LUIZ PAULO KOWALSKI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Impact of pandemic COVID-19 outbreak on oral mucositis preventive and treatment protocols: new perspectives for extraoral photobiomodulation therapy(2020) FARIA, Karina Morais; GOMES-SILVA, Wagner; KAUARK-FONTES, Elisa; BONFIM-ALVES, Carolina Guimaraes; KOWALSKI, Luiz Paulo; PRADO-RIBEIRO, Ana Carolina; VECHIATO-FILHO, Aljomar Jose; LOPES, Marcio Ajudarte; MARTA, Gustavo Nader; JR, Gilberto de Castro; LEME, Adriana Franco Paes; MIGLIORATI, Cesar Augusto; SANTOS-SILVA, Alan Roger; BRANDAO, Thais BiancaThis communication discusses the current challenges of oral mucositis (OM) management during the pandemic COVID-19 outbreak and reflects about an extraoral photobiomodulation protocol as an optimal alternative for preventing and treating OM in advanced cancer patients while minimizing the risk of infection by avoiding intraoral manipulation.
- The hidden curve behind COVID-19 outbreak: the impact of delay in treatment initiation in cancer patients and how to mitigate the additional risk of dying-the head and neck cancer model(2021) MATOS, Leandro L.; FORSTER, Carlos Henrique Q.; MARTA, Gustavo N.; CASTRO JUNIOR, Gilberto; RIDGE, John A.; HIRATA, Daisy; MIRANDA-FILHO, Adalberto; HOSNY, Ali; SANABRIA, Alvaro; GREGOIRE, Vincent; PATEL, Snehal G.; FAGAN, Johannes J.; D'CRUZ, Anil K.; LICITRA, Lisa; MEHANNA, Hisham; HAO, Sheng-Po; PSYRRI, Amanda; PORCEDDU, Sandro; GALLOWAY, Thomas J.; GOLUSINSKI, Wojciech; LEE, Nancy Y.; SHIGUEMORI, Elcio H.; MATIELI, Jose Elias; SHIGUEMORI, Ana Paula A. C.; DIAMANTINO, Leticia R.; SCHIAVETO, Luiz Felipe; LEAO, Lysia; CASTRO, Ana F.; CARVALHO, Andre Lopes; KOWALSKI, Luiz PauloPurpose The rapid spread of the SARS-CoV-2 pandemic around the world caused most healthcare services to turn substantial attention to treatment of these patients and also to alter the structure of healthcare systems to address an infectious disease. As a result, many cancer patients had their treatment deferred during the pandemic, increasing the time-to-treatment initiation, the number of untreated patients (which will alter the dynamics of healthcare delivery in the post-pandemic era) and increasing their risk of death. Hence, we analyzed the impact on global cancer mortality considering the decline in oncology care during the COVID-19 outbreak using head and neck cancer, a known time-dependent disease, as a model. Methods An online practical tool capable of predicting the risk of cancer patients dying due to the COVID-19 outbreak and also useful for mitigation strategies after the peak of the pandemic has been developed, based on a mathematical model. The scenarios were estimated by information of 15 oncological services worldwide, given a perspective from the five continents and also some simulations were conducted at world demographic data. Results The model demonstrates that the more that cancer care was maintained during the outbreak and also the more it is increased during the mitigation period, the shorter will be the recovery, lessening the additional risk of dying due to time-to-treatment initiation. Conclusions This impact of COVID-19 pandemic on cancer patients is inevitable, but it is possible to minimize it with an effort measured by the proposed model.
- Impact of pandemic COVID-19 outbreak on oral mucositis preventive and treatment protocols: new perspectives for extraoral photobiomodulation therapy (vol 28, pg 4545, 2020)(2021) FARIA, Karina Morais; GOMES-SILVA, Wagner; KAUARK-FONTES, Elisa; BONFIM-ALVES, Carolina Guimaraes; KOWALSKI, Luiz Paulo; PRADO-RIBEIRO, Ana Carolina; VECHIATO-FILHO, Aljomar Jose; LOPES, Marcio Ajudarte; MARTA, Gustavo Nader; CASTRO JR., Gilberto de; LEME, Adriana Franco Paes; MIGLIORATI, Cesar Augusto; SANTOS-SILVA, Alan Roger; BRANDAO, Thais Bianca
- Emergency changes in international guidelines on treatment for head and neck cancer patients during the COVID-19 pandemic(2020) CHAVES, Aline Lauda Freitas; CASTRO, Ana Ferreira; MARTA, Gustavo Nader; JUNIOR, Gilberto Castro; FERRIS, Robert L.; GIGLIO, Raul Eduardo; GOLUSINSKI, Wojciech; GORPHE, Philippe; HOSAL, Sefik; LEEMANS, C. Rene; MAGNE, Nicolas; MEHANNA, Hisham; MESIA, Ricard; NETTO, Eduardo; PSYRRI, Amanda; SACCO, Assuntina G.; SHAH, Jatin; SIMON, Christian; VERMORKEN, Jan B.; KOWALSKI, Luiz Paulo
- Salivary alpha-1-antitrypsin and macrophage migration inhibitory factor may be potential prognostic biomarkers for oncologic treatment-induced severe oral mucositis(2021) PALMIER, Natalia Rangel; LEME, Adriana Franco Paes; ROSSI, Tatiane De; TELLES, Guilherme Pimentel; MORAIS-FARIA, Karina; KOWALSKI, Luiz Paulo; MARTA, Gustavo Nader; BRANDAO, Thais Bianca; ARANY, Praveen R.; MIGLIORATI, Cesar Augusto; SANTOS-SILVA, Alan Roger; PRADO-RIBEIRO, Ana CarolinaAims Evaluate the abundance of the selected targets, alpha-1-antitrypsin (A1AT) and macrophage migration inhibitory factor (MIF), and correlate these findings with the risk of developing severe oral mucositis (OM). Materials and methods Head and neck squamous cell carcinoma (HNSCC) patients submitted to radiotherapy (RT) or chemoradiotherapy (CRT) were assessed. OM grade and pain were evaluated daily during treatment. Two protein targets, A1AT and MIF, were evaluated, using selected reaction monitoring-mass spectrometry (SRM-MS), in whole saliva, collected prior to oncologic treatment. The results obtained from the targeted proteomic analysis were correlated with OM clinical outcomes. Results A total of 27 patients were included, of whom 21 (77.8%) had locally advanced disease (clinical stage III or IV). Most patients (70.4%) received CRT. OM grades 2 (40.8%) and 3 (33.3%) were the most prevalent during RT with a mean highest reported OM-related pain of 3.22 through the visual analogue scale (VAS). The abundance of A1AT and MIF correlated significantly with severe (grades 3 or 4,p < 0.02) compared with moderate-low (grades 1 or 2,p < 0.04) OM grade. Conclusions There is a correlation between the abundance of salivary A1AT and MIF and oncologic treatment-induced OM. The correlation of MIF expression with severe OM appears to be compatible with its physiological pro-inflammatory role. These results open up great possibilities for the use of salivary MIF and A1AT levels as prognostic markers for effective therapeutic interventions, such as photobiomodulation therapy, patient-controlled analgesia, or personalized medicaments.
- Direct costs associated with the management of mucositis: A systematic review(2021) RODRIGUES-OLIVEIRA, Leticia; KOWALSKI, Luiz Paulo; SANTOS, Marcos; MARTA, Gustavo Nader; BENSADOUN, Rene-Jean; MARTINS, Manoela Domingues; LOPES, Marcio Ajudarte; CASTRO, Gilberto de; WILLIAM, William Nassib; CHAVES, Aline Lauda Freitas; MIGLIORATI, Cesar Augusto; SALLOUM, Ramzi G.; RODRIGUES-FERNANDES, Carla Isabelly; KAUARK-FONTES, Elisa; BRANDAO, Thais Bianca; SANTOS-SILVA, Alan Roger; PRADO-RIBEIRO, Ana CarolinaMucositis is one of the more frequent and costly adverse events following cancer treatment. To evaluate and report the direct economic outcomes associated with the management of mucositis across several cancer treatments we conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Scopus, MEDLINE/PubMed, and Embase were searched electronically and a total of 37 relevant studies were included. The costs attributable to mucositis in the hematopoietic stem cell transplantation setting ranged from 1124,47 US dollars (USD) to 299 214,14 USD per patient. The radiotherapy/ chemoradiotherapy/radiotherapy plus molecular targeted therapy accounted for mucositis costs that ranged from 51,23 USD to 33 560,58 USD per patient. Costs for mucositis in the chemotherapy setting ranged from 4,18 USD to 31 963,64 USD per patient. When the cancer treatment was not specified, costs of mucositis ranged from 565,85 USD to as high as 20 279, 12 USD per patient. Mucositis costs from multimodal therapy ranged from 12,42 USD to 5670,46 USD per patient. The molecular targeted therapy setting included only one study and depending on the healthcare providers' perspective of each country evaluated, mucositis' costs ranged from 45,78 USD to 3484,91 USD per patient. Mucositis is associated with increased resource use, consultations, hospitalizations and extended hospitalizations, leading to a substantial incremental cost that exacerbates the economic burden on the patient, health plan and health system across several cancer treatments and diagnosis. More studies with a prospective evaluation of the economic costs associated with mucositis management are needed.
- Effect of the COVID-19 Pandemic on the Activity of Physicians Working in the Areas of Head and Neck Surgery and Otorhinolaryngology(2020) KOWALSKI, Luiz Paulo; IMAMURA, Rui; CASTRO JUNIOR, Gilberto de; MARTA, Gustavo Nader; CHAVES, Aline Lauda Freitas; MATOS, Leandro Luongo; BENTO, Ricardo FerreiraIntroduction Coronavirus disease 2019 (COVID-19) is an acute infection caused by the new coronavirus (SARS-CoV-2) and it is highly transmissible, especially through respiratory droplets. To prepare the health system for the care of these patients also led to a restriction in the activity of several medical specialties. Physicians who work with patients affected by diseases of the head and neck region constitute one of the populations most vulnerable to COVID-19 and also most affected by the interruption of their professional activities. Objective The aim of the present study was to assess the impact of the COVID-19 pandemic on the practice of head and neck surgeons and otorhinolaryngologists in Brazil. Methods An anonymous online survey of voluntary participation was applied, containing 30 questions regarding demographic aspects, availability of personal protective equipment (PPE), and impact on the routine of head and neck surgeons and otorhinolaryngologists, as well as clinical oncologists and radiation oncologists who work with head and neck diseases. Results Seven hundred and twenty-nine answers were received in a period of 4 days, similar to 40 days after the 1(st)confirmed case in Brazil. With professionals working in public and private services, there was a high level of concerns with the disease and its consequences, limited availability of PPE and a significant decrease in the volume of specialized medical care. Conclusion The study demonstrated a direct impact of the COVID-19 pandemic on the clinical practice of specialties related to the treatment of patients with diseases of the head and neck region already in the beginning of the illness management in Brazil.