MAURA SALAROLI DE OLIVEIRA
Projetos de Pesquisa
Unidades Organizacionais
PAHC, Hospital das Clínicas, Faculdade de Medicina
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- Impact of COVID-19 on healthcare-associated infections: Antimicrobial consumption does not follow antimicrobial resistance(2023) FREIRE, Maristela Pinheiro; ASSIS, Denise Brandao de; TAVARES, Bruno de Melo; BRITO, Valquiria O. C.; MARINHO, Igor; LAPCHIK, Milton; GUEDES, Ana Rubia; MADALOSSO, Geraldine; OLIVEIRA, Maura Salaroli; LIMA, Antonio Carlos Pedroso de; LEVIN, Anna S.Background: This study aimed to analyze the Healthcare-Associated Infections (HAI) rates and antimicrobial consumption in Intensive Care Units (ICU) in Sao Paulo city during the COVID-19 pandemic and compare them with the pre-pandemic period. Methods: This cohort included all hospitals that reported HAI rates (Central-Line-Associated Bloodstream Infection CLABSI and Ventilator-Associated Pneumonia - VAP), the proportion of microorganisms that caused CLABSI, the proportion of resistant microorganisms, and antimicrobial consumption from January 2017 - December 2020. Hospitals were stratified by the number of beds, Central Venous Catheter (CVC) utilization rate, Mechanical-Ventilation (MV) utilization rate, and type of funding. Statistical analyses were based on time-series plots and regression models. Results: 220 ICUs were included. The authors observed an abrupt increase in CLABSI rates after the pandemic onset. High CLABSI rates during the pandemic were associated with hospital size, funding (public and non-profit private), and low CVC use (<= 50%). An increase in VAP rates was associated with public hospitals, and high MV use (> 35%). The susceptibility profile of microorganisms did not differ from that of the pre-pandemic period. polymyxin, glycopeptides, and antifungal use increased, especially in COVID-19 ICUs. Conclusions: HAI increased during COVID-19. The microorganisms' susceptibility profile did not change with the pandemic, but the authors observed a disproportionate increase in large-spectrum antimicrobial drug use.
- Nationwide surveillance system to evaluate hospital-acquired COVID-19 in Brazilian hospitals(2022) COSTA, M. Machado de Miranda; GUEDES, A. R.; NOGUEIRA, M. D. S. P.; OLIVEIRA, L. S. C.; BARROS, L. de Souza; GONCALVES, M. R. S.; CARVALHO, A. A.; MOURA, H. L. C. Amaral de; LEVIN, A. S.; OLIVEIRA, M. S.Background: Although the risk of SARS-CoV-2 transmission within hospitals has been well recognized, there is a paucity of data on its occurrence. Our aim was to report the incidence of hospital-acquired (HA) COVID-19 at Brazilian hospitals. Methods: We investigated the incidence of HA COVID-19 in Brazilian hospitals using data from a national surveillance system, from August 2020 through September 2021. Definitions of HA COVID-19 were: (1) symptom onset >14 days after hospital admission plus a positive SARS-CoV-2 RNA or antigen test; (2) symptom onset on days 8-14 after admission, plus a positive SARS-CoV-2 RNA or antigen test positive, plus documented high-risk exposure. We performed descriptive analyses and reported HA COVID-19 rates using pooled mean and percentile distribution. Results: A total of 48,634 cases of HA COVID-19 were reported from 1428 hospitals. Incidence ranged from 0.16/1000 patient-days at neonatal intensive care units (ICUs) to 5.8/1000 patient-days at adult ICUs. The highest incidence of HA COVID-19 was during the months March to July 2021, similar to that which was observed for community-acquired COVID-19. Conclusions: This report provides a national view of the burden of HA COVID-19. The highest incidence of HA COVID-19 similar that which was observed for community-acquired COVID-19. We believe that this reflects the difficulty of implementing preventive measures. Further studies evaluating risk factors for the hospital transmission of SARS-Cov-2 should clarify strategies to minimize the risk of HA COVID-19 and may be applicable to other respiratory diseases. Furthermore, the implementation of a national system to evaluate HA COVID-19 has the potential to shine a light on this problem and lead to interventions in each hospital.
- Evaluation of eleven immunochromatographic assays for SARS-CoV-2 detection: investigating the dengue cross-reaction(2022) OLIVEIRA, Beatriz Araujo; OLIVEIRA, Lea Campos de; OLIVEIRA, Franciane Mendes de; PEREIRA, Geovana Maria; SOUZA, Regina Maia de; MANULI, Erika Regina; MARCHINI, Fabricio Klerynton; ESPINOZA, Evelyn Patricia Sanchez; PARK, Marcelo; TANIGUCHI, Leandro; MENDES, Pedro Vitale; FRANCO, Lucas Augusto Moyses; NASTRI, Ana Catharina; OLIVEIRA, Maura Salaroli de; VIEIRA JUNIOR, Jose Mauro; KALLAS, Esper Georges; LEVIN, Anna Sara; SABINO, Ester Cerdeira; COSTA, Silvia FigueiredoCOVID-19 disease is spread worldwide and diagnostic techniques have been studied in order to contain the pandemic. Immunochromatographic (IC) assays are feasible and a low-cost alternative especially in low and middle-income countries, which lack structure to perform certain diagnostic techniques. Here we evaluate the sensitivity and specificity of eleven different IC tests in 145 serum samples from confirmed cases of COVID-19 using RT-PCR and 100 negative serum samples from blood donors collected in February 2019. We also evaluated the cross-reactivity with dengue using 20 serum samples from patients with confirmed diagnosis for dengue collected in early 2019 through four different tests. We found high sensitivity (92%), specificity (100%) and an almost perfect agreement (Kappa 0.92) of IC assay, especially when we evaluated IgG and IgM combined after 10 days from the onset of symptoms with RT-PCR. However, we detected cross-reactivity between dengue and COVID-19 mainly with IgM antibodies (5 to 20% of cross-reaction) and demonstrated the need for better studies about diagnostic techniques for these diseases.
- Brazilian Guidelines for the pharmacological treatment of patients hospitalized with COVID-19(2022) FALAVIGNA, M.; STEIN, C.; AMARAL, J. L. G. do; AZEVEDO, L. C. P. de; BELLI, K. C.; COLPANI, V.; CUNHA, C. A. da; DAL-PIZZOL, F.; DIAS, M. B. Souza; FERREIRA, J. C.; FREITAS, A. P. da Rocha; GRäF, D. D.; GUIMARãES, H. P.; LOBO, S. M. A.; MONTEIRO, J. T.; NUNES, M. S.; OLIVEIRA, M. S. de; PRADO, C. C. Lucas; SANTOS, V. C. C.; SILVA, R. M. da; SOBREIRA, M. L.; VEIGA, V. C.; Vidal Á.T.; XAVIER, R. M.; ZAVASCKI, A. P.; MACHADO, F. R.; CARVALHO, C. R. R. deObjective: Several therapies are being used or proposed for COVID-19, and many lack appropriate evaluations of their effectiveness and safety. The purpose of this document is to develop recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil. Methods: A group of 27 experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method. Results: Sixteen recommendations were generated. They include strong recommendations for the use of corticosteroids in patients using supplemental oxygen, the use of anticoagulants at prophylactic doses to prevent thromboembolism and the nonuse of antibiotics in patients without suspected bacterial infection. It was not possible to make a recommendation regarding the use of tocilizumab in patients hospitalized with COVID-19 using oxygen due to uncertainties regarding the availability of and access to the drug. Strong recommendations against the use of hydroxychloroquine, convalescent plasma, colchicine, lopinavir + ritonavir and antibiotics in patients without suspected bacterial infection and also conditional recommendations against the use of casirivimab + imdevimab, ivermectin and rendesivir were made. Conclusion: To date, few therapies have proven effective in the treatment of hospitalized patients with COVID-19, and only corticosteroids and prophylaxis for thromboembolism are recommended. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and promote economical resource use. © 2022 Associacao de Medicina Intensiva Brasileira - AMIB. All rights reserved.
- Predicting the outcome for COVID-19 patients by applying time series classification to electronic health records(2022) RODRIGUES, Davi Silva; NASTRI, Ana Catharina S.; MAGRI, Marcello M.; OLIVEIRA, Maura Salaroli de; SABINO, Ester C.; FIGUEIREDO, Pedro H. M. F.; LEVIN, Anna S.; FREIRE, Maristela P.; HARIMA, Leila S.; NUNES, Fatima L. S.; FERREIRA, Joao EduardoBackground COVID-19 caused more than 622 thousand deaths in Brazil. The infection can be asymptomatic and cause mild symptoms, but it also can evolve into a severe disease and lead to death. It is difficult to predict which patients will develop severe disease. There are, in the literature, machine learning models capable of assisting diagnose and predicting outcomes for several diseases, but usually these models require laboratory tests and/or imaging. Methods We conducted a observational cohort study that evaluated vital signs and measurements from patients who were admitted to Hospital das Clinicas (Sao Paulo, Brazil) between March 2020 and October 2021 due to COVID-19. The data was then represented as univariate and multivariate time series, that were used to train and test machine learning models capable of predicting a patient's outcome. Results Time series-based machine learning models are capable of predicting a COVID-19 patient's outcome with up to 96% general accuracy and 81% accuracy considering only the first hospitalization day. The models can reach up to 99% sensitivity (discharge prediction) and up to 91% specificity (death prediction). Conclusions Results indicate that time series-based machine learning models combined with easily obtainable data can predict COVID-19 outcomes and support clinical decisions. With further research, these models can potentially help doctors diagnose other diseases.
- Brazilian guidelines for the treatment of outpatients with suspected or confirmed COVID-19. A joint guideline of the Brazilian Association of Emergency Medicine (ABRAMEDE), Brazilian Medical Association (AMB), Brazilian Society of Angiology and Vascular Surgery (SBACV), Brazilian Society of Geriatrics and Gerontology (SBGG), Brazilian Society of Infectious Diseases (SBI), Brazilian Society of Family and Community Medicine (SBFMC), and Brazilian Thoracic Society (SBPT)(2022) FALAVIGNA, Maicon; BELLI, Karlyse Claudino; BARBOSA, Alexandre Naime; ZAVASCKI, Alexandre Prehn; NASTRI, Ana Catharina de Seixas Santos; SANTANA, Christiane Machado; STEIN, Cinara; GRAF, Debora Dalmas; CADEGIANI, Flavio Adsuara; GUIMARAES, Helio Penna; MONTEIRO, Jose Tadeu; FERREIRA, Juliana Carvalho; AZEVEDO, Luciano Cesar Pontes de; MAGRI, Marcelo Mihailenko Chaves; SOBREIRA, Marcone Lima; DIAS, Maria Beatriz Gandra de Souza; OLIVEIRA, Maura Salaroli de; CORRADI, Mirian de Freitas Dal Ben; ROSA, Regis; HEINZELMANN, Ricardo Souza; SILVA, Rosemeri Maurici da; BELFORT JUNIOR, Rubens; CIMERMAN, Sergio; COLPANI, Veronica; VEIGA, Viviane Cordeiro; CARVALHO, Carlos Roberto Ribeiro deBackground: Several therapies have been used or proposed for the treatment of COVID-19, although their effectiveness and safety have not been properly evaluated. The purpose of this document is to provide recommendations to support decisions about the drug treatment of outpatients with COVID-19 in Brazil.Methods: A panel consisting of experts from different clinical fields, representatives of the Brazilian Ministry of Health, and methodologists (37 members in total) was responsible for preparing these guidelines. A rapid guideline development method was used, based on the adoption and/or adaptation of recommendations from existing international guidelines combined with additional structured searches for primary studies and new recommendations whenever necessary (GRADE-ADOLOPMENT). The rating of quality of evidence and the drafting of recommendations followed the GRADE method.Results: Ten technologies were evaluated, and 10 recommendations were prepared. Recommendations were made against the use of anticoagulants, azithromycin, budesonide, colchicine, corticosteroids, hydroxychloroquine/chloroquine alone or combined with azithromycin, ivermectin, nitazoxanide, and convalescent plasma. It was not possible to make a recommendation regarding the use of monoclonal antibodies in outpatients, as their benefit is uncertain and their cost is high, with limitations of availability and implementation.Conclusion: To date, few therapies have demonstrated effectiveness in the treatment of outpatients with COVID-19. Recommendations are restricted to what should not be used, in order to provide the best treatment according to the principles of evidence-based medicine and to promote resource savings by aboiding ineffective treatments. (c) 2022 Sociedade Brasileira de Infectologia.
- Nucleoprotein-based ELISA for detection of SARS-COV-2 IgG antibodies: Could an old assay be suitable for serodiagnosis of the new coronavirus?(2021) TOZETTO-MENDOZA, Tania Regina; KANUNFRE, Kelly Aparecida; VILAS-BOAS, Lucy Santos; ESPINOZA, Evelyn Patricia Sanchez; PAIAO, Heuder Gustavo Oliveira; ROCHA, Mussya Cisotto; PAULA, Anderson Vicente de; OLIVEIRA, Maura Salaroli de; ZAMPELLI, Daniella Bosco; JR, Jose Mauro Vieira; BUSS, Lewis; COSTA, Silvia Figueiredo; SABINO, Ester Cerdeira; WITKIN, Steven S.; OKAY, Thelma Suely; MENDES-CORREA, Maria CassiaObjectives: We evaluated the performance of a nucleoprotein-based enzyme-linked immunosorbent assay (ELISA) for detection of IgG antibodies to SARS-CoV-2. Methods: The ELISA was based on serum IgG reactivity to a 46-kDa protein derived from the recombinant SARSCoV2 nucleoprotein. Assay sensitivity was assessed using serum samples from 134 COVID-19 confirmed cases obtained > 15 days after symptom onset. Specificity was determined by testing sera from 94 healthy controls. Cross-reactivity was evaluated with sera from 96 individuals with previous dengue or zika virus-confirmed infections, with 44 sera from individuals with confirmed infections to other respiratory viruses or with bacterial and fungal infections that cause pneumonia and with 40 sera negative for SARS-CoV-2 nucleoprotein by commercial ELISA kits. Results: The majority of subjects were male and >= 60 years old. Assay sensitivity was 90.3 % (95 % confidence interval 84.1 %-94.2 %) and specificity was 97.9 % (92.6 %-99.4 %). There was no cross-reactivity with sera from individuals diagnosed with dengue, zika virus, influenza virus, rhinovirus, adenovirus, respiratory syncytial virus, seasonal coronavirus, Mycobacterium tuberculosis, Staphylococcus (S. aureus and coagulase-negative), Streptococcus pneumoniae, Klebsiella pneumoniae and the fungus Aspergillus fumigatus. The level of concordance of our test with results from commercial ELISA kits was 100 %. Conclusion: The nucleoprotein-based ELISA was specific for detection of IgG anti-nucleoprotein antibodies to SARS-CoV-2. It utilizes a frequently employed low expense assay protocol and is easier to perform than other currently available commercial SARS-CoV2 antibody detection tests.
- Diretrizes Brasileiras para o tratamento farmacológico de pacientes hospitalizados com COVID-19: Diretriz conjunta da Associação Brasileira de Medicina de Emergência, Associação de Medicina Intensiva Brasileira, Associação Médica Brasileira, Sociedade Brasileira de Angiologia e Cirurgia Vascular, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Pneumologia e Tisiologia e Sociedade Brasileira de Reumatologia(2022) FALAVIGNA, Maicon; STEIN, Cinara; AMARAL, José Luiz Gomes do; AZEVEDO, Luciano Cesar Pontes de; BELLI, Karlyse Claudino; COLPANI, Verônica; CUNHA, Clóvis Arns da; DAL-PIZZOL, Felipe; DIAS, Maria Beatriz Souza; FERREIRA, Juliana Carvalho; FREITAS, Ana Paula da Rocha; GRäF, Débora Dalmas; GUIMARÃES, Hélio Penna; LOBO, Suzana Margareth Ajeje; MONTEIRO, José Tadeu; NUNES, Michelle Silva; OLIVEIRA, Maura Salaroli de; PRADO, Clementina Corah Lucas; SANTOS, Vania Cristina Canuto; SILVA, Rosemeri Maurici da; SOBREIRA, Marcone Lima; VEIGA, Viviane Cordeiro; VIDAL, Ávila Teixeira; XAVIER, Ricardo Machado; ZAVASCKI, Alexandre Prehn; MACHADO, Flávia Ribeiro; CARVALHO, Carlos Roberto Ribeiro deABSTRACT Objective: Several therapies are being used or proposed for COVID-19, and many lack appropriate evaluations of their effectiveness and safety. The purpose of this document is to develop recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil. Methods: A group of 27 experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method. Results: Sixteen recommendations were generated. They include strong recommendations for the use of corticosteroids in patients using supplemental oxygen, the use of anticoagulants at prophylactic doses to prevent thromboembolism and the nonuse of antibiotics in patients without suspected bacterial infection. It was not possible to make a recommendation regarding the use of tocilizumab in patients hospitalized with COVID-19 using oxygen due to uncertainties regarding the availability of and access to the drug. Strong recommendations against the use of hydroxychloroquine, convalescent plasma, colchicine, lopinavir + ritonavir and antibiotics in patients without suspected bacterial infection and also conditional recommendations against the use of casirivimab + imdevimab, ivermectin and rendesivir were made. Conclusion: To date, few therapies have proven effective in the treatment of hospitalized patients with COVID-19, and only corticosteroids and prophylaxis for thromboembolism are recommended. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and promote economical resource use.
- Statewide evaluation of infection control measures for preventing coronavirus disease 2019 in hemodia-lysis facilities(2021) GUEDES, Ana Rubia; TAVARES, Bruno de Melo; ASSIS, Denise Brandao de; FREIRE, Maristela Pinheiro; MADALOSSO, Geraldine; LEVIN, Anna S.; PERDIGAO NETO, Lauro Vieira; OLIVEIRA, Maura Salaroli deOBJECTIVE: This study aimed to evaluate the occurrence of coronavirus disease 2019 (COVID-19) in hemodialysis facilities and the occurrence of and risk factors for clustering of COVID-19 cases. METHODS: We conducted a cross-sectional online survey between March and July 2020, in all dialysis facilities in Sao Paulo state, using Google Forms. The online questionnaire contained questions addressing specific components of infection prevention and control practices and the number of cases during the COVID-19 pandemic. RESULTS: A total of 1,093 (5%) COVID-19 cases were reported among 20,984 patients; approximately 56% of the facilities had X1 cluster. Most facilities implemented various measures (such as allocation of dedicated COVID-19 areas/shifts, symptom screening, environmental disinfection, and maintenance of adequate ventilation) to prevent the transmission of severe acute respiratory syndrome coronavirus 2. Clustering of COVID-19 cases was suspected in only 7% of dialysis facilities. The only variable associated with this event was the performance of aerosol-generating procedures (odds ratio: 4.74; 95% confidence interval: 1.75-12.86). CONCLUSION: Attention should be paid to avoiding the performance of aerosol-generating procedures in dialysis facilities and monitoring the clustering of cases.