < 0.001), and current acute renal replacement therapy (50% vs. 2%, p=0.002) were also significantly higher in patients with MIS-C. Logistic regression analysis showed that the presence of MIS-C was significantly associated with gastrointestinal manifestations [odds ratio (OR)=10.98; 95%CI (95% confidence interval)=1.20-100.86; p=0.034] and hypoxemia [OR=16.85; 95%CI=1.34-211.80; p=0.029]. Further univariate analysis showed a positive association between MIS-C and death [OR=58.00; 95%CI=6.39526.79; p <0 .0001]. CONCLUSIONS: Pediatric patients with laboratory-confirmed COVID-19 with MIS-C had a severe clinical spectrum with a high mortality rate. Our study emphasizes the importance of investigating MIS-C in pediatric patients with COVID-19 presenting with gastrointestinal involvement and hypoxemia.
  • article 3 Citação(ões) na Scopus
    Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital
    (2021) MARQUES, Heloisa Helena de Sousa; PEREIRA, Maria Fernanda Badue; SANTOS, Angelica Carreira dos; FINK, Thais Toledo; PAULA, Camila Sanson Yoshino de; LITVINOV, Nadia; SCHVARTSMAN, Claudio; DELGADO, Artur Figueiredo; GIBELLI, Maria Augusta Bento Cicaroni; CARVALHOL, Werther Brunow de; ODONE FILHO, Vicente; TANNURI, Uenis; CARNEIRO-SAMPAIO, Magda; GRISI, Sandra; DUARTE, Alberto Jose da Silva; ANTONANGELO, Leila; FRANCISCO, Rossana Pucineli Vieira; OKAY, Thelma Suely; BATISTTELLA, Linamara Rizzo; CARVALHO, Carlos Roberto Ribeiro de; BRENTANI, Alexandra Valeria Maria; SILVA, Clovis Artur
    OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p < 0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p <0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.
  • article 1 Citação(ões) na Scopus
    Role of a Neonatal Intensive Care unit during the COVID-19 Pandemia: recommendations from the neonatology discipline
    (2020) CARVALHO, Werther Brunow de; GIBELLI, Maria Augusta Bento Cicaroni; KREBS, Vera Lucia Tornado; TRAGANTE, Carla Regina; PERONDI, Maria Beatriz Moliterno
    On 11th March 2020, the World Health Organization (WHO) declared the COVID-19 a pandemic. The Obstetrics and Neonatology disciplines needed to be revised to suit the institutional need to expand intensive care beds to care for confirmed or suspected patients with COVID-19 in the state of Sao Paulo, following the recommendations of the Institutional Crisis Committee. Three different actions were needed: the structuring of teams and advanced medical post to attend COVID-19-free patients and those with suspect or confirmed COVID-19; elaborating the protocols from the delivery room throughout hospitalization. Some special considerations about breastfeeding and rooming-in were needed. The third action was the drafting of a protocol to admit infants from other hospitals with confirmed COVID-19 as the unit never admitted outpatients before.
  • article 88 Citação(ões) na Scopus
    An autopsy study of the spectrum of severe COVID-19 in children: From SARS to different phenotypes of MIS-C
    (2021) DUARTE-NETO, Amaro Nunes; CALDINI, Elia Garcia; GOMES-GOUVEA, Michele Soares; KANAMURA, Cristina Takami; MONTEIRO, Renata Aparecida de Almeida; FERRANTI, Juliana Ferreira; VENTURA, Andrea Maria Cordeiro; REGALIO, Fabiane Aliotti; FIORENZANO, Daniela Matos; GIBELLI, Maria Augusta Bento Cicaroni; CARVALHO, Werther Brunow de; LEAL, Gabriela Nunes; PINHO, Joao Renato Rebello; DELGADO, Artur Figueiredo; CARNEIRO-SAMPAIO, Magda; MAUAD, Thais; SILVA, Luiz Fernando Ferraz da; SALDIVA, Paulo Hilario Nascimento; DOLHNIKOFF, Marisa
    Background: COVID-19 in children is usually mild or asymptomatic, but severe and fatal paediatric cases have been described. The pathology of COVID-19 in children is not known; the proposed pathogenesis for severe cases includes immune-mediated mechanisms or the direct effect of SARS-CoV-2 on tissues. We describe the autopsy findings in five cases of paediatric COVID-19 and provide mechanistic insight into the mechanisms involved in the pathogenesis of the disease. Methods: Children and adolescents who died with COVID-19 between March 18 and August 15, 2020 were autopsied with a minimally invasive method. Tissue samples from all vital organs were analysed by histology, electron microscopy (EM), reverse-transcription polymerase chain reaction (RT-PCR) and immunohistochemistry (IHC). Findings: Five patients were included, one male and four female, aged 7 months to 15 years. Two patients had severe diseases before SARS-CoV-2 infection: adrenal carcinoma and Edwards syndrome. Three patients were previously healthy and had multisystem inflammatory syndrome in children (MIS-C) with distinct clinical presentations: myocarditis, colitis, and acute encephalopathy with status epilepticus. Autopsy findings varied amongst patients and included mild to severe COVID-19 pneumonia, pulmonary microthrombosis, cerebral oedema with reactive gliosis, myocarditis, intestinal inflammation, and haemophagocytosis. SARSCoV-2 was detected in all patients in lungs, heart and kidneys by at least one method (RT-PCR, IHC or EM), and in endothelial cells from heart and brain in two patients with MIS-C (IHC). In addition, we show for the first time the presence of SARS-CoV-2 in the brain tissue of a child with MIS-C with acute encephalopathy, and in the intestinal tissue of a child with acute colitis. Interpretation: SARS-CoV-2 can infect several cell and tissue types in paediatric patients, and the target organ for the clinical manifestation varies amongst individuals. Two major patterns of severe COVID-19 were observed: a primarily pulmonary disease, with severe acute respiratory disease and diffuse alveolar damage, or a multisystem inflammatory syndrome with the involvement of several organs. The presence of SARS-CoV-2 in several organs, associated with cellular ultrastructural changes, reinforces the hypothesis that a direct effect of SARS-CoV-2 on tissues is involved in the pathogenesis of MIS-C. (c) 2021 The Author(s).
  • article 4 Citação(ões) na Scopus
    Neonatal manifestations in COVID-19 patients at a Brazilian tertiary center COMMENT
    (2020) BEOZZO, Glenda Priscila Neves dos Santos; CARVALHO, Werther Brunow de; KREBS, Vera Lucia Jornada; GIBELLI, Maria Augusta Bento Cicaroni; ZACHARIAS, Romy Schmidt Brock; ROSSETTO, Larissa Elizabeth Schulz; FRANCISCO, Rossana Pulcinelli Vieira
  • article 9 Citação(ões) na Scopus
    An unfavorable intrauterine environment may determine renal functional capacity in adulthood: a meta-analysis
    (2018) SENRA, Janaina Campos; CARVALHO, Mariana Azevedo; RODRIGUES, Agatha Sacramento; KREBS, Vera Lucia Jornada; GIBELLI, Maria Augusta Bento Cicaroni; FRANCISCO, Rossana Pulcineli Vieira; BERNARDES, Lisandra Stein
    Since studies show that an unfavorable environment during intrauterine development predisposes individuals to several diseases in adulthood, our objective is to assess the relation between fetal growth restriction and chronic renal disease in adults. We searched four different electronic databases through November 2017: CENTRAL, EMBASE, LILACS and MEDLINE. We selected studies with longitudinal or transversal designs associating kidney function in adulthood with low birth weight. Two reviewers evaluated the inclusion criteria and the risk of bias and extracted data from the included papers. Thirteen studies were selected for the systematic review and meta-analysis. We observed increased risks of presenting end-stage renal disease (risk ratio 1.31, 95% confidence interval: 1.17, 1.47), a lower glomerular filtration rate (ml/min) (mean difference 7.14; 95% confidence interval: -12.12, -2.16), microalbuminuria (risk ratio 1.40; 95% confidence interval: 1.28, 1.52) and a small increase in the albumin/creatinine ratio (mean difference 0.46; 95% confidence interval: 0.03, 0.90) in the low birth weight patients, compared with control group. These findings suggest that low birth weight is associated with renal dysfunction in adults.
  • article 1 Citação(ões) na Scopus
    Clinical characteristics and evolution of 71 neonates born to mothers with COVID-19 at a tertiary center in Brazil
    (2022) DUARTE, Bruna de Paula; KREBS, Vera Lucia Jornada; CALIL, Valdenise Martins Laurindo Tuma; CARVALHO, Werther Brunow de; GIBELLI, Maria Augusta Bento Cicaroni; FRANCISCO, Rossana Pulcineli Vieira
    Introduction: Limited data are available on pregnant women with COVID-19 and their neonates.Objective: This study aimed to describe clinical characteristics and evolution from birth to discharge of a retrospec-tive cohort of 71 neonates, with one set of twins, born to women with COVID-19 diagnosed at the end of preg-nancy. The authors included all newborns admitted into a neonatal unit of a tertiary hospital in Brazil, between March 2020 and March 2021, whose unvaccinated mothers had COVID-19 symptoms and RT-PCR (Real-Time Polymerase Chain Reaction) for SARS-CoV-2 positive within fourteen days prior to delivery. Newborns to mothers with COVID-19 symptoms and negative tests for SARS-CoV-2 were excluded. Results: The main route of birth delivery was cesarean, corresponding to 60 pregnant women (84.5%). The fore-most indications for cesarean were pregnant with critical disease (24.6%) and acute fetal distress (20.3%). The mean birth weight was 2452 g (865-3870 g) and the mean gestational age was 345/7 weeks (25-40 weeks). There were 45 premature newborns (63.3%), of which 21 newborns (29.5%) were less than 32 weeks of gestational age. RT-PCR for SARS-CoV-2 on oropharyngeal swabs was positive in 2 newborns (2.8%) and negative in the other 69 newborns (97.2%). Most newborns (51.4%) needed respiratory support. Therapeutic interventions dur-ing hospitalization were inotropic drugs (9.9%), antibiotics (22.8%), parenteral nutrition (26.8%), and photother-apy (46.5%).Conclusion: Maternal COVID-19 diagnosticated close to delivery has an impact on the first days of neonatal life.